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Review
. 2018 May;31(3):e12589.
doi: 10.1111/dth.12589. Epub 2018 Mar 6.

Underdiagnosed and undertreated psoriasis: Nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails

Joseph F Merola  1 , Abrar Qureshi  2 , M Elaine Husni  3
Affiliations
Review

Underdiagnosed and undertreated psoriasis: Nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails

Joseph F Merola et al. Dermatol Ther. 2018 May.

Abstract

Psoriasis of the scalp, face, intertriginous areas, genitals, hands, feet, and nails is often underdiagnosed, and disease management can be challenging. Despite the small surface area commonly affected by psoriasis in these locations, patients have disproportionate levels of physical impairment and emotional distress. Limitations in current disease severity indices do not fully capture the impact of disease on a patient's quality of life, and, combined with limitations in current therapies, many patients do not receive proper or adequate care. In this review, we discuss the clinical manifestations of psoriasis in these less commonly diagnosed areas and its impact on patient quality of life. We also examine clinical studies evaluating the effectiveness of therapies on psoriasis in these regions. This article highlights the need to individualize treatment strategies for psoriasis based on the area of the body that is affected and the emerging role of biologic therapy in this regard.

Keywords: clinical studies; difficult to treat psoriasis; intertriginous; nails; palmoplantar; psoriasis; psoriasis of the extremities; quality of life; review; scalp; treatment options.

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Conflict of interest statement

Dr. Merola has served as an investigator for Amgen, Pfizer, and Biogen IDEC; has consulted for Biogen IDEC, Amgen, Eli Lilly, Janssen and Novartis; has served as a speaker for AbbVie. Dr. Qureshi has consulted for AbbVie, Celgene, Novartis, and Eli Lilly. Dr. Husni has consulted for AbbVie, Bristol‐Myers Squibb, Pfizer, Celgene, Novartis, Eli Lilly, and Genentech.

Figures

Figure 1
Figure 1
Symptoms of psoriasis by body region
Figure 2
Figure 2
Images of psoriasis in underdiagnosed and undertreated areas. (a) Scalp psoriasis (courtesy of Dr Joseph Merola and Dr Abrar Qureshi). (b) Inverse psoriasis of the groin (courtesy of Dr Joseph Merola and Dr Abrar Qureshi). (c) Plantar psoriasis (courtesy of Dr Joseph Merola and Dr Abrar Qureshi). (d) Nail psoriasis (courtesy of Dr Joseph Merola and Dr Abrar Qureshi)
See this image and copyright information in PMC

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