Chronic Plaque Psoriasis in a Middle-Aged Male

Abstract

A 40-year-old male patient presents with a 10-year history of psoriasis, characterized by well-demarcated, erythematous plaques with thick silvery-white scales primarily on the knees, legs, trunk and scalp. The lesions have gradually enlarged and increased in number, with intermittent exacerbations often triggered by stress. He has no history of arthritis or systemic symptoms. His past treatments include topical corticosteroids, vitamin D analogs but he has not undergone consistent systemic therapy. Family history is significant for his father having psoriasis. The physical examination reveals multiple well-defined plaques with silvery scales on extensor surfaces, without nail or joint involvement, and no systemic abnormalities. Grattage test and auspitz sign are positive. Laboratory tests are within normal limits, and the diagnosis is supported clinically without the need for biopsy. The patient is diagnosed as a case of chronic plaque psoriasis and is planned to begin topical treatments with corticosteroids and vitamin D analogs, with consideration for phototherapy if necessary. Education on trigger avoidance and skin care is also emphasized, along with regular follow-up for disease management. Psoriasis is a chronic, relapsing condition, but with appropriate therapy, follow-up and lifestyle modifications, good control is achievable.