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VERRUCOUS PSORIASIS OF THE THORACOLUMBAR AREA
Abstract Number: S 77
Abstract Type: Case Report/Case Series
Psoriasis is a common skin disorder worldwide with a prevalence of 0.6 to 4.8%. The typical lesions of plaque psoriasis consist of erythematous papules and plaques with sharply defined raised margins with a silver scale. They are symmetrically distributed in the scalp, extensor elbows, knees, and back. These comprise 75 to 80% of psoriasis lesions. There are other forms of psoriasis, of which verrucous psoriasis (VP) is one of the rarest.
28yo G9P4044 at 39 weeks was admitted for elective repeat C/S and BTL. Prenatal care began at 23 weeks. PE during initial OB visit described her skin and extremities as WNL with no scar, tattoo, or anomaly noted. She gave a history of psoriasis since 12 yrs ago with no mention of the location of lesions. She had two prior vaginal deliveries, 2 C/S via epidural anesthesia, and 4 D&Cs under general anesthesia. On admission: Ht 4’11” 217lbs. VSS. Heart and lungs exam WNL. Airway – Mallampati class 2, bucked teeth, good TMD.
In the OR, she was placed in a sitting position and examination of her back revealed an irregular island of elevated flat-topped tan-colored cauliflower lesions scattered over the thoracic and lumbar areas. The patient insisted that she had the same lesions for many years and had 3 prior epidurals for her C/S and vaginal delivery. I asked her permission to photograph her back so I could show her that we do not have any safe area to place the needle in. After a discussion with the patient and her significant other, she agreed to undergo general anesthesia. She tolerated the procedure well and was discharged three days later.
A dermatologist reviewed pictures of the lesions and believed they were most likely VP, a rare variant of psoriasis. Thus the patient was referred to an outpatient dermatology clinic for a complete evaluation. Though little is known about the pathogenesis and treatment of VP, the use of phototherapy, topical steroids and Vitamin D analogs can be tried. Since psoriasis may be associated with co-morbidities, it is important to exclude metabolic syndrome, cardiovascular disease, inflammatory bowel disease and malignancy. Smoking, obesity and alcohol consumption have also been associated with psoriasis.
The use of digital photography significantly facilitated our discussion with the patient. It can also serve as a useful tool for following the progression and /or regression of the disease as well as the response to treatment.
1. Holly R et al. Dermatology Online Journal. 17(5):10