Rupioid Psoriasis Research Articles

Rupioid psoriasis: A complex, multifactorial presentation

Introduction: Secondary syphilis, also termed the great mimicker due to its vast array of clinical presentations, is associated with skin manifestations including rupioid, macular, psoriasiform, and condylomatous lesions. On clinical examination alone, it can be difficult to differentiate between rupioid syphilis and rupioid psoriasis, especially among cases of human immunodeficiency virus (HIV) and syphilis co-infection; however, histologic examination can aid in their differentiation. Additional testing such as serum rapid plasma reagin (RPR), anti-HIV antibody, rheumatoid factor, and fungal cultures should be performed to exclude other causes of rupioid lesions. Case Report: A 19-year-old HIV-positive male developed numerous hyperkeratotic skin lesions involving the head, trunk, and extremities over a 4-week period. His RPR was positive (1:64), suggesting a diagnosis of rupioid syphilis. The patient was treated with doxycycline, given a reported history of penicillin allergy. Rapid plasma reagin titers decreased to 1:2 following treatment; however, the skin eruption did not improve. A biopsy of a lesion demonstrated psoriasiform acanthosis with confluent hyperkeratosis, clusters of intracorneal neutrophils, and negative spirochete immunostaining. Based on histopathology and clinical presentation, a diagnosis of rupioid psoriasis was favored. The patient was started on targeted anti-psoriatic therapy with apremilast and maintains close follow-up with his dermatologist every three months. Conclusion: Although the patient’s presentation was initially presumed to be secondary to syphilis, his lack of response to treatment prompted further workup to assess the etiology of the patient’s skin findings more accurately. In doing so, a diagnosis of rupioid psoriasis was favored based on the histologic findings observed.

Rupioid psoriasis with inverse psoriasis.

Rupioid psoriasis with inverse psoriasis.

A rupioid rash.

A 72-year-old man presented for a thick hyperkeratotic skin rash on the shins that had erupted 7 months earlier after minimal local trauma (Fig. 1A, B). Topical treatments with glucocorticoids and antibiotics were ineffective, although a slight improvement was noted during summer. Additionally, low-grade fevers and an asymmetric oligoarthritis of the upper and lower limbs and dactylitis of the thumb and fourth toe on the left appeared over the last weeks. Mild non-specific onychodystrophy of the toes was found, whereas no inflammatory back pain or enthesitis was present. Plain radiographs did not reveal disease-specific deformities, erosions or osteo-proliferative lesions. Laboratory tests showed raised inflammatory markers (CRP: 17.7 mg/dl, ESR: 107 mm/h), leukopoenia (2.580/μL) and anaemia (haemoglobin: 10.3 g/dl). Differential diagnosis of the rash included crusted scabies, secondary syphilis, neutrophilic dermatoses, histoplasmosis and a hyperkeratotic psoriasis variant [1]. Skin biopsy revealed psoriasiform acanthosis, thick parakeratosis, dense neutrophilic infiltration and microabscess formation (Fig. 1C). Based on the type of musculoskeletal involvement and the skin histopathology, the patient was diagnosed with psoriatic arthritis with rupioid psoriasis. Treatment with medium-to-low dose systemic glucocorticoids and infliximab led to arthritis remission, skin (Fig. 1D) and laboratory improvement. Rupioid psoriasis (derived from the Greek word ρύπος = dirt) is a rare hyperkeratotic variant of psoriasis characterized by well-demarcated plaques with thick, dirty-appearing adherent crusts. It is associated with local treatment failure [2], psoriatic arthritis and male sex and it may present challenges in the diagnosis of patients with arthritis and systemic inflammation. Written informed consent has been obtained from the patient.

PA12: Cracking the limpet: rupioid psoriasis successfully treated with adalimumab

PA12: Cracking the limpet: rupioid psoriasis successfully treated with adalimumab

Rupioid Psoriasis and Psoriatic Arthritis in a Patient With Skin of Color

Rupioid Psoriasis and Psoriatic Arthritis in a Patient With Skin of Color

Rupioid psoriasis preceded by varicella presenting as Koebner phenomenon

Rupioid psoriasis preceded by varicella presenting as Koebner phenomenon

Norwegian scabies mimicking rupioid psoriasis

Norwegian scabies is a highly contagious skin infestation caused by an ectoparasite, Scarcoptes scabiei var. Hominis, which mainly affects immunosuppressed individuals. Clinically, it may simulate various dermatoses such as psoriasis, Darier's disease, seborrheic dermatitis, among others. This is a case report of a 33-year-old woman, immunocompetent, diagnosed with generalized anxiety disorder (cancer phobia), who had erythematous, well-defined plaques, covered with rupioid crusts, on her neck, axillary folds, breast, periumbilical region, groin area, besides upper back and elbows, mimicking an extremely rare variant of psoriasis, denominated rupioid psoriasis.

A Case of Rupioid Psoriasis

A Case of Rupioid Psoriasis

PUSTULAR PSORIASIS OF THE PALMS AND SOLES

There is a type of erythematosquamous pustular eruption on the palms and soles which is frequently considered to be due to mycotic infection and is treated as such in spite of negative results of laboratory observations. I feel convinced that this is an atypical form of psoriasis. Its apparent rarity is due to the fact that it is often overlooked as a special entity. The existence of exudative forms of psoriasis was observed long ago. So-called rupioid psoriasis, the main feature of which is marked exudation, was described as long ago as 1865 by Anderson. 1 In 1877 Kaposi 2 remarked that it was sometimes difficult to differentiate psoriasis from eczema, and he mentioned 3 cases in which eczematous lesions developed on psoriatic plaques. Neumann 4 reported three cases of eczema the lesions of which changed to typical psoriatic patches. Mathieu 5 saw four patients with psoriasis whose condition changed