A 34-year-old man comes to the office due to a persistent skin rash. He has a 6-month history of a scaly rash involving the upper and lower extremities that is associated with mild pruritus. The patient has attempted treatment with topical antihistamines and emollients without relief. Medical history is notable for childhood asthma and orolabial herpes simplex virus infection. He does not use tobacco or alcohol and works as a sales associate for a home improvement store. On examination, the patient has skin lesions as shown in the image below. This patient's disorder is most likely associated with which of the following extradermal complications?

Question

A 34-year-old man comes to the office due to a persistent skin rash.  He has a 6-month history of a scaly rash involving the upper and lower extremities that is associated with mild pruritus.  The patient has attempted treatment with topical antihistamines and emollients without relief.  Medical history is notable for childhood asthma and orolabial herpes simplex virus infection.  He does not use tobacco or alcohol and works as a sales associate for a home improvement store.  On examination, the patient has skin lesions as shown in the image below.  This patient's disorder is most likely associated with which of the following extradermal complications?

Quizplus · Accepted Answer

This patient with well-demarcated, scaly, erythematous plaques involving extensor surfaces of the extremities has typical features of psoriasis. Patients with psoriasis frequently develop additional complications, including: Psoriatic arthritis is an inflammatory disorder affecting the synovium and often the insertion of tendons and ligaments (ie, enthesopathy). It typically manifest as asymmetric oligoarthritis or symmetric polyarthritis (resembling rheumatoid arthritis) that often affects the distal interphalangeal joints. In severe cases, patients can develop an aggressive and destructive arthritis mutilans. The risk is increased in patients who are human leukocyte antigen B27-positive. (Choice A) Chronic glomerulonephritis frequently occurs in systemic lupus erythematosus. However, lupus is typically associated with an erythematous malar rash. (Choice C) Medullary thyroid cancer is frequently linked to multiple endocrine neoplasia type 2. (Choice D) Skin lesions, renal insufficiency, and peripheral neuropathy (eg, mononeuropathy multiplex) are frequent findings in polyarteritis nodosa, a vasculitis affecting medium-sized arteries. (Choice E) Pulmonary fibrosis is a common extradermal manifestation of systemic sclerosis (scleroderma). Educational objective: Common complications of psoriasis include psoriatic arthritis, nail changes, and uveitis. __________ References: Clinical features and diagnostic considerations in psoriatic arthritis. (http://www.ncbi.nlm.nih.gov/pubmed/26476219)

A 34-Year-Old Man Comes to the Office Due to a Persistent