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Plaque Psoriasis With Severe Hyperpigmentation in Skin of Color

A 51-year-old African American woman with a more than 20-year history of severe plaque psoriasis presented to the clinic due to a flare-up of her symptoms, including moderate joint pain (but no muscle aches or weakness), enlargement of plaques, severe pruritus, flaking, and erythema. Her family history was noncontributory.

Physical examination. At presentation, the woman appeared healthy, well-nourished, and well-developed. The patient’s height was 170.7 cm and her weight was 95.7 kg, corresponding to a body mass index of 34.1 kg/m2. Her vital signs were normal. Her mood was normal; she was active and alert, and oriented to time, place, and person; and she was in distress as a result of her skin discomfort. Plaques were noted all over the body, along with hyperpigmented annular lesions with crusting and silvery scales (Figure). The diagnosis of psoriasis had been confirmed previously by way of a skin biopsy while she had been receiving specialist treatment at a hospital. The rest of the physical examination findings were normal.


Figure. Hyperpigmented scaly plaques were present on the patient’s abdomen (A) and upper extremity (B).

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