Przypadek Kliniczny
A 34-year-old man presented to the dermatology clinic with a history of recurrent skin lesions affecting the elbows, knees, and scalp for the past six years. The lesions appeared gradually and followed a chronic course with periods of partial remission and exacerbation. The patient reported pruritus of mild to moderate intensity, which worsened during the winter months and periods of increased psychological stress.
The patient’s medical history was significant for obesity and arterial hypertension. He denied any recent infections, new medications, or exposure to contact allergens. He reported smoking one pack of cigarettes daily for 12 years. A positive family history of a chronic inflammatory skin condition was noted in his father.
On physical examination, multiple well-demarcated erythematous plaques were observed on the extensor surfaces of both elbows and knees, as well as on the lumbosacral region and scalp. The plaques were covered with thick, adherent, silvery-white scales. Removal of the scales resulted in pinpoint bleeding.
Examination of the scalp revealed diffuse scaling extending beyond the hairline. Fingernail examination showed multiple small depressions of the nail plate and distal onycholysis. No mucosal involvement was observed.
The patient reported intermittent pain and stiffness in the small joints of the hands, particularly in the morning, lasting approximately 30 minutes.
Routine laboratory investigations, including complete blood count and inflammatory markers, were within normal limits. Skin biopsy demonstrated marked epidermal hyperplasia with elongation of rete ridges, parakeratosis, diminished granular layer, and collections of neutrophils within the stratum corneum.
Based on the clinical case above, identify the most likely diagnosis.