Rupioid Psoriasis with Psoriatic Arthritis: A Rare Case Report

Abstract

Background: Rupioid psoriasis, a distinct and rare form of psoriasis, is a chronic autoimmune disease characterized by thick, hyperkeratotic, circular or conical plaques with central umbilication and scale resembling oyster shells. Diagnosis of this condition can be challenging due to its clinical resemblance to other dermatological diseases, including syphilis, keratotic scabies, reactive arthritis, sarcoidosis, and disseminated histoplasmosis. Given the importance of early and accurate diagnosis for effective management, there is a recognized need to raise awareness regarding the clinical features and therapeutic approaches for this rare form of psoriasis.

Objective: This study aims to enhance dermatologists' awareness of rare skin diseases and improve their ability to differentiate them from other dermatological conditions presenting with rupioid manifestations.

Case Findings: A 21-year-old male presented with a two-year history of progressively worsening hyperkeratotic lesions distributed over the scalp, ears, face, neck, trunk, and extremities. He also reported intermittent episodes of severe pain and swelling in multiple joints, including the elbows, wrists, knees, and ankles. Histopathological examination of skin lesions confirmed the diagnosis of rupioid psoriasis. The patient was managed with systemic methotrexate, oral loratadine, topical corticosteroids, and intralesional corticosteroid injections, leading to clinical improvement.

Conclusion: Rupioid psoriasis may be associated with intermittent and severe joint pain. Differentiation from other rupioid-like conditions, particularly secondary syphilis, is crucial. Methotrexate is an effective therapeutic agent for controlling both cutaneous and articular manifestations of the disease, and intralesional corticosteroid injections play a beneficial role in its management.