# A nurse is assessing a 60-year-old client with psoriasis. Which finding would be most characteristic of this condition? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540949 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a 60-year-old client with psoriasis. Which finding would be most characteristic of this condition? A 45-year-old client presents to the dermatology clinic with skin lesions that have been present for several months. ## 보기 1. Well-demarcated, raised, erythematous plaques covered with silvery-white scales **✔ 정답** 2. Fluid-filled vesicles that rupture and form honey-colored crusts 3. Flat, brown patches with irregular borders and varying colors 4. Small, red, itchy bumps that appear in linear patterns **정답: 1** ## 해설 Psoriasis is characterized by well-demarcated, raised, erythematous plaques with silvery-white scales. Other options describe conditions like impetigo or eczema. ## 심화 해설 Core Clinical Feature of Psoriasis The most characteristic finding of psoriasis is well-demarcated, raised, erythematous plaques covered with silvery-white scales. This description directly reflects the underlying pathophysiology of the disease. Psoriasis is a chronic, immune-mediated systemic inflammatory condition, where the central pathogenic mechanism involves the interleukin-23/interleukin-17 (IL-23/IL-17) axis [3]. In this process, activated T helper 17 (Th17) cells and group 3 innate lymphoid cells (ILC3s) release pro-inflammatory cytokines, primarily IL-17A, IL-17F, and IL-22 [3]. These cytokines act on keratinocytes, triggering a cascade that results in epidermal hyperproliferation and the sustained inflammatory microenvironment typical of psoriatic lesions [3]. The rapid turnover of skin cells leads to the accumulation of immature keratinocytes on the surface, which clinically manifests as the thick, silvery-white scales. The underlying inflammation causes the dilation of dermal capillaries, producing the raised, erythematous (red) base. The term "well-demarcated" highlights the sharp, distinct border between the affected plaque and the surrounding normal skin, a key feature that helps differentiate it from other dermatological conditions like eczema. This classic plaque morphology is the hallmark of the most common form of the disease, chronic plaque psoriasis, which affects approximately 1-3% of the global population . The condition is not merely a skin disorder but is perceived as a systemic disease associated with a chronic inflammatory state, often linked to multiple comorbidities . Analysis of Incorrect Options The other options describe findings characteristic of different dermatological conditions, which is a common testing strategy on the NCLEX-RN. - **Option 2: Fluid-filled vesicles that rupture and form honey-colored crusts.** This is the classic presentation of impetigo, a superficial bacterial skin infection, most commonly caused by Staphylococcus aureus or Streptococcus pyogenes. The honey-colored crust is a pathognomonic sign. - **Option 3: Flat, brown patches with irregular borders and varying colors.** This description is a red flag for malignant melanoma. The irregular borders and color variation are part of the ABCDE criteria (Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving) used for assessing suspicious pigmented lesions. - **Option 4: Small, red, itchy bumps that appear in linear patterns.** A linear pattern of pruritic, erythematous papules is highly suggestive of scabies, a skin infestation caused by the mite Sarcoptes scabiei. The linear burrows represent the tracks created by the mite within the stratum corneum. A thorough integumentary assessment requires the nurse to distinguish between these primary lesion morphologies, as they point to vastly different etiologies, treatment plans, and nursing interventions. In psoriasis, treatment strategies may range from topical anti-inflammatory agents, such as calcipotriol/betamethasone dipropionate combinations, to systemic therapies targeting the IL-23/IL-17 pathway [3]. References (research sources) - [3]T helper 17 cells and group 3 innate lymphoid cells define a spectrum of psoriasis endotypes.Research articleSchön MP. (2026) · DOI: 10.3389/fimmu.2026.1880068 ## 임상 시나리오 Psoriasis Assessment GuideIdentifying the Hallmark Plaque The most characteristic finding is a well-demarcated, raised, erythematous plaque covered with silvery-white scales. This results from a hyperproliferative epidermis with a rapid turnover rate of 3 to 5 days instead of the normal 28 to 30 days. Common sites include the extensor surfaces (elbows, knees), scalp, and lower back. The plaques are often symmetrical. Gently scraping a scale may reveal pinpoint bleeding, known as the Auspitz sign. Clinical AlertDo not confuse psoriatic plaques with the honey-colored crusts of impetigo or the irregular borders of actinic keratosis. Always assess for associated psoriatic arthritis, which occurs in up to 30% of patients. ## 핵심 개념 - **Psoriasis** — A chronic, immune-mediated systemic inflammatory condition characterized by well-demarcated, erythematous plaques with silvery-white scales due to epidermal hyperproliferation. - **Well-demarcated** — Having a sharp, distinct border between the lesion and the surrounding normal skin, a key diagnostic feature of psoriasis. - **Erythematous** — Redness of the skin caused by dilation of dermal capillaries due to underlying inflammation. - **Silvery-white scales** — Accumulation of immature keratinocytes on the skin surface resulting from rapid epidermal cell turnover. - **IL-23/IL-17 Axis** — The central pathogenic pathway in psoriasis involving T helper 17 cells and cytokines that trigger keratinocyte hyperproliferation and inflammation. ## 같은 주제 문제 - [A nurse is assessing a 45-year-old client newly diagnosed with psoriasis. 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