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These include: Early age of onset 50 years Acute eg guttate psoriasis vs chronic plaque psoriasis Localised eg, scalp, palmoplantar psoriasis vs generalised psoriasis Small plaques ( 3 cm) Thin plaques vs thick plaques Nail involvement vs no nail involvement Types of psoriasis Guttate psoriasis Post-streptococcal acute guttate psoriasis Widespread small plaques Often resolves after several months Small plaques of psoriasis appear almost like rain drops splashed over the skin Close up of guttate psoriasis Post-inflammatory hypopigmentation as guttate psoriasis is resolving Small plaque psoriasis Often late age of onset Plaques 3 cm Most often affects elbows, knees, and lower back Ranges from mild to very extensive Well demarcated plaques with silvery scale in chronic plaque psoriasis Thick silvery scale over the elbow Close up of well demarcated plaques with silvery scale in chronic plaque psoriasis Unstable plaque psoriasis The rapid extension of existing or new plaques Koebner phenomenon: new plaques at sites of skin injury Induced by infection, stress, drugs, or drug withdrawal Flexural psoriasis (inverse psoriasis) Affects body folds and genitals Smooth, well-defined patches Colonised by candida yeasts Well demarcated salmon pink erythema which extends to the apex of the skin fold due to flexural psoriasis Well demarcated salmon pink erythema which extends to the apex of the skin fold and into the natal cleft due to flexural psoriasis Axillary psoriasis Scalp psoriasis Often the first or only site of psoriasis Well demarcated plaques of scalp psoriasis Scalp psoriasis often extends beyond the hair line Adherent scale in scalp psoriasis Sebopsoriasis Overlap of seborrhoeic dermatitis and psoriasis Affects the scalp, face, ears and chest Colonised by malassezia Sebopsoriasis of ear Sebopsoriasis of chest Sebopsoriasis affecting the retroauricular skin Palmoplantar psoriasis Affecting the palms and/or soles Keratoderma Painful fissuring Hyperkeratosis of the soles and heels due to psoriasis - painful fissuring is often a problem Palmar plaque psoriasis Hyperkeratosis of the soles and heels due to psoriasis Nail psoriasis Pitting, onycholysis, yellowing, and ridging Associated with inflammatory arthritis Irregular pits and onycholysis of a finger nail - note the yellow band proximal to the onycholysis Onycholysis, proximal yellow band and nail plate splitting due to nail unit psoriasis Onycholiasis (separation of the plate from the bed) due to psoriasis Erythrodermic psoriasis Erythrodermic psoriasis is rare

Jaiswal S, Jawade S

Song W, Chen Y, Qin L, Xu X, Sun Y, Zhong M, et al

And what they found is when they introduced drug, heroin and cocaine to these monkeys, disproportionately, the monkeys that were deprived died and od, whereas the monkeys that had that love and affection and warmth and comfort and essential needs met died at a much lower rate

A variety of GLP-1RAs agents are currently available, including exenatide, liraglutide, dulaglutide, albiglutide, lixisenatide, semaglutide, and the dual GLP-1/GIP receptor agonist, tirzepatide