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Psoriasis vs LSC — SCE Dermatology MCQ

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HardInflammatory DermatosesPsoriasis vs LSCSCE Dermatology

A 45-year-old woman presents with a chronic erythematous plaque on her shin. Clinical differential includes psoriasis and lichen simplex chronicus. What histological feature is most helpful in distinguishing psoriasis from lichen simplex chronicus?

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Correct answer: E — Neutrophils in the stratum corneum (Munro microabscesses) and thinned suprapapillary plates — favouring psoriasis

The best answer is “Neutrophils in the stratum corneum (Munro microabscesses) and thinned suprapapillary plates — favouring psoriasis”. NICE recommends treatment matched to severity, high-impact sites, functional burden, comorbidity and prior response; narrowband UVB is a finite specialist option for plaque or guttate psoriasis that topical therapy cannot control. The alternatives “Parakeratosis (present in both), after clinicopathological correlation, after specialist assessment, when the full phenotype supports it”, “Acanthosis (present in both), after specialist assessment, when the full phenotype supports it”, “Spongiosis, when the full phenotype supports it, within an appropriate UK pathway”, “Dermal fibrosis, within an appropriate UK pathway, after clinicopathological correlation, after specialist assessment” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: NICE CG153 psoriasis recommendations: https://www.nice.org.uk/guidance/cg153/chapter/Recommendations