A 44-year-old male accountant comes to the office for an initial visit because of a progressively worsening rash and recent joint pain for the past 2 years. He works at a small computer firm. He is not exposed to chemicals, uses a mild soap for personal cleaning and has no pets. He describes the rash as scaly and red but not itchy. He says, “The rash is embarrassing when I have to work with clients.” Several months ago he had mild transient joint pain but there has been no recurrence. On physical examination you evaluate the rash shown. There are similar lesions on his elbows and knees. The rash has never been treated before
phototherapy and topical high potency corticosteroids, but in psoriasis if arthritis is present we will add methotrexate and biologics.