Case presentation and medical history 

A 57-year-old female presented to the clinic with plaque psoriasis originally diagnosed in 2018. The elbow, knees, and sacral region were the primary areas of involvement, with the left olecranon region being the area of greatest concern and associated with redness, thickening, and significant itch (Figure 1). 

The patient was experiencing difficulty resting her left elbow on hard surfaces while working and reported that the itch sometimes woke her up at night (PGA 3, NRS-I 7). 

The patient was initially treated with topical steroids with the eventual addition of vitamin D analogs in a rotational fashion, periodically for several years with limited responses and poor patient compliance and adherence, primarily due to a lack of efficacy. The patient also failed 3 months of fixed combination therapy with topical halobetasol/tazarotene lotion. Figure 2 demonstrates the lack of therapeutic response and an overall worsening of disease on the left elbow.

Physical exam and lab results 

Physical examination revealed pink-to-salmon-colored erythema, induration, and scale, most prominently located on both elbows, with worse presentation on the left. 

Diagnostic review 

The diagnosis was determined on clinical grounds, noting typical silver-scaled pink plaques of psoriasis in typical areas of involvement. No nail pits nor scalp involvement were noted, and there were no complaints of arthralgia or morning stiffness.