34 years, Male ,Caucasian, Office worker , Married, no children

Generally healthy, no chronic diseases. Family history of psoriasis (father), no significant past medical conditions. •Non-smoker, occasional alcohol use, no recreational drug use.

Red, itchy skin lesions, Scaly patches on elbows, knees, and scalp, some discomfort after hot showers, Stress exacerbates the symptoms ,Progressive spread of lesions over 3 months No joint pain or swelling

Erythema , scaly plaques , Rash

Scaly plaques measuring up to 5 cm in diameter, with distinct borders, are found on the scalp and behind the ears.

Pitting of the nails on the hands (small depressions on the surface of the nails) and mild onycholysis (separation of the nail from the nail bed).

1. Laboratory Results: o CBC (Complete Blood Count): Normal white blood cell count, hemoglobin, and platelets. o Erythrocyte Sedimentation Rate (ESR): Mildly elevated (15 mm/h; normal < 10 mm/h), which can be associated with inflammation. o C-reactive protein (CRP): Slightly elevated (2.5 mg/L; normal < 3 mg/L), indicative of mild inflammation. 2. Histology Results: A skin biopsy of an affected lesion was taken. The histopathology revealed: o Hyperkeratosis: Thickened stratum corneum with scaling. o Acanthosis: Epidermal thickening with elongation of the rete ridges. o Parakeratosis: Retention of nuclei in the stratum corneum. o Inflammatory Infiltrate: Mixed inflammatory cell infiltrate, primarily composed of T-lymphocytes, in the dermis. o Dilated Capillaries: In the papillary dermis, indicative of psoriasis.

Atopic dermatitis ,Seborrheic dermatitis ,Tinea corporis ,contact dermatitis, lichen Planus

Moderate Chronic plaque psoriasis

For therapy, topical treatment

Methotrexate , Adalimumab