What is the Auspitz sign (Auspitz's sign)?

From the Guidelines

Auspitz sign is a clinical finding characterized by pinpoint bleeding that occurs when the scales of a psoriatic plaque are gently scraped off, and it is considered a diagnostic indicator for psoriasis. The Auspitz sign is a significant diagnostic tool in dermatology, particularly for psoriasis, a chronic inflammatory skin condition. When performing the test, a healthcare provider carefully removes the silvery scales from a psoriatic lesion, which causes tiny droplets of blood to appear on the underlying skin surface 1. This bleeding occurs because psoriasis causes elongation of dermal papillae with thin suprapapillary plates and dilated capillaries that are easily traumatized when the overlying scales are removed. Some key points to consider when evaluating the Auspitz sign include:

• The sign is not present in all cases of psoriasis and may occasionally be observed in other scaling skin conditions.
• It should be considered alongside other clinical features and sometimes biopsy findings.
• The test should be performed gently to minimize discomfort to the patient.
• Alternative diagnostic methods should be considered if the patient has a bleeding disorder or is on anticoagulant therapy. In the context of psoriasis diagnosis and management, as discussed in the guidelines of care for the management of psoriasis and psoriatic arthritis 1, the Auspitz sign remains a valuable clinical tool, although it is not mentioned explicitly in the provided study. However, understanding its significance in diagnosing psoriasis can aid in the differentiation of psoriasis from other skin conditions, such as erythrodermic psoriasis, which is discussed in the guidelines.

From the Research

Definition of Auspitz Sign

• The Auspitz sign refers to the appearance of small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques 2.

Characteristics of Auspitz Sign

• The Auspitz sign is not sensitive or specific for psoriasis, as it can be produced when scale is forcibly removed from several nonpsoriatic, scaling disorders, including Darier's disease and actinic keratoses 2.
• The sign is not always present in patients with psoriasis, as it was only observed in 41 of 234 patients with psoriasis in one study 2.

Clinical Context

• The Auspitz sign is associated with psoriatic papules or plaques, which are characteristic skin lesions of psoriasis 2.
• Psoriasis is a chronic, inflammatory disease affecting the skin, joints, and nails, with a significant negative impact on the quality of life 3, 4.