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Chronic
papulosqamous
disease
of
unknown
etiology
characterised by multiple erythematous papules & plaques with
micaceous
scales
mainly
involving
extensor
aspect
of
legs,elbows,lower buttocks,scalp due to accelerated epidermopoiesis
In simple words,
*
A Chronic (longlasting) skin disease characterized by scaling
and inflammation. Scaling occurs when cells in the outer layer of skin
reproduce faster than normal and pile upon the skin’s surface
• Genetic factors
- Autosomal dominant with incomplete penetrance.
- Increased prevalence of HLACw6.
- 9 locations on different chromosomes that are associated wit psoriasis.
• Major determinant is PSORS1,which is located on chromosome 9 in
MHC.3genes in PSORS1 locus have a strong association with psoriasis vulgaris.
• Environmental factors
• About 1 to 2% of the U.S population or 5.5 million people get infected.
• Mostly common between the age 15 to 35 years old.
• Mostly frequently occurs are male Caucasians population.
• It is also inherited
* Stress
* Alcohol
* Drugs
- AntiHT(beta blockers)
- Lithium
- Antimalarials(chloroquine)
- NSAID's-(Aspirin,Ibuprofen)
* Infection
* Sunlight
* Climate
* Metabolic Factors like Pregnancy
* Trauma & surgery
• Predominantly affects extensor aspects of extremities & lumbosacral area of
trunk
• Erythematous papules and plaques wit white micaceous scales
• Classically lesions demonstrate AUSPITZ sign
• Method of doing this test is called GRATTAGE Test
• +ve koebners phenomenon
• Associated nail & joint involvement
Skin -> 1.Epidermis
2.Dermis
3.Hypodermis
•Skincells are created in the dermis and is moved to through the epidermis to
the skin surface.
•Process takes 28-30 days
•In psoriasis patients hyperpoliferation takes place
•Transit time is shortened to 4-5 days, thus scales appear in the skin
• Psoriasis vulgaris
• Guttate psoriasis
• Palmoplander psoriasis
• Flexular psoriasis
• Psoriatic arthrcpathy
• Erthrodermic psoriasis
• Psoriasis of nails
According to the site of involvement it is specified as
• Scalp psoriasis
• Palmoplantar psoriasis
• Nail psoriasis
• Acropustolosis
• Hyperkeratosis
• Parakeratosis
• Acanthosis
• Papillomatosis
• Munromicroabscesses
• Suprapapillary thinnin of epidermis
Clinical Features - Primary Test
Grettage test
Biopsy
- Diagnosis
- Confirmation
How severe
1. Mild
-> affecting < 3% of skin
2. Moderate -> affecting 3-10% of skin
3. Severe
-> depends on the following
• Proportion of body surface affected
• Disease activity
• Response of previous therapies
• Impact of disease on the person
• Secondary Syphilis
• Lichen Planus
• Pityriasis Rubra Pilaris
• Seborrheic Dermatitis
Three types of treatment, also called 1-2-3 approach
• Topical treatment
• Systemic treatment
• Photo therapy treatment
Topical Treatment
Coal tar application over lesions
* Icthyol salicylic ointment-6%ichthyol+35%salicylic acid used.
* Goeckermans regime - daily application of tar, UVR exposure
Dithramol
* 0.1 to 1 %conc used
* ointment based anthralin applied to lesions n washed off after 30 min to
2hr application time
Topical Treatment
Calapotrial
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It is a Vitamin d3 analogue
Effective 4 both short n long term treatment of psoriasis
Mainly used 4 resistant localized psoriatic patches
Highly expensive
Tazarotene
* 0.1% to 0.05%gel
* Modified vitamin A molecule formulated as topical agent
* Mainly used for treatment of nail psoriasis
Topical steriods
* Mild to moderate psoriasis
* Clobetasol propionate,halobetasol used
* Reduces the itching n redness
Systemic treatment
• Methotrescale
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Antometabolie,folic acid antagonist
Inhibits mitosis
Drug of choice in psoriatic arthropathy
Dose : 7.5mg to 15mg/week
• Puva Therapy
* Psoarlen,photosensitising agent
* Pro drug that upon oral administration is distributed through out the
body,bt is only activated by UVR in those sites that are exposed to uva
* Taken on alternate days
* Puva sol-psoralen +exposure to sunlight
* Patient need to wear UVR resistant glasses for 24 hrs after therapy
Systemic treatment
•Oral retinoids
* Especially for pustular patients
* 0.5mg to 1mg/kg body wt
• Cyclosporine
* Immunosuppressive
* Dose 2.5 to 5 mg/kg body wt per day
•Biologicals
* Infliximab, etanercept
* Other drugs that can b used are hydroxy urea and sulfasalazine
Systemic treatment
•Hydroxyurea
•Antibiotics
* Doxycycline
* Polymorphonuclear chemotaxis
•Rotating treatment
* All modalities of Rx used for wide spread severe patients
* Have side effects when used for long time
* So switch the medicine in 1-2 years
• Photo therapy treatment
• UVB photo therapy
• PUVA (ultraviolet A (UVA)
•Psoriasis is a lifelong condition.
•Many of the most effective agents used to treat severe psoriasis
carry an increased risk of significant morbidity including skin
cancers, lymphoma and liver disease.
•Controlling the signs and symptoms typically requires lifelong
therapy.
Thank you