2. Objectives.
• To have a brief overview of the background of psoriasis.
• To understand the signs and symptoms.
• To understand the various causes.
• To understand the mechanism.
• To understand the various types of work up.
• To understand the management.
3. Background.
• ‘’Psoriasis vulgaris’’
• Psoriasis is a chronic, noncontagious, multisystem, inflammatory
disorder.
• Skin lesions vary from localized patches to entire body coverage.
• Affects 2-4% of general population.
• Occur at any age. Commonly in 15-25 years. M-F – 1:1.
• 5 types – plaque*, guttate, inverse, pustular and erythrodermic.
5. Plaque psoriasis.
• 85-90% of people with psoriasis.
• Raised areas of inflamed skin covered with silvery-white scaly skin.
• Elbows, knees, scalp & back.
• Uncontrolled plaque psoriasis -> psoriatic eythroderma.
• Severe itching, swelling and pain.
• Often occurs from abrupt withdrawal of glucorticosteroids.
• Fatal – affects the function of skin – temperature and barrier
functions.
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7.
8. Pustular psoriasis.
• Raised bumps filled with noninfectious pus.
• Skin around the pustules is red and tender.
• Usually localized to hands and feet - palmoplantar pustulosis.
• Generalized pustular psoriasis (von Zumbusch) – rare psoriasis during
pregnancy.
• Annular pustular psoriasis – rare form. Seen during childhood.
9.
10.
11. Inverse psoriasis.
• Flexural psoriasis.
• Smooth, inflamed patches of skin.
• Affects skin folds – around genitals, armpits, overweight patients (
panniculus), intergluteal cleft and under breasts.
12.
13. Guttate psoriasis.
• Numerous small, scaly, red/pink, ‘teardrop’ shaped lesions.
• Primarily appears on the trunk but also limbs and scalp.
• Usually preceded by a streptococcal infection – streptococcal
pharyngitis.
14.
15. Other.
• Seborrheic-like psoriasis – red plaques with greasy scales usually on
scalp, forehead, skin folds close to the nose, around mouth and trunk.
• Psoriatic arthritis –
• painful inflammation of joints and connective tissue – fingers and toes –
sausage shaped – dactylitis.
• Can also affect hip, knees, spine and sacroiliac joint.
• 30% psoriasis affect individuals will develop psoriatic arthritis.
16. Medical signs
• Other than clinical presentation.
• Auspitz’s sign – pinpoint bleeding when scale is removed.
• Koebner phenomenon – psoriatic skin lesions induced by trauma.
• Itching and pain localized to papules/ plaques.
18. Causes.
• Genetics
• 1/3 psoriasis patients report a family history.
• PSORS1 to PSORS9.
• Lifestyle
• Chronic infections, stress, climate (temperate countries).
• HIV
• Advanced HIV. More severe in patients with HIV along with psoriatic arthritis.
• Medication
• Beta blockers, calcium channel blockers, statins, NSAIDS, Lithium, terbinafine,
steroid withdrawal.
19. Mechanism.
• Hyperproliferation of the keratinocytes in the epidermis, with an
increase in the epidermal cell turnover rate.
• Skin cells are replaced every 3-5 days in psoriasis rather than the
usual 28-30 days.
• Inflammatory cascade involving dendritic cells, macrophages & T-cells
-> Premature maturation of kertainocytes.
23. Prognosis.
• Most people experience mild lesions that can be treated with topical
therapies.
• -ve impact on quality of life – physical, aesthetic discomfort.
• Linked with low self esteem & depression.
• Increased risk of diabetes & HTN, Crohn’s disease & Ulcerative colitis.
