Psoriasis
Jevin
Definition
• Psoriasis is a chronic, non-infectious inflammatory
  dermatosis characterized by well-demarcated erythematous
  plaques topped by silvery scales.
• The sex incidence is equal.
• The condition may start at any age; peak onset is in the 2nd
  and 3rd decades; unusual in children less than 8 years old.
Aetiopathogenesis
• Genetics:
  • about 35% of patients show a family history
  • identical twin studies show a concordance of 80%.
  • strong correlations with the HLA antigens CW6, B13 and B17.
• Epidermal kinetics and metabolism.
  • The epidermal cell proliferation rate is increased 20 fold or more in
    psoriasis
  • the germinative cell population is expanded.
Precipitating factors
• Koebner phenomenon: Trauma to the epidermis and
  dermis, such as scratch or surgical scar can precipitate
  psoriasis in the damaged skin.
• Infection: Typically, a streptococcal sore throat may
  precipitate guttate psoriasis.
• Drugs: Beta-blockers, lithium and antimalarials.
• Sunlight.
• Psychological stress.
Clinical presentation
• Psoriasis varies in severity from the trivial to the life-
  threatening.
• Presentation patterns of psoriasis include:
   •   Plague.
   •   Guttate.
   •   Flexural.
   •   Localized forms.
   •   Generalized pustular.
   •   Nail involvement.
   •   Erythoderma.
Plaque
• Well-defined, disc-shaped plaques involving the elbows,
  knees, scalp hair margin or sacrum are the classic
  presentation.
• The plaques are usually red and covered by waxy white
  scales which if which, if detached may leave bleedng points.
Guttate
• Guttate psoriasis is an acute symmetrical eruption of “drop-
  like” lesions usually on the trunk and limbs. The form mostly
  occurs in adolescents or young adults and may follow a
  streptococcal throat infection.
 Localized forms
• Psoriasis can also present in a number of localized forms
  •   Palmoplantar pustulosis
  •   Acrodermatitis of Hallopeau
  •   Scalp psoriasis
  •   Napkin psoriasis
Generalized pustular
• Generalized pustular is a rare but serious and even life-
  threatening form of psoriasis.
• Sheets of small, sterile yellowish pustules develop on an
  erythematous background and may rapidly spread.
• The onset is often acute. The patient is unwell, with fever
  and malaise, and requires hospital admission.
Nail involvment
• Psoriasis affects the matrix or nail bed in up to 50% of cases.
• An oily or salmon pink discoloration of the nail bed is seen,
  often adjacent to onycholisis.
Treatment
• Topical therapy:
  • topical corticosteroids
  • vit D analogues – dovonex.
  • keratolytic and scalp preparations – salicylic acid ointment
• systemic therapy:
  •   PUVA
  •   Retinoids
  •   methotrexate
  •   cyclosporin.