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psoriasis

psoriasis

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Published by: denaturals on Nov 07, 2009
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01/06/2013

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History
Psoriasis is probably one of the longest known illnesses of humans and simultaneously one of themost misunderstood. Some scholars believe psoriasis to have been included among the skinconditions calledtzaraatin the Bible.
In more recent times psoriasis was frequently describedas a variety of leprosy. The Greeks used the term lepra (λεπρα) for scaly skin conditions. Theyused the term psora to describe itchy skin conditions. It became known as
Willan's lepra
in thelate 18th century when Englishdermatologists Robert Willan and Thomas Bateman differentiated it from other skin diseases. Leprosy, they said, is distinguished by the regular,circular form of patches, while psoriasis is always irregular. Willan identified two categories:
leprosa graecorum
and
 psora leprosa
.
While it may have been visually, and later  semantically,confused withleprosy,it was not until 1841that the condition was finally given the name
 psoriasis
by theViennesedermatologistFerdinand von Hebra. The name is derived from the Greek word
 psora
which means
to itch
.
It was during the 20th century that psoriasis was further differentiated into specific types.
[edit] Types
An arm covered with plaque psoriasisThe symptoms of psoriasis can manifest in a variety of forms. Variants include plaque, pustular,guttate and flexural psoriasis. This section describes each type (withICD-10code [6]).
Plaque psoriasis (
 psoriasis vulgaris
) (L40.0)
is the most common form of psoriasis. It affects 80to 90% of people with psoriasis. Plaque psoriasis typically appears as raised areas of inflamedskin covered with silvery white scaly skin. These areas are called plaques.
 
Flexural psoriasis (inverse psoriasis) (L40.83-4)
appears as smooth inflamed patches of skin. Itoccurs inskin folds, particularly around thegenitals (between the thigh and groin), thearmpits, under an overweight stomach ( pannus), and under the breasts (inframammary fold). It is aggravated byfrictionand sweat, and is vulnerable tofungal infections.
Guttate psoriasis (L40.4)
is characterized by numerous small round spots (differential diagnosis —pityriasis rosea—oval shape lesion). These numerous spots of psoriasis appear over large areasof the body, such as the trunk, limbs, andscalp.Guttate psoriasis is associated withstreptococcal throatinfection.
Pustular psoriasis (L40.1-3, L40.82)
appears as raised bumps that are filled with non-infectious pus (pustules). The skin under and surrounding the pustules is red and tender. Pustular psoriasiscan be localised, commonly to the hands and feet (palmoplantar pustulosis), or generalised withwidespread patches occurring randomly on any part of the body.Psoriasis of a fingernail
produces a variety of changes in the appearance of finger and toe nails.These changes include discolouring under the nail plate, pitting of the nails, lines going acrossthe nails, thickening of the skin under the nail, and the loosening (onycholysis
 
) and crumbling of the nail.
involves joint andconnective tissue inflammation. Psoriatic arthritis can affect any joint but is most common in the joints of the fingers and toes. This can result in asausage-shaped swelling of the fingers and toes known as dactylitis. Psoriatic arthritis can also affect the hips, knees and spine (spondylitis). About 10-15% of people who have psoriasis alsohave psoriatic arthritis.
[
 
]
Erythrodermic psoriasis (L40.85)
involves the widespread inflammation and exfoliation of theskin over most of the body surface. It may be accompanied by severe itching, swelling and pain.It is often the result of an exacerbation of unstable plaque psoriasis, particularly following theabrupt withdrawal of systemic treatment. This form of psoriasis can be fatal, as the extremeinflammation and exfoliation disrupt the body's ability to regulate temperature and for the skin to perform barrier functions.
[edit] Clinical classification
 
Psoriasis is a chronic relapsing disease of the skin that may be classified into nonpustular and pustular types as follows
[7]:414
:
 Nonpustular psoriasis
o
Psoriasis vulgaris(Chronic stationary psoriasis, Plaque-like psoriasis)
o
Psoriatic erythroderma(Erythrodermic psoriasis)
Pustular psoriasis
o
Generalized pustular psoriasis(Pustular psoriasis of von Zumbusch)
o
Pustulosis palmaris et plantaris(Persistent palmoplantar pustulosis, Pustular  psoriasis of the Barber type, Pustular psoriasis of the extremities)
o
o
o
Impetigo herpetiformisAdditional types of psoriasis include
[8]:191-197
:
[edit] Diagnosis
Adiagnosisof psoriasis is usually based on the appearance of the skin. There are no special blood tests or diagnostic procedures for psoriasis. Sometimes a skin biopsy,or scraping, may be needed to rule out other disorders and to confirm the diagnosis. Skin from a biopsy will showclubbed Rete pegs if positive for psoriasis. Another sign of psoriasis is that when the plaques arescraped, one can see pinpoint bleeding from the skin below (Auspitz's sign
 
).
[edit] Severity

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