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UNTAR MEDICAL FACULTY April 14th 08 May 17th 08

PSORIASIS
DESNI PARAMITA IVONNE KURNIAWAN VINA LIAWATI RADOT SIHOMBING YONGKY SUTANTO WILLIAM KESTER

COMPLEX & PERPLEXING

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HISTORY

The condition was finally given the name PSORIASIS.

Ferdinand von Hebra - 1841

Be identified two categories = 1. Leprosa Graecorum had scales 2. Psora Leprosa became eruptive The fourth variant of impetigo, a condition caused by staphylococcus pyogenes. Psoriasis was first to be talked with.

Robert Willan - 1812

Cornelius Celsus 1st C Hippocrates 377 BC

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SIGN of PSORIASIS
Tetesan Lilin phenomena
= milky white blister , radiance index changing

Silver

Auspitz Sign =
pint point bleeding , papilomatous

White Scales

Koebner respon = skin


trauma by scratching

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ERUPTION
SOLITAIR

MULTIPLE

CHRONIC RESIDIF

SYMETRIS

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HISTOPATHOLOGY

Hiperkeratosis Papilomatosis Acantosis Agranulosis Parakeratosis PSORIASIS

Subepidermal Vasodilatation
Munro Abcess

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RISK FACTOR

STRESS

OBESITY

SMOKING

OTHER MEDICAL CONDITION

Strong impact to : immune system

Skin folds friction Inverse psoriasis

Physic & Psycho Stress Polution

Immuno deficient Child : Strept inf Adult : HIV ( + )

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TYPE
PLAQUE - raised, inflamed, red

lesions covered by a silvery white scale. Occurs in scalp & extensor

INVERSE eritema only,


occurs in skin fold obesity, armpits and groin.

PSORIASIS

ERYTHRODERMIC generalized eritema,


over treatment Koebner respon

4
5

GUTTATE generalized small lession


red spots on the trunk.

PUSTULAR acute milky white blisters surrounded by red skin, caused by Steroid withdrawal

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PLAQUE type

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INVERSE type

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ERYTHRODERMIC type

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GUTTATAE type

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PUSTULAR type

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DIFFERENTIAL DIAGNOSIS
Chronic Type

Corporis Tinea Numularis Dermatitis Morbus Hansen

Gutata Type

Pitriasis Rosea Drug Eruption Lues std 2

Psoriasis
Atopic Dermatitis
Eritroderm Contact Dermatitis Type Drug Eruption

THE GREAT IMITATOR

Flexural Type

Cruris Tinea Atopic Dermatitis Candidosis

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DIFFERENTIAL DIAGNOSIS

Nail

Unguium Tinea

Psoriasis
Facial

Capitis Tinea Seborrhoic Dermatitis

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DIFFERENTIAL DIAGNOSIS
CHRONIC type
PSORIASIS NUMULARIS DERMATITIS MORBUS HANSEN
Squama = ( - ) Nodul = ( + ) Infiltrate = ( + ) < 5 Cardinal Sign >

Perifer = Central = Active KOH = ( - ) hypha Epitel = ( + ) nucleated Squama = ( ++ ) Size = lentikular, CORPORIS TINEA numular, plaqued.

Squama = ( - ) Size = numular Madidans. Erosive crust.

Perifer > Active KOH = ( + ) long hypha

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DIFFERENTIAL DIAGNOSIS
CHRONIC type
PSORIASIS CORPORIS TINEA NUMULARIS Ds MORBUS HANSEN

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DIFFERENTIAL DIAGNOSIS
GUTTATE type
PSORIASIS DRUG ERUPTION LUES std 2
Adults. Bacterial induced. Dark red / brownish lesions with soft and infiltrated scales.

Adults. Genetic. Red rash with rough scales.

Drug induced. PITRIASIS Scales = ( - ) ROSEA Burning sensation. Acute Tends to disappear in 4 8 weeks. Children & young adults. Virally induced. Pink rash with fine scale.

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DIFFERENTIAL DIAGNOSIS
GUTTATE type
PSORIASIS PITRIASIS ROSEA DRUG ERUPTION LUES std 2

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DIFFERENTIAL DIAGNOSIS
ERYTHRODERMIC type
PSORIASIS CONTACT DERMATITIS
Squama = ( - ) Patch tes = ( + ) Squama = ( - ) Burning sensation.

DRUG ERUPTION

Squama = ( + ) Eritema = ( + ) Patch tes = ( - )

ATOPIC DERMATITIS
Ig E = increase Atophy stigma

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DIFFERENTIAL DIAGNOSIS
ERYTHRODERMIC type
PSORIASIS ATOPIC Ds CONTACT Ds DRUG ERUPTION

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DIFFERENTIAL DIAGNOSIS
FLEXURAL type
PSORIASIS CANDIDOSIS

ATOPIC DERMATITIS
KOH = ( - ) Scales = (++ ) rough
Ig E and eosinophilia increase. Lichenification,fossa cubiti& poplitea Stigma atopy.

KOH = ( + ) pseudohypha Scales = ( + ) wet Corimbiformis + Satelite lessions.

CRURIS TINEA

KOH = ( + ) long hypha Scales = ( + ) soft Polycyclic,

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DIFFERENTIAL DIAGNOSIS

FLEXURAL type

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DIFFERENTIAL DIAGNOSIS
SEBORRHOIC DERMATITIS

PSORIASIS SCALP
ROUGH white scales

CAPITIS TINEA
Black dot ringworm Mousy odor

Oilly yellowish lession

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DIFFERENTIAL DIAGNOSIS
SCALP type
PSORIASIS SEBORRHOIC Ds CAPITIS TINEA

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DIFFERENTIAL DIAGNOSIS
NAIL type

PSORIASIS
Pitting nail. Onycholysis.

UNGUIUM TINEA
Broken nail from distal. Hyperpigmentation.

Nail dystrophy.

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DIFFERENTIAL DIAGNOSIS
NAIL type
UNGUIUM TINEA PSORIASIS

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TREATMENT OVERVIEW
Psoriasis have no cure, but many different therapies can reduce, or nearly stop their symptoms. No single treatment works for everyone, but something is likely to work in most cases.
Topical treatments are usually the first line of defense in treating psoriasis. Researchers believe psoriasis occurs when faulty signals in the immune system cause skin cells to grow too rapidly. Topicals slow down or normalize that excessive cell reproduction and reduce inflammation (redness) associated with psoriasis.

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TREATMENT

TOPICAL ACUTE CHRONIC

EMOLIEN

ANTHRALIN TER LCD

CALCI POTRIOL

PUVA PUVB

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TREATMENT

TRANQUILIZER
CORTICOSTEROID

SYSTEMIC

CYCLOSPORIN METHOTREXATE ETRETINATE

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METHODS OF USING TOPICAL STEROIDS

Apply to the lession

Occlusion

Pulse Dosing

Cover with

Directly to the
lession. Once / twice daily. Not to uninvolved skin.

an airtight plastic wrap, waterproof dressing. 2hours only. Increase the effect of steroid.

On the schedule / tappering off.

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POTENTIAL SIDE EFFECTS OF TOPICAL STEROIDS

Skin Damage

Rebound Phenomena
Facial Psoriasis

Internal Absorption
Cushing's Disease

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AVOIDING STEROIDS SIDE EFFECTS

HEALTHY LIFE AFTER MEAL


LOW DOSE SHORT TERM
BASED ON PRESCRIPTION

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SPECIAL CONDITIONS CONCERNING STEROIDS


Allergies

Pregnancy

Diabetes

Breast Feeding

Triggered by withdrawal of SYSTEMIC STEROID THERAPY

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generalisata
Zumbusch type

PALMOPLANTAR
( BARBER type )

PUSTULAR PSORIASIS

ACROPUSTULOSIS

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BOTTOM LINE OF STEROIDS


Corticosteroids are powerful drugs which can improve symptoms and provoke incredible results. There are potential consequences to their use though. The power of corticosteroids should not be feared, but must be respected.

PSORIASIS and YOUR EMOTIONS


Don't hesitate to talk to a professional

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Acknowledge your feelings

Share your feelings with others

WAYS TO MAKE A POSITIVE CHANGE

Don't give up on finding a treatment that work

Ask for help

Educate yourself about your disease

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What are some other trigger ?


Drugs Imunology Infection Weather

Obesity Stress Trauma Iritation

Hormonal Genetic

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MEDICINE TRIGGERING PSORIASIS


WHAT ARE
Lithium Anti Malaria

Quinidin

Medications associated with ?

Inderal

Indometasin

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REFERENCES
Catherine H Smith, consultan dermatologist; J N W N Barker, professor of clinical dermatology. Risk Of Myocardial Infraction with Psoriasis. Last updated : August 19, 2006

Joel M. Gelfand, MD, MSCE; Andrea L. Neimann, MD; Daniel B. Shin, BA. Psoriasis and Its Management. Last updated : 2006

Randy Parks, MD, Chair, Associate Professor, Departement of Emergency Medicine, Denton Regional Medical Center. Psoriasis. Last updated : May 1, 2007

Tim Editor Fakultas Kedokteran Universitas Indonesia, 2003. Metode Diagnostik dan Penatalaksanaan Psoriasis dan Dermatitis Seroboik. Balai Penerbit FKUI. Jakarta.

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DERMATOLOGY HUSADA HOSPITAL UNTAR MedFac

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..:: Radot Ivonne William Desni Vina Yongky ::..