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.