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Psoriasis - Wikipedia
Psoriasis - Wikipedia
Psoriasis - Wikipedia
Specialty Dermatology
Other forms …
Pustular psoriasis …
Severe pustular psoriasis.
Inverse psoriasis …
Napkin psoriasis E…
Guttate psoriasis …
Example of guttate psoriasis
Erythrodermic psoriasis …
Mouth …
Seborrheic-like psoriasis …
Seborrheic-like psoriasis is a common
form of psoriasis with clinical aspects of
psoriasis and seborrheic dermatitis, and it
may be difficult to distinguish from the
latter. This form of psoriasis typically
manifests as red plaques with greasy
scales in areas of higher sebum
production such as the scalp, forehead,
skin folds next to the nose, skin
surrounding the mouth, skin on the chest
above the sternum, and in skin folds.[19]
Psoriatic arthritis …
Nail changes …
Medical signs …
Causes
The cause of psoriasis is not fully
understood, but a number of theories
exist.
Genetics …
HIV …
The rate of psoriasis in HIV-positive
individuals is comparable to that of HIV-
negative individuals; however, psoriasis
tends to be more severe in people infected
with human immunodeficiency virus
(HIV).[39] A much higher rate of psoriatic
arthritis occurs in HIV-positive individuals
with psoriasis than in those without the
infection.[39] The immune response in
those infected with HIV is typically
characterized by cellular signals from Th2
subset of CD4+ helper T cells,[40] whereas
the immune response in psoriasis vulgaris
is characterized by a pattern of cellular
signals typical of Th1 subset of CD4+
helper T cells and Th17 helper T
cells.[41][42] It is hypothesized that the
diminished CD4+-T cell presence causes
an overactivation of CD8+-T cells, which
are responsible for the exacerbation of
psoriasis in HIV-positive people. Psoriasis
in those with HIV/AIDS is often severe and
may be untreatable with conventional
therapy.[43] In those with long-term, well-
controlled psoriasis, new HIV infection can
trigger a severe flare of psoriasis and/or
psoriatic arthritis.
Microbes …
Medications …
Mechanism
Psoriasis is characterized by an
abnormally excessive and rapid growth of
the epidermal layer of the skin.[47]
Abnormal production of skin cells
(especially during wound repair) and an
overabundance of skin cells result from
the sequence of pathological events in
psoriasis.[16] The sequence of pathological
events in psoriasis is thought to start with
an initiation phase in which an event (skin
trauma, infection or drugs) leads to
activation of the immune system and then
the maintenance phase consisting of
chronic progression of the disease.[31][17]
Skin cells are replaced every 3–5 days in
psoriasis rather than the usual 28–30
days.[48] These changes are believed to
stem from the premature maturation of
keratinocytes induced by an inflammatory
cascade in the dermis involving dendritic
cells, macrophages, and T cells (three
subtypes of white blood cells).[12][39] These
immune cells move from the dermis to the
epidermis and secrete inflammatory
chemical signals (cytokines) such as
interleukin-36γ, tumor necrosis factor-α,
interleukin-1β, interleukin-6, and
interleukin-22.[31][49] These secreted
inflammatory signals are believed to
stimulate keratinocytes to proliferate.[31]
One hypothesis is that psoriasis involves a
defect in regulatory T cells, and in the
regulatory cytokine interleukin-10.[31] The
inflammatory cytokines found in psoriatic
nails and joints (in the case of psoriatic
arthritis) are similar to those of psoriatic
skin lesions, suggesting a common
inflammatory mechanism.[17]
Gene mutations of proteins involved in the
skin's ability to function as a barrier have
been identified as markers of
susceptibility for the development of
psoriasis.[50][51]
Diagnosis
Morphological …
Psoriasis is classified as a
papulosquamous disorder and is most
commonly subdivided into different
categories based on histological
characteristics.[3][11] Variants include
plaque, pustular, guttate, and flexural
psoriasis. Each form has a dedicated ICD-
10 code.[57] Psoriasis can also be
classified into nonpustular and pustular
types.[58]
Pathogenetic …
Severity …
Distribution of severity
Management
Topical agents …
UV phototherapy …
Systemic agents …
Diet …
Prognosis
Most people with psoriasis experience
nothing more than mild skin lesions that
can be treated effectively with topical
therapies.[69]
Cardiovascular disease …
History
Scholars believe psoriasis to have been
included among the various skin
conditions called tzaraath (translated as
leprosy) in the Hebrew Bible, a condition
imposed as a punishment for slander. The
person was deemed "impure" (see tumah
and taharah) during their afflicted phase
and is ultimately treated by the kohen.[118]
However, it is more likely that this
confusion arose from the use of the same
Greek term for both conditions. The
Greeks used the term lepra (λεπρα) for
scaly skin conditions. They used the term
psora to describe itchy skin conditions.[118]
It became known as Willan's lepra in the
late 18th century when English
dermatologists 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.[119]
Etymology …
Cost …
Research
The role of insulin resistance in the
pathogenesis of psoriasis is under
investigation. Preliminary research has
suggested that antioxidants such as
polyphenols may have beneficial effects
on the inflammation characteristic of
psoriasis.[125]
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Further reading
Baker BS (2008). From Arsenic to Biologicals:
A 200 Year History of Psoriasis . Beckenham
UK: Garner. ISBN 978-0-9551603-2-5.
"Guidelines for the assessment and
management of psoriasis" . U.S. National
Guideline Clearinghouse. Archived from the
original on 27 September 2013. Retrieved
26 July 2013.
World Health Organization (2016). Global
report on psoriasis . World Health
Organization (WHO). hdl:10665/204417 .
ISBN 9789241565189.
External links
Classification ICD-10: L40 • D
ICD-9-CM: 696 •
OMIM: 177900 •
MeSH: D011565 •
DiseasesDB: 10895
eMedicine:
emerg/489 plaque
derm/365 , guttate
derm/361 , nails
derm/363 , pustular
derm/366
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