Psoriasis

Definition Psoriasis is a chronic, non-

infectious inflammatory dermatosis
characterized by well-demarcated
erythematous plaques topped by silvery
scales.

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Psoriasis is an inflammatory rash with
increased epidermal proliferation
(acanthosis) resulting in an accumulation
of stratum corneum (scale).
The etiology is unknown

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Psoriasis effects 2% of the population in
Europe and Noth America, but is less common
in Africa and Japan.
The sex incidence is equal, the condition may
start at any age, even in the elderly.
The two peaks of onset are the [2nd-3th] and
6th decades.
it is unusual in children less than8 years old.

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The disease usually starts gradually,
although occasionally
it is explosive in onset or exacerbation. The
sudden appearance of multiple small
(guttate) lesions of psoriasis in a generalized
distribution is often preceded by a
streptococcal throat infection

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In patients with severe
sudden onset or rapidly worsening large-
plaque psoriasis,
a predisposing human immunodeficiency virus
(HIV) infection should be considered: 1% of
patients with acquired immune deficiency
syndrome (AIDS) develop severe psoriasis

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Other aggravating factors
that have been implicated in psoriasis
include trauma to the skin that precipitates
a psoriatic lesion (Koebner phenomenon)
A few drugs have been found to aggravate
psoriasis. Lithium is the best proven culprit,
but beta-blockers and nonsteroidal
antiinflammatory drugs have also been
implicated
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Psoriasis is thought to be an autoimmune
skin disease with an
inherited genetic predisposition and
immunological triggers.
It causes skin cells to multiply rapidly and to
accumulate on the surface of the skin. Eg
The epidermal turnover time is reduced
from 23-28 days to 3-5 days.

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 Koebner phenomin, lesions appear in an
area of trauma which is often linear such as a
scratch or surgical scar can precipitate
psoriasis in the damaged skin Infection,
Typically a streptococcal Sor throat may
precipitate guttate psoriasis

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Presentation patterns of psoriasis include
 plaque
 guttate
Flexural
localized forms
generalized pustular
 nail involvement
 erythroderma
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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
detachd, may leave bleeding points-Auspitz
sign.

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This variant of psoriasis affects the axillae,
sub-mammary areas. It is mostly found in
the elderly. Loses its haracteristic silvery
scales, but the well demarcated
erythematous area remain.

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Flexural psoriasis
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Guttate psoriasis is an acute
symmetrical eruption of 'drop-like'
lesions usually on the trunk and
limbs. This form mostly occurs in
adolescents or young adults and may follow
a streptococcal throat infection.

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Guttate psoriasis.
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The lesions are sharply demarcated,
erythematous papules, patches, and
plaques surmounted by scale,
which is characteristically silvery. In
intertriginous areas, maceration
prevents scales from accumulating, but
the lesions remain red and sharply
defined.

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Psoriasis is classically distributed on the scalp,
elbows, and knees The intergluteal cleft is also
a common site, and is frequently overlooked.
Although these are typical sites, psoriatic
lesions can occur anywhere and may cover the
entire skin surface .

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Nail involvement is present in as many as
50% of patients with psoriasis and can be
associated with involvement of the hands

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Generalised plaques.
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Pitting and onycholysis of the nails.
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Scalp psoriasis.
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Diagnosis usually is not difficult, especially
when the lesions have the characteristic
silvery scale and involve the typical
locations. It may be more difficult when
scale is not present, as in extremely early
lesions or in intertriginous areas.

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Psoriasis of the scalp is most often confused
with seborrheic dermatitis, in which the
scaling is usually finer, yellower, and more
diffuse with indistinct borders. Guttate
psoriasis on the trunk is sometimes
confused with pityriasis rosea or tinea
corporis

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The goal of therapy is to decrease the
epidermal proliferation and the underlying
dermal inflammation. Five
types of topical agents are used:

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I. Topical therapy
II. Topical cortico steroids
III. Vitamin D analogues
IV. Dithranol (Anthralin)
V. Keratolytics and scalp preparations

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