Psoriasi

Presented To:
Dr. Tariq Zaman
(Dermatology Department)
Presented by :
Zujaja Dastgir (NM-2008-01)
Final Year MBBS

Contents

Definition
Etiology
Symptoms
Clinical features
Clinical presentation
Types
Management
Summary

Definition
A Chronic (long lasting)
skin disease
characterized by scaling
and inflammation.
Scaling occurs when
cells in the outer layer
of skin reproduce faster
than normal and pile
upon the skins surface.

Introduction
Psoriasis is a disease which affects the skin
and joints.
It commonly causes red scaly patches to
appear on the skin.
The scaly patches caused by psoriasis, called
psoriatic plaques, are areas of inflammation
and excessive skin production.

 Skin rapidly
accumulates at these
sites and takes a silverywhite appearance.
Plaques frequently occur
on the skin of the elbows
and knees, but can affect
any area including the
scalp and genitals.

Psoriasis is an inflammatory skin disease in which skin cells

replicate at an extremely rapid rate. New skin cells are
produced about eight times faster than normal--over several
days instead of a month--but the rate at which old cells
slough off is unchanged. This causes cells to build up on the
skin's surface, forming thick patches, or plaques, of red sores
(lesions) covered with silvery-white dead skin cells (scales).

 The disorder is a chronic recurring condition

which varies in severity from minor localized
patches to complete body coverage.
Fingernails and toenails are frequently affected
(psoriatic nail dystrophy) - and can be seen as an
isolated finding.
Psoriasis can also cause inflammation of the
joints, which is known as psoriatic arthritis.

Etiology
The cause of psoriasis is not known, but it is believed to
have a genetic component.
Several factors are thought to aggravate psoriasis. These
include stress, excessive alcohol consumption, and
smoking.
Individuals with psoriasis may suffer from depression and
loss of self-esteem.
As such, quality of life is an important factor in evaluating
the severity of the disease.
Certain medicines, including lithium salt and beta blockers,
have been reported to trigger or aggravate the disease.

 There are two main hypotheses about the process that

occurs in the development of the disease.
The first considers psoriasis as primarily a disorder of
excessive growth and reproduction of skin cells. The
problem is simply seen as a fault of the epidermis and its
keratinocytes.
The second hypothesis sees the disease as being an
immune-mediated disorder in which the excessive
reproduction of skin cells is secondary to factors
produced by the immune system. T cells (which normally
help protect the body against infection) become active,
migrate to the dermis and trigger the release of cytokines
(tumor necrosis factor-alpha , in particular) which cause
inflammation and the rapid production of skin cells. It is
not known what initiates the activation of the T cells.

Symptoms
Lesion appear on the
trunk, limbs, scalp
Noninfectious pus
appear on the skin
Silvery scales
Red plaques near the
Inflammation
genitals
Itching under the breasts

Clinical
Features

PLAQUES
1. Well-defined raised areas. SCALING
2. May be large or small.
1. Causing plaques to
3. Scattered over the trunk
appear thickened with
and limbs.
masses of adherent and
shedding white scales.
2. scratching produces
waxy appearance.

Clinical
Features

ERYTHEMA (Redness)
1. Of affected skin may
be very marked.
2. Especially in the
flexures.
3. Prominent feature in
pts with erythrodermic
psoriasis.

PUSTULES
1. Commonly seen in
palmoplantar
pustulosis
2. Pustules associated
with plaques on the
trunk and limbs are
rare.
3. Can be seen if the
psoriasis become
unstable.

Clinical
presentation

Presents with plaques on elbows, knees and

scalp.
Lesions on trunk are variable in size and often
annular.
Psoriasis may develop in scars and areas of
minor skin trauma: (koebners phenomenon).
May manifest as hyperkeratosis on the palms,
associated with repetitive trauma from manual
labor.

Clinical
presentation

Scalp scaling is very thick, especially around the

hair line.
Erythema often extends beyond the hair margin.
Psoriatic nail dystrophy is characterized by:
Oncholysis
Subungal hyperkeratosis
Pitting
Beaus lines
Splinter haemorrhages

Types of
Psoriasis

Plaque psoriasis
(psoriasis vulgaris) is the
most common form of
psoriasis. It affects 80 to
90% of people with
psoriasis. Plaque psoriasis
typically appears as raised
areas of inflamed skin
covered with silvery white
scaly skin. These areas are
called plaques.

Types of
Psoriasis

Guttate psoriasis (from the

latin gutta, a drop) is
characterized by numerous
small oval (teardrop-shaped)
spots. These numerous spots
of psoriasis appear over
large areas of the body, such
as the trunk, limbs, and
scalp. Guttate psoriasis is
associated with streptococcal
throat infection

Types of
Psoriasis

Flexural psoriasis appears

as smooth inflamed patches
of skin. It occurs in skin
folds, particularly around the
genitals (between the thigh
and groin), the armpits,
under an overweight
stomach, and under the
breasts (inframammary fold).
It is aggravated by friction
and sweat, and is vulnerable
to fungal infections.

Types of
Psoriasis

Pustular psoriasis appears as

raised bumps that are filled
with non-infectious pus
(pustules). The skin under and
surrounding pustules is red
and tender. Pustular psoriasis
can be localized, commonly
to the hands and feet , or
generalized with widespread
patches occurring randomly
on any part of the body.

Types of
Psoriasis

Nail psoriasis produces a

variety of changes in the
appearance of finger and
toe nails. These changes
include discoloring under
the nail plate, pitting of the
nails, lines going across
the nails, thickening of the
skin under the nail, and the
loosening (onycholysis)
and crumbling of the nail.

Types of
Psoriasis

Erythrodermic psoriasis
involves the widespread
inflammation and
exfoliation of the skin
over most of the body
surface. It may be
accompanied by severe
itching, swelling and
pain.

Types of
Psoriasis

Psoriatic arthritis (psoriatic

arthropathy) involves joint and
connective tissue inflammation.
Affect 5-10 % of patients with
psoriasis
40 % of these have a family
history of psoriasis
Characteristically patients
develop skin manifestations of
psoriasis before joint
involvement, but in 15% this is
reversed.

Types of
Psoriasis

Types of psoriatic arthropathy

1. Distal interphalangeal joints
2. Asymmetrical oligoarticular
3. Symmetrical polyarthritis
4. Arthritis mutilans
5. spondylitis

Types of
Psoriasis

Management

Topical treatment
Photo therapy treatment
Systemic treatment

Topical
Treatment

Emollients
Corticosteroids
Calcipotriol
Coal tar
Moisturizes
Dithranol

Phototherapy
Treatment
UVA, UVB
UVB preferred

Systemic
Treatment

Methotrexate
Cyclosporine A

Summary
Psoriasis is a lifelong condition.
There is currently no cure but various
treatments can help to control the symptoms.
Individuals will often experience flares and
remissions throughout their lives. Controlling
the signs and symptoms typically requires
lifelong therapy.

Thank
you