Psoriasis

Introduction
• Psoriasis is a long-lasting, noncontagious  autoimmune
disease characterized by raised areas of abnormal
skin. These areas are typically red, or purple on some
people with darker skin, dry, itchy, and scaly. 
• Psoriasis varies in severity from small, localized patches
to complete body coverage. Injury to the skin can trigger
psoriatic skin changes at that spot, which is known as
the Koebner phenomenon
 Types of psoriasis
• The five main types of psoriasis are
1. plaque, 
2. guttate, 
3. inverse, 
4. pustular, and 
5. erythrodermic. 
• Plaque psoriasis, also known as psoriasis vulgaris, makes up about
90% of cases. It typically presents as red patches with white scales on
top.Areas of the body most commonly affected are the back of the
forearms, shins, navel area, and scalp.
• Guttate psoriasis has drop-shaped lesions.
• Pustular psoriasis presents as small, noninfectious, pus-
filled blisters. 
• Inverse psoriasis forms red patches in skin folds. 
• Erythrodermic psoriasis occurs when the rash becomes
very widespread, and can develop from any of the other
types. Fingernails and toenails are affected in most people
with psoriasis at some point in time.This may include pits in
the nails or changes in nail color.
• Psoriasis is generally thought to be a genetic disease that is triggered
by environmental factors. If one twin has psoriasis, the other twin is
three times more likely to be affected if the twins are identical than if
they are nonidentical. 
• This suggests that genetic factors predispose to psoriasis. Symptoms
often worsen during winter and with certain medications, such as beta
blockers or NSAIDs.Infections and psychological stress can also
play a role. 
• The underlying mechanism involves the immune system reacting to 
skin cells.Diagnosis is typically based on the signs and symptoms
• Psoriasis is associated with an increased risk of psoriatic
arthritis, lymphomas, cardiovascular disease, Crohn
disease, and depression. Psoriatic arthritis affects up to 30%
of individuals with psoriasis.
• The word "psoriasis" is from Greek word, meaning "itching
condition" or "being itchy" from psora, "itch", and -iasis,
"action, condition".
Clinical picture
• Psoriasis vulgaris (also known as chronic stationary
psoriasis or plaque-like psoriasis) is the most common form
and affects 85–90% 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
and are most commonly found on the elbows, knees, scalp,
and back
Causes
• The cause of psoriasis is not fully understood, but a number
of theories exist.
1. Genetics
2. Lifestyle
3. HIV
4. Microbes “after throat “
5. Medications such as Beta-blockers, lithium, Antimalarial
medications, NSAIDS, Terbinafine, CCBs, Captopril, lipid
lowering agents
Diagnosis
• A diagnosis  of psoriasis is usually based on the appearance
of the skin.
• Skin characteristics typical for psoriasis are
scaly, erythematous plaques, papules, or patches of skin that
may be painful and itch.
• No special blood tests or diagnostic procedures are usually
required to make the diagnosis.
Differential diagnosis
1. discoid eczema, 
2. seborrheic eczema, 
3. pityriasis rosea
4. Nail fungus
5. Cutaneous T-cell lymphoma
6. Rash of Secondary syphilis
Treatment
1. Topical Therapy
2. Light therapy
3. Injection therapy
4. Alternative medicine
Topical therapy
• Corticosteroids. These drugs are the most frequently
prescribed medications for treating mild to moderate psoriasis.
They are available as ointments, creams, lotions, gels, foams,
sprays and shampoos. 
• Vitamin D analogues. Synthetic forms of vitamin D, such as
calcipotriene and calcitriol (Vectical) slow skin cell growth. This
type of drug may be used alone or with topical corticosteroids. 
• Retinoids. Tazarotene (Tazorac, Avage) is available as a gel
and cream and applied once or twice daily. 
• Calcineurin inhibitors. Calcineurin inhibitors — such as
tacrolimus (Protopic) and pimecrolimus (Elidel) — reduce
inflammation and plaque buildup. 
• Salicylic acid. Salicylic acid shampoos and scalp solutions
reduce the scaling of scalp psoriasis. 
• Coal tar. Coal tar reduces scaling, itching and inflammation. It's
available over-the-counter or by prescription in various forms,
such as shampoo, cream and oil. These products can irritate
the skin. 
• Goeckerman therapy. Some doctors combine coal tar
treatment with light therapy, which is known as Goeckerman
therapy. The two therapies together are more effective than
either alone because coal tar makes skin more receptive to
UVB light.
• Anthralin. Anthralin (another tar product) is a cream used to
slow skin cell growth.
Light therapy
• Sunlight. Brief, daily exposures to sunlight (heliotherapy) might
improve psoriasis. Before beginning a sunlight regimen.
• UVB broadband. Controlled doses of UVB broadband light
from an artificial light source can treat single patches,
widespread psoriasis and psoriasis that doesn't improve with
topical treatments. 
• UVB narrowband. UVB narrowband light therapy might be
more effective than UVB broadband treatment and in many
places has replaced broadband therapy.
• Psoralen plus ultraviolet A (PUVA). This treatment involves
taking a light-sensitizing medication (psoralen) before exposure
to UVA light. 
• Excimer laser. With this form of light therapy, a strong UVB
light targets only the affected skin. 
Injection medications
1. Steroids
2. Retinoids
3. Cyclosporine
4. Methotrexate
5. Other medications. Thioguanine (Tabloid) and
hydroxyurea (Droxia, Hydrea) are medications that
can be used when other drugs can't be given. 
Alternative medicine
• Aloe extract cream. Taken from the leaves of the aloe vera
plant, aloe extract cream may reduce redness, scaling, itching
and inflammation. 
• Fish oil supplements. Oral fish oil therapy used in combination
with UVB therapy might reduce the amount of affected skin.
• Oregon grape. Also known as barberry, this product is applied
to the skin and may reduce the severity of psoriasis.
• Essential oils. Essential oils used for aromatherapy have been
shown to reduce stress and anxiety.