Plaque psoriasis presentation

anatomy, physiology of skin. causes, treatment and diagnosis of plaque Psoriasis.

1. Plaque Psoriasis Yogesh Vishwakarma Abigail greaves Emmanuel kingsley

2. What is Psoriasis? A chronic condition in which the body makes new cells in 3-7 days rather than 3-4 weeks Red, itchy scaly patches seen on the surface of skin as the cells pile on each other The patches can be seen on various parts of body depending on type of Psoriasis It can be triggered by infections, medications, stress, genetics and trauma

3. What is Plaque Psoriasis? Most common form of psoriasis The skin can become inflamed, and it can be covered in plaques Plaque is a broad, raised area on the skin Most commonly found on the elbow, knees and scalp

4. Plaque Psoriasis cont’d It is autoimmune disease, overactive T cells attack healthy skin and trigger the production of more skin cells. Symptoms such as painful swollen joints and soreness occurs in patients with plaque psoriasis. It is caused by a mutation in the gene CARD14 when it is exposed to an infection.

5. Risk Factors If an individual has a relative with plaque psoriasis. A person with HIV can have plaque psoriasis. Persons who are obese have a higher chance of getting plaque psoriasis. Persons with high stress also may develop plaque psoriasis.

6. Anatomy and Physiology of Cutaneous Membrane

7. Skin is composed of 3 layers, Stratified squamous epithelium. Dense irregular connective tissue Adipose Tissue

8. Epidermis The epidermis is a thin and most superficial layer of skin. Further epidermis divided into five separate layers.

9. Epidermis Stratum Basale It is the layer that’s closest to the blood supply. The cells of this layer divide via the process of mitosis and they form keratinocytes. Keratinocytes produce the most important protein called keratin.

10. Keratinocytes It consist 90% - 95% of epidermis layer.   Life cycle of keratinocytes are around 8 to 10 days from mitosis.   Skin wound repairing.

11. Keratin makes our skin tough and provides us protection from microorganisms, physical harm, and chemical irritation. Two other cell types are found dispersed among the stratum Basale. First is a Merkel cell which functions as a receptor and second is a melanocyte which produces the pigment melanin.

12. Stratum Spinosum The stratum spinosum is composed of eight to 10 layers of keratinocytes. This layer is a type of dendritic cell called the Langerhans cell. Langerhans functions as a macrophage by engulfing bacteria, foreign particles, and damaged cells that occur in this layer.

13. Stratum granulosum This layer has a grainy appearance de to further changes to keratinocytes. Stratum lucidum The stratum lucidum is a smooth, seemingly translucent layer of the epidermis. This thin layer of cells is found only in the thick skin of the palms, soles, and digits.

14. Stratum corneum This is dry and dead layer of skin. This layer prevent the penetration of microbes and dehydration of underlying tissue and provides a mechanical protection.

15. Dermis

16. Dermis Papillary layer In the papillary layer are fibroblasts, a small number of fat cells (adipocytes), and an abundance of small blood vessels. The papillary layer contains phagocytes, defensive cells that help fight bacteria or other infections that have breached the skin.  This layer also contains lymphatic capillaries, nerve fibers, and touch receptors which is called the Meissner corpuscles.

17. Reticular layer The reticular layer serves to strengthen the skin and also provides our skin with elasticity. Reticular layer also contains hair follicles, sweat glands, and sebaceous glands. Sweat glands regulate our body temperature through the process of evaporation. Sebaceous glands secretes sebum that helps to lubricate and protect our skin from drying out.

18. Hypodermis

19. Hypodermis Subcutaneous layer or superficial fascia is a layer below the dermis and serves to connect the skin to the fibrous tissue of the bones and muscles. This layer consist adipose tissue, which functions as a mode of fat storage and provides insulation and cushioning.

20. Structures That Contain Keratinocytes 1. Nails The nail is a plate like, keratinous, translucent structure that consists of highly specialized epithelial cells.

21. Hair Hair is made of a tough protein called keratin. The hair follicle serves as a reservoir for epithelial and melanocyte stem cells. It has different color pigments.

22. Physiology/function of the skin For protection Insulates, waterproof i.e. keratin Protects from harsh weather conditions i.e dermis. Protects from UV rays Regulates body temperature

23. Helps to synthesis vitamin D An organ for sensation Also helps to prevent excess water escaping from our body.

24. Risks factors of plaque psoriasis Family history: approximately 30% of all patients with psoriasis have a close relative who also has the condition HIV- Patients with HIV have high risks of plaque psoriasis compared to people who don’t have. Mental stress: high stress levels also increases plaque psoriasis.

25. Overweight or obesity: people that are too at have a great chance of getting plaque psoriasis. Regular tobacco smoking: not only is the risk of developing psoriasis higher, but also its severity. Recurring infections: people with recurring infections have a higher risk of developing psoriasis e.g strep throat.

26. Pathophysiology Pathogenesis is not completely understood Caused by interactions of leucocytes, resident skin cells and an array of proinflammatory cytokines Specific factors like genetics or trauma causes activation of immune cells against the skin This causes thickening and plaque formation on skin

27. Early Stage Unknown factors such as genetics and injury or trauma causes activation of T cells in lymph nodes and skin These T cells are produced in response to keratinocyte antigens These cells along with dermal dendritic cells migrate to dermal layer of skin Blood vessels dilate and the T cells along with other immune cells emerge from them

28. This inflammatory process causes production of various cytokines, e.g. TNF-a They accumulate around the basal membrane of epidermis These T cells interact with keratinocytes They induce proliferation of keratinocytes This leads to accelerated cell turnover (from 23d to 3-5d) and improper cell maturation Increased hard and died keratinized cells and decreased stratum spinosum and granulosum layers This causes thickening and hardening of the affected area

29. Cells in stratum granulosum which normally loses their nuclei, retain them a condition known as “Parakeratosis” Lipids work as cement adhesion between corneocytes Epidermal cells fail to release adequate levels of lipids This cause poorly adherent stratum corneum leading to flaky and scaly surface of lesions

30. Later Stages It is characterized by acanthosis (thickening of stratum spinosum) Psoriasiform hyperplasia which consists of; Elongated Rete Ridges Suprapapillary thinning Dilation of dermal blood vessels Parakeratosis becomes confluent and finally granular layer is lost Intracorneal collection of neutrophils Collection of neutrophils in stratum spinosum known as “Spongiform Pustule Kogoj’

31. Diagnosis and treatment Diagnosis No special blood tests or diagnostic tests are needed. Physical exam and medical history- by examining the patient’s skin, scalp and nails. Skin Biopsy- A part of skin is removed and observed under the microscope.

32. Treatment Treatments can be divided into 3 types Topical treatments. light therapy systematic medications.

33. Topical treatments include… Topical corticosteroids Prescribed medications for treating mild to moderate psoriasis. Mild corticosteroid creams can be used in sensitive like face, or skin folds. stronger ones are used in areas which are less sensitive or tough layers. using stronger corticosteroid for a longer time can worsen the condition,

34. Vitamin -D analogues …….. These analouges slow down the skin growth. Calcipotriene ( Dovonex ) is a prescription cream or solution that treats mild to moderate psoriasis . Calcitriol ( Vectical ) is expensive but may be equally effective as Calcipotriene Less irritating than calcipotriene.

35. Light therapy [Photo therapy] the treatment uses natural sunlight or artificial UV light. They include …….. Sunlight exposure to UV light slows down skin growth reducing scaling and inflammation. exposure to sunlight everyday may improve skin. But intense exposure to sunlight may worsen the condition.

36. Psoralen plus ultraviolet A (PUVA).   Photochemotherapy involves taking Psoralen before exposure to UVA light. Then, you are exposed to ultraviolet A (UVA) light to alleviate your symptoms. This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis.

37. Oral or injected medications this type of medications are used when psoriasis is resistant to other type of medications. Methotrexate Helps the patient by decreasing the production of skin cells and suppressing inflammation. It may also slow the progression of psoriatic arthritis in some people. When used for long periods, it causes severe liver damage and decreased production of red and white blood cells and platelets.

38. Retinoids Contains vitamin A This group of drugs help in severe conditions when other therapies doesn’t work. Side effects may include lip inflammation and hair loss. Retinoids such as acitretin (Soriatane) can cause severe birth defects. women must avoid pregnancy for at least three years after taking the medication.

39. References Boundless. (n.d.). Boundless Anatomy and Physiology. Retrieved from https://courses.lumenlearning.com/boundless-ap/chapter/the-skin/ Erdoğan , B. (2017, May 03). Anatomy and Physiology of Hair. Retrieved from https://www.intechopen.com/books/hair-and-scalp-disorders/anatomy-and-physiology-of-hair Brannon, H., & Gallagher, C. (n.d.). An Overview of Plaque Psoriasis. Retrieved from https://www.verywellhealth.com/plaque-psoriasis-overview-1069489 (n.d.). Retrieved from https://www.nhs.uk/conditions/psoriasis/ Psoriasis. (2018, March 06). Retrieved from https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840