Psoriasis

PSORIASIS ETIOLOGY PATHOGENESIS, PATHOPHYSIOLOGY,TREATMENT, DIAGNOSIS

1. Psoriasis  Presented by :- VIKAS AAGRAHARI PHARM-D 4th YR

2. Psoriasis It is one of the most common skin disease.  It is thought that this chronic disease stems from a hereditary effect that causes overproduction of keratin.  Incidence - It affect approximately 2% of the population. It occurs in any age, most commonly occurs in people between 15-35 years of age.

3. Definition  It is a chronic, non-infectious skin inflammation involving keratin synthesis that results in psoriatic patches.  It is an inflammatory skin disease in which the skin cell replicate at an extremely rapid rate. New cells are produced 8 times faster then normal but the rate at which old cells sloughed off is unchanged, this cause the cell build up on skin surface, forming thick patches or plaque of red sores, covered with flaky, silvery white dead skin cells (scale). 

4. Etiology • Unknown  • Genetic  Some factor may aggravate the condition such as:  • Stress  • Smoking, alcohol  • Trauma  • Obesity  • Hormonal changes  • Climate  • Autoimmune disease  • Medication – lithium salt, beta blockers

5. Plaque psoriasis – also known as psoriasis vulgaris. It appear as raised, inflamed red skin, covered by silvery patches or scales. Site are: - elbow, knee, sacrum, scalp, hands, feet's & lower back. 

6. Guttate psoriasis:-  Eruption of small papule over the upper trunk and proximal extremities. 

7. Inverse psoriasis It is found in the skin folds such as inguinal, axilla and sweating areas. Scaling is minimal or absent and lesion appears glossy, smooth and bright red. 

8. Pustular psoriasis   It is an pus filled lesion surrounded by a red skin. It appears at hands and feet. 

9. Erythrodermic psoriasis   it is a superficial scaling/ peeling that may appear like burning. It affect all the body sites. Causes is sunburn, allergic reaction and strong coal product use.  This Photo by Unknown author is licensed under CC BY .

10. Nail psoriasis   It appear as small nail, yellow brown nail with chalk like debris build up under nails.

11. Psoriatic arthritis   This condition involve both psoriasis and joint inflammation.

12. Clinical manifestation  • The first sign is ‘red spot’ on body.  • Patches of the skin is dry, swollen and inflamed covered with silvery flakes.  • Raised and thick skin.  • Pain, itching and burning.  • Yellow discolouration , pitting and thickening of the nails are noted if they are affected.  • Cracked and bleeding points, if the scale are scraped away.  • Koebner phenomenon – it is develop at the site of injury such as scratch or sunburn.

13. Diagnostic evaluation History  Physical examination  Skin biopsy  Blood and radiography to rule out psoriatic arthritis.

14. Management   1. Topical treatment – it slow overactive epidermis.   I. Topical corticosteroids – they slow the turnover by suppressing the immune system which reduce inflammation & relieve itching.  II. Topical steroids  III. Vitamin D analogues – e.g.. – calcipotriene, it suppress epidermopoiesis (development of epidermal cells) causing sloughing of growing epidermal cells.  IV. Coal tar – dry distillation product of organic matter heated in the absence of oxygen, combination of creams, ointments and pastes.  V. Tazarotene – it reduce mainly scaling & plaque Thickness, normalize the DNA activity.  VI. Topical Calcineurin Inhibitors – tracolimus , they inhibit activation of the cells which reduce inflammation and plaque build up .  VII. Emollients – to avoid dryness. It reduce scaling and limit pain

15. 2. Phototherapy  I. Sunlight – activated T-cells in skin are destroy lead to reduce scaling and inflammation.  II. UV broadband phototherapy – artificial light sources. It used to treat single patches.  IV. Photo chemotherapy Plus UVA – light sensitizing medication taken before exposure to UV light.  V. Eximer laser – control beam of UVB light directed to psoriatic plaque to control scaling.  VI. Pulse dye laser – it destroy the tiny blood vessels that contribute psoriasis.

16. 3. Systemic therapy – e.g.  Cyclosporine, methotraxate , acitretin. Complication:- • Psoriatic arthritis  • Erythrodermic psoriasis 

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