PSORIASIS dermatology slides for medical students

PSORIASIS- dermatology slides for medical students
It is for educational purpose only,
one correction slide 20 : erythroderma can involve more than 90 percent of BSA, it is an acute medical emergency - we have to admit the patient.

1. PSORIASIS DR AYSHA THAZNEEM KP FAMILY MEDICINE RESIDENT

2. INTRODUCTION Chronic inflammatory multisystem condition Characterised by clearly defined, red and scaly plaques 2–4% of males and females start at any age: onset peaks at 15–25 years and 50–60 years  About one-third of patients with psoriasis have family history

3. CLINICAL FEATURES symmetrically distributed, red, scaly plaques with well-defined edges scale is typically silvery white skin folds- plaques appear shiny with a moist peeling surface MOST COMMON SITES: SCALP, ELBOWS, KNEES Auspitz   sign Koebner phenomenon

4. Various clinical presentations of psoriasis and its subtypes (A) A well demarcated, pink plaque on white skin. (B) On black skin, the plaques are grey. (C) Symmetry of plaques is characteristic. (D) Small centripetal papules in guttate psoriasis. (E) Erythroderma. (F) Generalised pustular psoriasis. (G) Palmoplantar pustulosis. (H) Flexural or inverse psoriasis with absence of scale.

5. Thick silvery scale over elbow

6. Well demarcated plaque with silvery scale in chronic plaque psoriasis

7. Plaque with scale

8. Chronic plaque psoriasis

9. Small plaques of psoriasis-Guttate

10. Axillary psoriasis

11. Generalised pustular psoriasis

12. Scalp psoriasis

13. Adherent scale in scalp psoriasis Psoriasis in ear (scaly blocking canal)

14. Flexural Psoriasis Well demarcated salmon pink erythema which extends to the apex of skin fold

15. Palmoplantar psoriasis

16. Hyperkeratosis of sole of foot

17. Erythroderma Erythroderma is a severe, potentially life-threatening form of psoriasis It typically presents with confluent erythema, scales, or exfoliation involving more than 75% of the total body surface area This extent of skin involvement can be associated with hypothermia, high-output cardiac failure, electrolyte imbalance, pruritus, and skin pain

18. Erythrodermic psoriasis a skin biopsy might be necessary to help to exclude cutaneous T-cell lymphoma.

19. Structural components of nail unit

20. Nail involvement

21. Post inflammatory hypopigmentation- guttate psoriasis reolving

22. Psoriatic arthritis generally asymmetrical and affects the distal interphalangeal joints, sometimes with axial involvement Other: enthesitis and dactylitis. Psoriasis and psoriatic arthritis share some pathogenetic and immunological features and therapies frequently overlap, but they are distinct genetic, immunological, and therapeutically responsive entities.

23. Psoriatic arthritis (PsA) 'sausage digits '

24. pencil-in-cup deformity of DIP, demonstrating erosive changes

25. Psoriasis and CVD

26. LIFESTYLE MODIFICATION IS IMPORTANT TO REDUCE CVD RISK

27. DIAGNOSIS- CLINICAL Detailed history , examination, and different severity scores can be used Evaluate for co morbid conditions: BMI , Waist circumference Bp Ecg Hba1c Lft Flp Uric acid

28. Management General advice : Smoking   cessation Safe limits for  alcohol  consumption Maintaining optimal weight Topical therapy : emollients and moisturisers Coal tar preparations Dithranol Salicylic acid Vitamin D  analogue  ( eg ,  calcipotriol ) Topical corticosteroids Combination  calcipotriol/betamethasone dipropionate ointment/gel  or  foam Calcineurin inhibitors  ( tacrolimus ,  pimecrolimus )

29. Phototherapy UVB phototherapy PUVA (photochemotherapy) Targeted phototherapy Excimer laser Systemic therapy Methotrexate Ciclosporin Acitretin Biologic therapy 1)TNF-alpha inhibitors : Adalimumab Etanercept Infliximab 2)Interleukin 17 (IL-17) inhibitors: Ixekizumab Secukinumab Brodalumab Bimekizumab 3 )Interleukin 23 (IL-23) inhibitors: Ustekinumab Guselkumab Tildrakizumab Risankizumab

30. Management of adult psoriasis with topicals (AAD Guideline

31. VITAMIN D ANALOGUE THERAPY

32. References Journal of American academy of dermatology AAD guidelines Dermnetnz.org The Journal of Rheumatology August 2021, 48 (8) 1208-1220; DOI: https://doi.org/10.3899/jrheum.201471 Lancet, The, 2021-04-03, Volume 397, Issue 10281, Pages 1301-1315, Copyright © 2021 

33. THANK YOU