Psoriasis.pptx skin disease bacterial infection

Psoriasis . Skin condition.

1. PRESENTATION ON Psoriasis. Presented By : HUSSAIN AHMED Presented To : DR. JEEVA GEORGE

2. INTRODUCTION : Psoriasis is a chronic skin disease result in patches of thick red skin covered with the silvery scales. These patches are referred as plaque which usually occur on the elbow, knees, legs, scalp, lower back, face, palm and sole of the feet, nails too

3. HISTORY : • The word psoriasis is derive from greek word 'psora' means 'itching'. The greek physician Galen of perganon (130-200 BC) use the term Psoriasis vulgaris to refer all dermo and epidermopathies accompanied by pruiritis . Since 1950 local application and systemic medications are used for the psoriasis.

4. DEFINITION : • Psoriasis is a chronic, non infectious inflammatory disease of the skin in which the production of epidermal cells occur at a rate that is about 6 to 9 times faster than normal. “Psoriasis is defined as a persistent skin disease causes cell to build rapidly on the surface of the skin, forming thick silvery scales, itchy, dry and red patches.“

5. EPIDEMIOLOGY / INCIDENCE : 1 to 3% of world population Affects 7.5 million of Americans Onset may occur at any age Median onset is at 28 years More prevalent women, Caucasians, &obese people.

6. ETIOLOGY : idiopathic Genetic Disorder Autoimmune reaction Infection Injury to skin

7. RISK FACTOR : Climatic change Stress & anxiety Trauma Smoking Drugs such as propranolol, lithium .

8. PATHOPHYSIOLOGY : Due to etiological and risk factor such as stress, genetic factors and autoimmune disorder Hyperactive of T Cell Epidermis infiltration & keratinocytes proliferation .

9. PATHOPHYSIOLOGY : Deregulated Inflammatory process Large production of various cytokines (interferon & Interleukin ) Superficial blood vessel dilated and vascular engorgement

10. PATHOPHYSIOLOGY : Epidermal hyperplasia and improper cell maturation Fails to release adequate lipids which lead to flaking, scaling presentation of psoriasis lesion Silver scaling of skin

11. CLINICAL FEATURES : The symptoms ranges from cosmetic annoyance to physically disabling and disfiguring affliction. The lesions appears as red, raised, patches of skin covered with silvery scales . Dry patching, itching Nail pitting, discoloration Separation of nail plates. If psoriasis occurs on the palms and soles , pustular lesions may develop . Fever, chills Electrolyte imbalance Despair and Frustration

12. TYPES : There are mainly 4 types of psoriasis. They are – 1. Psoriasis vulgaris or plaque psoriasis 2. Generalised pustular psoriasis 3. Guttate psoriasis 4. Generalised erythodermic psoriasis

13. DIAGNOSTIC MEASURES : History collection Physical examinations Skin biopsy : under local anaesthesia . Blood and radiography test was done to rule out psoriatic arthritis

14. MANAGEMENT : The goal of Management are - to slow the rapid turn over of epidermis to promote to promote resolution of psoriatic lesion and to control natural cycle of disease Remove scales and smooth skin, which is particularly remove by topical treatment.

15. MEDICAL MANAGEMENT : PHARMACOLOGIC THERAPY : Topical corticosteroids Topical calcineurine inhibitor Vitamin D analogue’s Coal tar Non medicated topical moisture

16. PHARMACOLOGICAL TREATMENT :

17. Topical therapy : First line agents : Corticosteroids: Ointments > creams > lotions (efficacy) Most frequently used to decrease erythema, scaling and pruritis Also has vasoconstrictive properties MOA : inhibit phospholipase A activity  arachidonic acid production   production of inflammatory mediators like prostaglandins , kinins and histamines

18. Topical therapy : First line agents : - Betamethasone dipropionate 0.05% as cream, ointment - Betamethasone benzoate 0.025% as cream, gel, lotion - Dexamethasone sod. phosphate 0.1% cream - Hydrocortisone 1% as cream, ointment, lotion ADR : - Local tissue atrophy - Degeneration of dermis and epidermis - Rarely : Cushing’s syndrome, hyperglycemia . 2-4 times daily Tearing of dermal connective tissue

19. MOA: bind to receptors in skin  inhibit keratinocyte proliferation, induce basal cell differentiation, inhibit T-cell activity Calcipotriol ( calcipotriene ) : - Synthetic analogue of calcitriol - 100 times less potent effect on Calcium metabolism - 0.005% cream, ointment, solution b . i . d - Effect seen after 2 weeks Calcitriol: 0.03% solution Tacalcitol Synthetic analog 0.0002-0.0004% once/twice daily for 4 weeks ADR: - Mild irritant contact dermatitis , burning, edema , peeling, dryness . Vitamin D3 analogues :

20. Keratolytics : Mostly used agent is salicylic acid. Promotes desquamation of scales. Used for lesions in scalp. Concentration ranges from 2-20% depending on thickness of scales Given in combination with topical corticosteroids   penetration of steroids efficacy of steroids. ADR : contact dermatitis and tenderness at application site, tinnitus, nausea, hyperventilation. Second line agents :

21. Keratolytic , anti-proliferative, anti-inflammatory Dose: 1-4 times daily as cream, use twice weekly for 2 weeks and then as needed Not used much because application is messy and has unpleasant odour ADR: folliculitis , acne, local irritation, phototoxicity Coal tar :

22. SYSTEMIC THERAPY : SYSTEMIC THERAPY is used for the treatment of psoriasis. Systemic drug therapy mainly include methotrexate, cyclosporine, and biological agents METHOTREXATE : Methotrexate 2.5 mg tab & 50 mg/ i . m vial Action Blocks dihydrofolate reductase leading to inhibition of purine and pyrimidine synthesis. Leading to accumulation of anti-inflammatory adenosine Dosage Start with a test dose of 2.5 mg and then gradually increase dose until a therapeutic level is achieved (average range, 10-15 mg weekly: maximum, 25- 30 mg weekly)

23. MOA: bind to TNF-  inhibit its binding to receptors  neutralises its activity in forming lesions  inhibits keratinocyte proliferation Infliximab : - Used in Crohn’s disease and RA and recently in psoriasis - Dose: 5-10mg/kg given on 0, 2 and 6 weeks by slow IV infusion - ADR: rashes, abdominal pain, nausea, hypersensitivity reactions TNF-  inhibitors :

24. Alefacept : Dose: IM injection 15mg once weekly for 12 weeks ADR: i nfluenza like symptoms, chills, dizziness, injection site infection, nausea (DOES NOT cause infections and malignancies) CD4 t-cell monitoring required Efalizumab : Dose: 1mg/kg SC once weekly ADR: h eadache, nausea, chills, pain On discontinuation, exacerbation of disease may occur, patient may require to continue this drug T-cell activator inhibitors :

25. Useful in treatment of moderate to severe psoriasis. It involves the repeated exposure of affected skin to ultraviolet light For patients who have failed to respond to aggressive topical therapy or have widespread disease Broadband UV spectrum ranges from 290 and 320 nm Narrower UV spectrum ranges from 311 to 313 nm Photochemotherapy ( PUVA ) is effective in the treatment of severe psoriasis and involves the use of light from the uva spectrum in combination with psoralens , a class of photoactive drugs Phototherapy :

26. Two topical agents Two systemic agents Topical agent + phototherapy Systemic + topical agents Systemic agent + phototherapy Combinations :

27. HEALTH EDUCATION : Take daily bath . Use moisturizer . Expose small amount of skin to sunlight , Cover the affected area over night . Apply medication cream or ointment . Avoid drinking alcohol and smoking . Eat healthy diet .

28. RESEARCH STUDIES : A study to assess psychological distress in patients with psoriasis, low consensus between a dermatologist and patient.

29. CONCLUSION : Psoriasis is considered as one of the most common chronic non communicable skin disease, psoriasis is typically characterized by appearance of slivery plague that most commonly appears on the skin over elbow , knees, scalp, lower back and buttocks.

30. QUESTIONS : 1. Explain the role of methotrexate in the management of psoriasis ? 2. Name four drugs for the treatment of psoriasis ? 3. What is the first line treatment for psoriasis? 4. Write a note on non-pharmacologic therapy for psoriasis ? 5. What is the role of TNF Inhibitor in psoriasis ? 6. Topical therapy for psoriasis ? 7. Adverse effects of topical treatment in psoriasis ? 8. Adverse effects of topical corticosteroids in psoriasis ? 9. Role of keratolytics in psoriasis ? 10. What is balneotherapy?

31. HAVE ANY QUERY