* chronic papulosqamous disease of unknown etiology characterised by multiple erythematous papules...

* Chronic papulosqamous disease of unknown etiology

characterised by multiple erythematous papules & plaques

with micaceous scales mainly involving extensor aspect of

legs,elbows,lower buttocks,scalp due to accelerated

epidermopoiesis

In simple words,

* A Chronic (longlasting) skin disease characterized by

scaling and inflammation. Scaling occurs when cells in the

outer layer of skin reproduce faster than normal and pile

upon the skin’s surface

• Genetic factors

- Autosomal dominant with incomplete penetrance.

- Increased prevalence of HLACw6.

- 9 locations on different chromosomes that are associated wit

psoriasis.

• Major determinant is PSORS1,which is located on chromosome 9 in

MHC.3genes in PSORS1 locus have a strong association with psoriasis

vulgaris.

• Environmental factors

• About 1 to 2% of the U.S population or 5.5 million people get

infected.

• Mostly common between the age 15 to 35 years old.

• Mostly frequently occurs are male Caucasians population.

• It is also inherited

* Stress

* Alcohol

* Drugs

- AntiHT(beta blockers)

- Lithium

- Antimalarials(chloroquine)

- NSAID's-(Aspirin,Ibuprofen)

* Infection

* Sunlight

* Climate

* Metabolic Factors like Pregnancy

* Trauma & surgery

• Predominantly affects extensor aspects of extremities &

lumbosacral area of trunk

• Erythematous papules and plaques wit white micaceous scales

• Classically lesions demonstrate AUSPITZ sign

• Method of doing this test is called GRATTAGE Test

• +ve koebners phenomenon

• Associated nail & joint involvement

Skin -> 1.Epidermis 2.Dermis 3.Hypodermis

•Skincells are created in the dermis and is moved to through the epidermis to the skin surface.

•Process takes 28-30 days

•In psoriasis patients hyperpoliferation takes place

•Transit time is shortened to 4-5 days, thus scales appear in the skin

• Psoriasis vulgaris

• Guttate psoriasis

• Palmoplander psoriasis

• Flexular psoriasis

• Psoriatic arthrcpathy

• Erthrodermic psoriasis

• Psoriasis of nails

According to the site of involvement it is specified as

• Scalp psoriasis

• Palmoplantar psoriasis

• Nail psoriasis

• Acropustolosis

• Hyperkeratosis

• Parakeratosis

• Acanthosis

• Papillomatosis

• Munromicroabscesses

• Suprapapillary thinnin of epidermis

Clinical Features - Primary Test

Grettage test - Diagnosis

Biopsy - Confirmation

How severe

1. Mild -> affecting < 3% of skin

2. Moderate -> affecting 3-10% of skin

3. Severe -> depends on the

following • Proportion of body surface

affected

• Disease activity

• Response of previous therapies

• Impact of disease on the person

• Secondary Syphilis

• Lichen Planus

• Pityriasis Rubra Pilaris

• Seborrheic Dermatitis

Three types of treatment, also called 1-2-3 approach

• Topical treatment

• Systemic treatment

• Photo therapy treatment

Coal tar application over lesions* Icthyol salicylic ointment-6%ichthyol+35%salicylic acid used.

* Goeckermans regime - daily application of tar, UVR exposure

Dithramol * 0.1 to 1 %conc used * ointment based anthralin applied to lesions n washed off after

30 min to 2hr application time

Topical Treatment

Calapotrial

* It is a Vitamin d3 analogue * Effective 4 both short n long term treatment of psoriasis * Mainly used 4 resistant localized psoriatic patches * Highly expensive

Tazarotene

* 0.1% to 0.05%gel * Modified vitamin A molecule formulated as topical agent * Mainly used for treatment of nail psoriasis

Topical steriods

* Mild to moderate psoriasis * Clobetasol propionate,halobetasol used * Reduces the itching n redness

Topical Treatment

Systemic treatment

• Methotrescale

* Antometabolie,folic acid antagonist * Inhibits mitosis * Drug of choice in psoriatic arthropathy * Dose : 7.5mg to 15mg/week

• Puva Therapy

* Psoarlen,photosensitising agent * Pro drug that upon oral administration is distributed through out the body,bt is only activated by UVR in those sites that are exposed to uva * Taken on alternate days * Puva sol-psoralen +exposure to sunlight * Patient need to wear UVR resistant glasses for 24 hrs after therapy

•Oral retinoids

* Especially for pustular patients * 0.5mg to 1mg/kg body wt

• Cyclosporine * Immunosuppressive * Dose 2.5 to 5 mg/kg body wt per day

•Biologicals * Infliximab, etanercept * Other drugs that can b used are hydroxy urea and sulfasalazine

Systemic treatment

•Hydroxyurea

•Antibiotics * Doxycycline * Polymorphonuclear chemotaxis

•Rotating treatment * All modalities of Rx used for wide spread severe patients * Have side effects when used for long time * So switch the medicine in 1-2 years

Systemic treatment

• UVB photo therapy

• PUVA (ultraviolet A (UVA)

• Photo therapy treatment

•Psoriasis is a lifelong condition.

•Many of the most effective agents used to treat severe

psoriasis carry an increased risk of significant morbidity

including skin cancers, lymphoma and liver disease.

•Controlling the signs and symptoms typically requires

lifelong therapy.

Thank you