| ID | 213 |
|---|---|
| Name | PSORIASIS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | Management: A. General measures: 1. Physical and mental rest specially during acute exacerbation. 2. Explanation, reassurance. 3. Treatment of anemia & infection (if any). 4. Treatment of depression and anxiety. B. Local measures: 1. Potent topical steroid ointment.34 Steroid-antifungal combinations are helpful for flexure psoriasis. N.B: only mild steroid should be used on face but moderately potent ones are suitable for elsewhere 2. Keratolytic agent like 2-5% Salicylic acid or Dithranol cream (0.1% initially and gradually increasing the strength up to 2%) should be applied thrice daily. N.B: in acute stage avoid salicylic acid 3. Coal tar preparations- - Crude coal tar (100%) applying once or twice daily is effective. - Coal tar + Salicylic acid (1-2%) is useful in the management of scalp psoriasis. - Tar-steroid combinations are rather effective than pure tar. 4. Ultraviolet radiation- most patients improved with natural sunlight, so sunbath should be encouraged. Ultraviolet B-spectrum (UV-B)- is effective alone, but combination with coal tar and dithranol are much more effective. Dose: 200-1000 rads, 2 to 3 times weekly for 6-8 weeks (specially during winter) is sufficient. 5. Methotrexate specially in psoriatic arthropathy. 6. PUVA- therapy (psoralen + ultraviolet-A) |
| Introduction | This is a chronic recurrent non-infectious skin disease of unknown origin characterized by sharply well defined erythematous patch or plaque covered by dry white silvery scales mainly affecting scalp, extensor surfaces of the limbs and lubmosacral region with occational nail pitting. The main abnormality in Psoriasis is increased epidermal proliferation due to excessive division of cells in the basal layer and a shorter cell cycle time. In Psoriasis the epidermal turnover tune falls from 28 to 5 or 6 days. Stages of psoriasis: 1. Stage of progression. 2 Stationary stage. 3. Remission stage. Patterns of psoriasis: A. Common: 1. Plaque patterun-most common type. 2. Guttate psoriasis- usually seen in children and adolescent. 3. Discoid psoriasis. . 4. Flexural psoriasis- involving natal cleft, submammary & axillary folds. B. Less common: 1. Napkin psoriasis. 2. Pustular psoriasis. 3. Erythrodermic psoriasis. |
| History | |
| Etiology | Etiology: It is a multifactorial disease. 1. Exact cause is unknown. 2. It is non-infectious. 3. 30% cases are hereditary. 4. Biochemical- increased level of serum prostaglandin, leukotriens and hydroxycicosatetrenoic acids are usually associated with Psoriasis. Increased activity of phospholipase A2 is also important. 5. Immunological factor. 6. Dermal factor- increased replication and metabolism of the dermal fibroblasts are suggestive of causing excessive epidermal cell proliferation in Psoriasis. 7. Predisposing factors are- trauma, severe sun-bum anxiety, emotion, cold climate, diet; and 8. Drugs- Chloroquine; withdrawal affect of systemic steroid. |
| Clinical Features | Clinical features: 1. Common sites: scalp, extensor aspect of limbs, lumbosacral region. 2. Erythematous, circumscribed plaque type lesions & are covered with silvery scales which after scraping leave behind a pin point bleeding surface (Auspitz sign positive). 3. Gradually these lesions enlarge and larger patches or plaques may be produced. 4. The psoriatic lesions may develop in the line of scratch & known as “Koebner phenomenon”. 5. The nails may become thickened, pitted and discoloured. |
| Preventions | |
| Treatment | |
| Complications | Complications: 1. Psoriatic arthropathy. 2. Exfoliative dermatitis. |
| Prognosis | |
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