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Autoimmune chronic inflammatory diseases of the skin.
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Occurs due to overstimulation of immune cells that causes excessive proliferation of keratinocytes.
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Silvery scaling of skin and itching.
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Not contagious and not severe in many cases (outpatient mx)
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Erythematous papules and silvery-white scaling plaques
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Well demarcated, raised, red patches
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Usually not itchy (pruritus is typically mild - 80% of cases)
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Affects scalp, back, elbows and knees (extensor surfaces), and nails (thimble pitting).
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Plaque psoriasis
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Well demarcated individual thick, scaly, erythematous lesions
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Guttate psoriasis
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numerous small, scaly, red or pink, tear-drop shaped lesions
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Psoriatic nail disease
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Drug-induces psoriasis
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Psoriatic arthritis
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Inflammation of joints on hand, feet and spine that can occur with psoriasis
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Pustular psoriasis
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appears as red bumps filled with noninfectious pus (pustules)
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Flexural/inverse psoriasis
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occurs in skin folds and flexor surfaces creases of joints
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Erythodermic psoriasis
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generalized erythematous lesions.
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Scalp psoriasis
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affects the scalp
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Most common type
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Thick, scaly, erythematous lesions
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Lesions are red with silver-white scaling
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Common sites:
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Extensor surfaces of elbows and knees.
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Lower back
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Scalp (can cause temporary hair loss)
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Palms
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Nails- pitting and onycholysis
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Often preceded by Streptococcal infection (Streptococcus pharyngitis)
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Resolves quickly
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There is increase in cutaneous blood flow, heat loss, and water loss
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Skin becomes red.
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Scaling is absent (although this can proceed the erythroderma).
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Common sites:
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Genitals (between thigh and groin)
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Armpits
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Under an overweight abdomen (panniculus)
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Under the breasts (inflammatory fold)
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Increased by friction and sweat
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Vulnerable to fungal infections
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Looks like smooth inflamed patches on skin
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Joint and Connective tissue inflammation.
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Most common joints affected:
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Fingers and toes
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Results in Dacylitis
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Other joints:
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Knees, hips, spine (spondylitis)
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Morning stiffness of affected joints
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Can be localized, common to hands and feet
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Palmoplantar pustulosis
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Or generalized, widespread patches
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Genetics
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Precipitating factors
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1. Infections
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Pharyngitis, HIV
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2. Drugs
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Beta blockers, anti-malarial, lithium, NSAIDs, systemic steroid withdrawal
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3. Alcohol and smoking
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4. Emotional stress
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5. Local trauma
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Mild (3% of the body)
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Moderate (3-10% of the body)
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Severe
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Degree of severity is based on:
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proportion of body surface area affected
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disease activity (plaque, redness, scaling)
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response to previous treatments
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impact of the disease in the patient
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Based on appearance of the skin
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Skin biopsy, or scrapping - to rule out other disorders
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Biopsy shows clubbed rete pegs if positive for psoriasis
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Auspitz sign
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small pinpoint bleeding when scales are scraped off
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Mild disease
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Emolients
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Mild-to-moderate disease
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Topical corticosteroids (triamcinolone, fluocinonide, clobetasol), emollients, topical retinoids (tazarotene), vitamin D analogs (calcipotriene, calcitriol)
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For facial areas
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Topical tacrolimus and Pimecrolimus
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Severe
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Phototherapy, MTX, cyclosporine, anti-T cell agent, anti-TNF agent
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Avoid use on delicate skin areas (face, flexures) because of irritation.
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Combine with steroids to increase efficiency
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Anti-inflammatory, anti-pruritic, anti-mitotic
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For severe generalized psoriasis intolerant after topical therapy
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MTX
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S/E: hepatic fibrosis, myelosuppression, teratogenic
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Hydroxyurea
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S/E: myelosuppression, skin reactions, liver toxicity, teratogenic
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Cyclosporine
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S/E: renal toxicity, HTN, gingival hypertrophy
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