F The word – ‘Psor’ means Itching and ‘iasis’ means condition
F One of the oldest recorded skin diseases – a challenge for the physicians till today
Non- contagious life long skin diseases
About 1.5 to 2% of total world’s population
Psoriasis may be defined as a chronic
inflammatory disease of skin with relapse &
remission characterized by well marked
erythematous papules & plaques which is
usually covered by dry silvery scales.
Main types of Psoriasis:
(1) Plaque Psoriasis-80% most common
(2) Guttate psoriasis
(4) Inverse psoriasis
(5) Erythrodermic psoriasis
Incidence : About 1.5% – 2% of total population
Age : The onset of psoriasis constitute a life long threat !
Peak onset : young adult ( 20 -30 yrs)
Sex : Male : Female = Equal
Race : All
Aetiology : Exact cause Unknown
But factors may flare up psoriasis :
Genetic : 1/3 family history may present
HLA Cw6, HLA-B13, HLA-B17
Season : Winter
Sunlight : Strong sun light exposure is found to be initiated psoriasis
Infection : Streptococci, HIV, HCV, HBV, Chlamydia
Pregnancy : Improve but deteriorate post partum period
Metabolic : Hypocalcaemia
Drugs : HPA-FLIM
Anti-Hypertensive :Beta blockers, ACE inhibitors, Calcium channel blockers(Nifidipine,)
Anti-Psychotic : Lithium
Antibiotic : Sulphonamides
Anti-Fungal : Terbinafine
Anti-Lipid : Gemfibrozil
Anti-Inflammatory : NSAIDs, With drawl systemic Steroids.
Anti-Malarial : Chloroquine
There is accelerated epidermopoiesis
T- cell Based immunopathogenesis
Mainly Cytokines responsible for Psoriasis
TNF alpha, IFN gamma, IL-1
The lesion of psoriasis result from an increase in epidermal cell turnover. The cell’s transit time from the basal layer of the epidermis to the stratum corneum is decreased from the normal 28 days to 3 or 4 days.
Course and Prognosis
The prognosis for control is good
‘ Psoriasis may undergo a remission for several months to years.
‘ The habit of scratching and rubbing the must be avoided to maintain the remission
Clinical features :
Erythematous hyperkeratotic mild to moderate pruritic papules and plaques almost bilaterally symmetrical on extensor distribution
Cardinal features ;
Sharply demarcated with clear cut border
Surface consists of non-coherent silvery scales
Under the scales the skin has glossy ,homogenous erythema
Auspitz’s sign positive :Pin pointed bleeding where a psoriatic scale forcibly removed (Severely thinning of epidermis over the tip of dermal papilla)
Others : Koebner’s phenomenon
:Isomorphic response resulting development of same type of new lesion at the site of injury or trauma
Nail changes : Nail pitting (deeper & broader), Oil spot ( rounded area of onycholysis), Sub-ungual hyperkeratosis, up lifting of distal portion of nail plate
Psoriatic arthopathy or arthritis
Severity of Psoriasis
According to Body Surface Area (BSA):
Mild < 10% BSA
Moderate > 10% BSA
Severe > 30% BSA
According to Psoriasis Area Severity Index (PASI)
Mild < 10% PASI
Moderate > 10-20% PASI
Severe > 20% PASI
Complications of Psoriasis :
Erythroderma or Exfoliative dermatitis
Secondary bacterial infections
For the diagnosis of disease :
Skin biopsy for histopathological examination
Munro microabscesses present at stratum corneum
thinning or absence of granular layer
Regular elongation of rete ridges
Elongation & edematous dermal papilla with tortuous blood vessels
To exclude the D/D :
Pityriasis rubra pilaris
Investigations to find out associated diseases / conditions
Investigations for therapeutic purposes
Example : Before MTX therapy need to investigate the follows
CXR P/A view
Serum ALT( SGPT
Laboratory abnormalities in Psoriasis
Serum Uric Acid é
Hb % ê
C – reactive protein é
ASO é (if streptococcal infection associated)
Skin biopsy for histopathological examination.
Management of Psoriasis
There is no magic cure for psoriasis , but many treatment options can help to control it & its symptoms . Sometimes spontaneous remission may occur or it can remain on the body for longer period of time.
ÜTreatment selection is very important ÜEffectiveness vary from person to person
ÜTreatment should never be worse than psoriasis itself
ÜScalp treatment must be continued or repeated until get adequate control of lesion. This can take up to 8 weeks or longer
ÜModerate sunlight exposure is often helpful. Avoid sunburn , since psoriasis may develop in areas of injured skin
Modalities of Treatment
◄Reassurance and explanation
Vit. D3 analogue(Calciprotriol)
Anti-histamine for itching :
Tab. Mebhyholin(50mg) 1 tab. 12 hourly
Cap. Fish Oil ( Omega-3)
Remove stress, anxiety,depression ; Tab. Amitryptyline(10mg) 1tab at night
Vitamin B – complex supplementation daily
Treatment of Complications if any
Psoriatic arthritis : Bed rest, Analgesics, for 2-3 weeks
Secondary bacterial infections : Antibiotics : Azithromycin (500mg) once daily dose for 7-10 days
Psoriasis is a life long disease with relapse and remission.
Non-contagious & Usually Non-infectious
Counseling is important— severe psychological trauma may lead to depression
One of the common skin diseases- about 1.5 – 2% of total world population
Mild to moderate sun exposure is beneficial but sunburn should be avoided.
Psoriasis tends to be remarkable symmetric. It usually spare the face.
Psoriasis is commonly a cause of nail deformity which is often mistaken for, and treated incorrectly as nail fungal infection (Onychomycosis)
Hair fall usually does not occur due to psoriasis.
Maximum cases of Psoriasis are non-pruritic.
Biologics are newer effective drugs for psoriasis but very expensive
Use of emollient, Keratolytic agent, Rational use of topical steroid are the simple effective way to control the disease.
Main 4 systemic drugs
(MTX,Acetretin,Cyclosporin,Mycophenolate mofetil) can be used as rotational therapy for psoriasis patients in the context of Bangladesh.
Systemic steroids are contraindicated in Psoriasis.
Emergency condition of psoriasis is developed due to systemic steroid and Homeopathy
Arthritis may be presented at first in 10% of psoriasis patients with out skin lesion.
Allergic foods,scratching,Alcohol must be strictly avoided and DM should be controlled.
Viva: Name some skin diseases associated with arthritis?
Erythema nodosum leprosum