Psoriasis is a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales. These patches normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body. Most people are only affected with small patches. In some cases, the patches can be itchy or sore.

1. Psoriasis
AN OVERVIEW
PRESENTED BY AYAAT A. KADHUM

2. What is psoriasis?
•Psoriasis is a chronic lifelong skin
inflammatory disorder.
• Characterized by the formation of well-defined
raised erythematous plaques.
•Accompanied with silvery white scales
depends on lesion type ,that preferentially
localize on the extensor surfaces.
•Anyone can get psoriasis. It occurs mostly in
adults, but children can also get it
•Psoriasis is not contagious.
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3. Prevalence
•According to current studies, more than 8 million Americans have psoriasis.
•125 million people worldwide—2 to 3 percent of the total population—have psoriasis, according
to the World Psoriasis Day consortium.
•An estimated 30 percent of people with psoriasis also develop psoriatic arthritis.
• Psoriasis prevalence in African Americans is 1.9 percent compared to 3.6 percent of Caucasians.
•Psoriasis is likely to be under-diagnosed among African-Americans and other individuals with
skin of color due to differences in clinical presentation.
• In Iraq the incidence of psoriasis is 1.8% of overall skin disease cases.
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4. Ayaat Alobaidy

5. Psoriasis and Skin Color
•Psoriasis can affect persons of any race; however, epidemiologic studies have shown a higher
prevalence in western European and Scandinavian populations. In these groups, 1.5-3% of the
population is affected by the disease.
•Psoriasis is found more frequently in white (3.6 percent) than in African American (1.9 percent) and
Hispanic (1.6 percent) populations.However, these numbers may not paint the full picture, as psoriasis
may be more readily identified in people with lighter skin and it is sometimes misidentified in people
with darker skin tones.
•Across skin types, many features present similarly, such as the symmetrical distribution of psoriasis on
the body and well-circumscribed nature of psoriasis plaques.
•Differences do exist and are important to recognize, such as “the red color or erythema that is typically
seen with psoriasis on light skin often appears more purple or brown in darker skin types. Sometimes
the scale that accompanies psoriasis is so thick that it is difficult to appreciate that underlying color of
the plaque itself. Nevertheless, psoriasis remains a common condition across skin types and
races/ethnicities.
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7. Common Comorbidities in Patients
with Psoriasis
•Depression: Prevalence is up to 60 percent : may improve with treatment of psoriasis.
•Immune-mediated inflammatory conditions : Risk of Crohn's disease or ulcerative colitis is 3.8 to
7.5 times greater in persons with psoriasis; reported increased risk of psoriasis in persons with a
family history of multiple sclerosis.
•Malignancy : Risk of lymphoma is increased 1.3- to 3.0-fold in persons with psoriasis; risk of
squamous cell carcinoma is increased 14-fold in white patients after 250 or more psoralen plus
ultraviolet A treatments.
•Metabolic syndrome, obesity : Increased prevalence in hospitalized patients with psoriasis.
•Myocardial infarction : Increased risk persists after controlling for major cardiovascular risk
factors.
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8. Safety Considerations for Biologic
Therapies in Patients with Psoriasis
•Demyelinating disorders.
•Exacerbation of cardiac failure.
•Hepatic dysfunction.
•Infections, including tuberculosis (Activation of latent tuberculosis or new infection).
•Lupus-like syndrome.
•Risk of nonmelanoma skin cancer, lymphoma, and solid-organ cancer.
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9. What are the causes of psoriasis?
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10. Immunopathogenic mechanisms in
psoriasis
•The exact cause is unknown, however researches believe heredity, environment and immune
system also play a role in psoriasis.
•Occasionally, psoriasis is provoked by drugs such as lithium, chloroquine and hydroxy
chloroquine, beta-blockers, non-steroidal anti-inflammatory drugs, and angiotensin converting
enzyme (ACE) inhibitors.
•As psoriasis is a common T-lymphocyte mediated inflammatory skin disease and is being an
immune-mediated disorder (immunosuppressant medications can clear psoriasis plaques) in
which the excessive reproduction of skin psoriasis — types, causes and medication cells are
secondary factors produced by the immune system.
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11. Role of T Cell in Psoriasis
•T cells become active, migrate to the dermis and trigger
the release of cytokines which cause inflammation and
the rapid production of skin cells.
• It is not known what initiates the activation of the T
cells.
• That work initially pointed towards a major role of T
lymphocytes as inducers of the disease phenotype and
the pathogenic contribution of this cell type has now
been tested through clinical studies of more than a dozen
immune modifying biological agents in patients with
psoriasis .
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12. Types of Psoriasis
1. Psoriasis Vulgaris:
• (chronic plaque psoriasis), is the most
common type.
•Well defined lesions and range from a few
millimeters to many centimeters in diameter.
•Pink or red with large, centrally adherent,
silvery-white, polygonal scales.
• Symmetrical sites on the elbows, knees, lower
back and scalp are sites of predilection .
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13. Types of Psoriasis
2. Guttate Psoriasis:
• Small drop-like papules.
•often occurs acutely after an event such as drug
exposure, or illness such as streptococcal
pharyngitis .
• More commonly seen in children and
adolescents.
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14. Types of Psoriasis
3. Erythrodermic Psoriasis:
• A very rare type of psoriasis.
•It only affects about 3 percent of people with
psoriasis, but it can be very serious.
•This variant of psoriasis is characterized by
generalized erythema and scaling.
• its onset can be gradual or acute.
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15. Types of Psoriasis
4. Pustular Psoriasis :
•Is a rare and severe form of psoriasis that
involves widespread inflammation of the skin
and small white or yellow pus-filled blisters or
pustules.
•Affects less than 5% of all psoriasis patients
and there are two types of pustular psoriasis:
1- Localized pustular psoriasis
2- Generalized Pustular Psoriasis
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16. Types of Psoriasis
5. Plaque psoriasis :
•Is the most common form of psoriasis.
• 80-90 percent of people with psoriasis
experience plaque psoriasis.
•Plaques appear as raised, inflamed and scaly
patches of skin that may also be itchy and
painful
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17. Types of Psoriasis
6.Inverse psoriasis:
• Sometimes called hidden psoriasis or
intertriginous psoriasis, a form of psoriasis that
affects skin folds.
•Inverse psoriasis can occur under arms, under a
woman’s breasts, or in the groin or inner thigh
area.
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19. Psoriasis severity determination
Several factors go into determining whether psoriasis is mild, moderate, or severe, including:
1. Body Surface Area: The 1% Hand Test: One of the most important factors is how much of the body
is covered by psoriasis. Dermatologist or the patient can use their hand to estimate this. One hand
covers roughly 1% of the body’s surface area.
2. Intensity of Symptoms: Dermatologists will look at the intensity of symptoms to help determine
severity. If the plaques and scales are especially thick, red, scaly, or itchy, that can contribute to
psoriasis being more severe.
3. Psoriasis Location:Having symptoms in places that have a greater impact on life can also play a
role in severity. For example, on face where it can be more embarrassing, or in folds of skin that
are constantly irritated.
4. Personal Impact: The non-physical impact of psoriasis can also contribute to severity. This could
include emotional well-being, day-to-day activities, and relationships with others.
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22. General approach for treatment of
psoriasis
•Treatment goals include improvement of skin, nail, and joint lesions plus enhanced quality of
life.
•Treatment must be individualized to incorporate patient preferences and the potential benefits and
adverse effects of therapies.
•Consultation with a dermatologist may be warranted for patients with severe disease that requires
systemic therapy.
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23. General and Topical management
•Assurance
•explanation of disease.
•Aviodance of precipitating factor.
•Control of secondary infection.
•Topical management Highly potent steroids: Clobetasol Propionate;dose depends upon severity of
patient.
•Salicylic acid and Vitamin D analogue: calcipotriol.
•Topical methotraxate Topical retinoids: tazarotene.
•Dithranol
•Topical PUVA
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25. Specific management
•Methotraxate: Dose: 2.5 mg or 5 mg 12hrly, 3 doses in a week for 3-12 months with folic acid
supplementation. Duration of treatment depends on patient's condition.
•systemic retinoids: Acitrectin. antibiotic, antifungal.
•Photo chemotherapy: Psoralen and ultraviolet A.
•During giving methotrexate & during treatment: - complete blood count - liver function test -
renal function test must be done.
•Methotrexate is contra-indicated in pregnancy.
•Never prescribe systemic steroid in psoriasis because it flares up the condition.
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26. Foods that help fight inflammation
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27. Psoriasis Triggers
Many people who are predisposed to psoriasis may be free of symptoms for years until the
disease is triggered by some environmental factor. Common psoriasis triggers include:
• Infections, such as strep throat or skin infections
• Weather, especially cold, dry conditions
• Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn
• Stress
• Smoking and exposure to secondhand smoke
• Heavy alcohol consumption
• Certain medications — including lithium, high blood pressure medications and antimalarial
drugs
• Rapid withdrawal of oral or systemic corticosteroids
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28. Medications may trigger Psoriasis
The following have all been linked to psoriasis:
•lithium
•beta-blockers
•Tetracycline
•Non-steroidal anti-inflammatory drugs (NSAIDs)
•malaria drugs
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29. Foods that can contribute to
inflammation
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30. Risk group :
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31. Risk group :
•Anyone can develop psoriasis. About a third of instances begin in the pediatric years. These
factors can increase the risk:
•Family history: The condition runs in families. Having one parent with psoriasis increases therisk
of getting the disease, and having two parents with psoriasis increases the risk even more.
•Stress: Because stress can impact the immune system, high stress levels may increase the risk of
psoriasis.
•Smoking: Smoking tobacco not only increases the risk of psoriasis but also may increase the
severity of the disease. Smoking may also play a role in the initial development of the disease.
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33. Diagnosis
1. Routine investigation of the disease through :
• Clinical checkup should be firstly done and diagnosis of psoriasis according to appearance,
distribution, history of lesions and family history .
• CBC – Normocytic normochromic Anaemia
• ESR – Increased level
• RBS
• Urine examination
• Chest X-ray
• Skin biopsy
2. Investigation of the secondary bacterial infection accompanied with psoriasis.
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34. Complications
People with psoriasis are of greater risk of developing other conditions, including:
•Psoriatic arthritis, which causes pain, stiffness and swelling in and around the joints
•Eye conditions, such as conjunctivitis, blepharitis and uveitis
•Obesity and Type 2 diabetes
•High blood pressure and Cardiovascular disease
•Other autoimmune diseases, such as celiac disease, sclerosis and the inflammatory bowel disease
called Crohn's disease
•Mental health conditions, such as low self-esteem and depression
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35. Secondary infections complicating skin
lesions
•The link between psoriasis and infection is probably explained by the superantigen theory,
•Superantigens (SAgs) are a class of antigens that result in excessive activation of the immune
system. Specifically it causes non-specific activation of T-cells resulting in polyclonal T cell
activation and massive cytokine release.
• So that superantigens are the products of bacteria, viruses, or fungi, which can bypass normal
immunological pathway and cause powerful stimulation to the immune system.
•The most common problem is secondary aerobic and anaerobic bacterial invaders complicate
psoriatic lesions.
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36. Which type of bacteria can we detect ?
•As previously mentioned both aerobic and anaerobic bacteria can be detect among infected
lesions in psoriasis patients.
•Recent studies showed that Staphylococcus aureus and group A -haemolytic streptococci were
the most prevalent aerobes and were isolated from all body sites. In contrast, organisms that
reside in the mucous membranes close to the lesions predominated in infections next to these
membranes.
•Proteus spp, Staphylococcus epidermidis, Pseudomonas aeruginosa, Bacillus spp.
• Enteric bacteria were primarily isolated from children, E. coli and Enterococcus fecalis.
• Anaerobic bacteria represented by Propionobacter spp., Fusarium spp. & Clostridium perfrinens
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37. References
1. Zohra Zaidi, Sean W. Lanigan, Dermatology in Clinical Practice, Springer-Verlag London Limited
2010.
2. Informa- DM, Lines PI, Services PI, Immunisation T, Travel N, Network H, et al. Medicines
information services. England. 2014;979.
3. Lafi, S., Hasan, A., Al-Alowssi, M. Secondary Bacterial Infections Complicating
Psoriasis. Egyptian Academic Journal of Biological Sciences, G. Microbiology, 2010; 2(2): 37-42.
doi: 10.21608/eajbsg.2010.16706
4. Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United
States. Journal of the American Academy of Dermatology. 2014;70(3):512-516.
5. Mease PJ, Gladman DD, Papp KA, et al. Prevalence of rheumatologist-diagnosed psoriatic arthritis
in patients with psoriasis in European/North American dermatology clinics. Journal of the
American Academy of Dermatology. 2013;69(5):729-735.

38. References
6. Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the
Unite States. J Am Acad Dermatol. 2014;70(3):512-516. doi:10.1016/j.jaad.2013.11.01.
7. Gottlieb A, Korman NJ, Gordon KB, et al. Guidelines of care for the management of psoriasis
and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for
treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008;58(5):851–864.
7. Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical
presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014;7(11):16-24.
8. Drugdexsystem. http://thomsonreuters.com/products_services/healthcare/healthcare_products/
a-z/drugdex_system/. Accessed May 8, 2012.

39. References
11. Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis
and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the
treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58(5):826–850.
12. Kimball AB, Gladman D, Gelfand JM, et al. National Psoriasis Foundation clinical consensus
on psoriasis comorbidities and recommendations for screening. J Am Acad Dermatol.
2008;58(6):1031–1042.
13. Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis
and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the
treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58(5):826–850.
14. Al Samarai, A. G. M. (2009). Prevalence of skin diseases in Iraq: a community based study.
International Journal of Dermatology, 48(7), 734–739.