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Psoriasis

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Psoriasis

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Description

Psoriasis is a skin diseas.
here we discuss etiology, what is it, pathogenesis along with clinical photographs...

Transcript

  1. 1. Psoriasiform Lesions
  2. 2. <ul><li>Some things common </li></ul>
  3. 3. Epidermal hyperplasia
  4. 6. <ul><li>Elongation of rete ridges </li></ul>
  5. 8. Psoriasis
  6. 9. <ul><li>Psoriasis </li></ul><ul><li>Greek word for 'itch' </li></ul>
  7. 10. <ul><li>“ chronic </li></ul><ul><li>non-infectious </li></ul><ul><li>erythematous plaques & papules </li></ul><ul><li>silvery scales </li></ul><ul><li>extensor distribution” </li></ul>
  8. 11. <ul><li>Psoriasis vulgaris </li></ul><ul><li>(common) </li></ul>Chronic Relapsing Papulosquamous dermatitis
  9. 12. <ul><li>Incidence : 2 % </li></ul><ul><li>All Races </li></ul><ul><li>More in western people </li></ul><ul><li>Mean age - 25 yrs </li></ul>
  10. 13. <ul><li>Chr - 6P21.3 </li></ul><ul><li>Associated with - HLA-CW0602 </li></ul><ul><li>(PCR) </li></ul>
  11. 14. How the patient presents ?
  12. 15. <ul><li>Erythematous plaques </li></ul><ul><li>with </li></ul><ul><li>Silver scaling </li></ul>
  13. 16. <ul><li>When the scales are removed … </li></ul>
  14. 17. <ul><li>Auspitz’s sign </li></ul>It bleeds
  15. 18. Capillaries Scratch
  16. 19. <ul><li>Which sites are involved ? </li></ul>
  17. 29. <ul><li>Scalp , </li></ul><ul><li>Lips no involved </li></ul><ul><li>Oral lesions are rare </li></ul>
  18. 30. <ul><li>5 % cases --- Polyarthritis </li></ul>
  19. 31. <ul><li>Do we know the Cause ? </li></ul>
  20. 32. <ul><li>Trigger factors </li></ul><ul><li>Trauma </li></ul><ul><li>Infection </li></ul><ul><li>Drugs : Lithium, iodine , B blockers, </li></ul><ul><li>Carbamazepine, NSAIDS, ACE inhibitors </li></ul><ul><li>Climate </li></ul><ul><li>Hormone, </li></ul><ul><li>Stress </li></ul><ul><li>Alcohol </li></ul><ul><li>Smoking </li></ul>
  21. 33. <ul><li>Lesions after Trauma </li></ul><ul><li>(Koebner phenomenon) </li></ul><ul><li>30 % cases. </li></ul>
  22. 34. <ul><li>What is the Pathogenesis ? </li></ul>
  23. 35. Y Y Y Its an Immune reaction
  24. 36. <ul><li>“Problem in signal transduction” </li></ul>Initiation
  25. 37. <ul><li>Cytokine </li></ul><ul><li>transcription regulation </li></ul><ul><li>problems </li></ul>
  26. 38. Stimulation of immunity by super antigen
  27. 39. <ul><li>Problem in signal transduction in between the cells </li></ul><ul><li>Cytokine transcription regulation problems </li></ul><ul><li>Stimulation of immunity by super antigen </li></ul>Initiation
  28. 40. Blood vessels in the papillary dermis Disease process starts here
  29. 41. <ul><li>Blood vessels in the papillary dermis </li></ul>Dilatation and tortuosity
  30. 42. <ul><li>Angiogenesis </li></ul><ul><li>(TGF alfa, IL 8 ) </li></ul><ul><li>Size of microcirculation Expands </li></ul><ul><li>New vessels bring T lymphocytes </li></ul>
  31. 43. <ul><li>Lymphocyte recruitment in papillary dermis </li></ul><ul><li>(PAF, LB4) </li></ul><ul><li>Lymphocytes come and bind to endothelial </li></ul><ul><li>cells in venules of papillary dermis </li></ul>
  32. 44. <ul><li>Even the expression of </li></ul><ul><li>adhesion molecules is </li></ul><ul><li>increased (E selectin) </li></ul>
  33. 45. E selectin correlates with the disease process UV rays decrease adhesion molecules! ( PUVA therapy !!)
  34. 46. <ul><li>Now the Lymphocytes come out </li></ul><ul><li>of the venules (C5a) </li></ul>
  35. 47. <ul><li>CD4 or CD8 ? </li></ul><ul><li>CD4 in the dermis </li></ul><ul><li>CD8 migrate to the epidermis </li></ul>
  36. 48. Mechanism <ul><li>T cell activation by super antigen </li></ul><ul><li>Release of huge quantity of cytokines </li></ul>
  37. 49. <ul><li> Transit time change </li></ul>53 days
  38. 50. in Psoriasis 7 days
  39. 51. <ul><li>Histopathology </li></ul>
  40. 52. <ul><li>Early changes </li></ul><ul><li>Dilatation and congestion of vessels </li></ul><ul><li>Mild perivascular lymphocytic infiltration </li></ul>

Description

Psoriasis is a skin diseas.
here we discuss etiology, what is it, pathogenesis along with clinical photographs...

Transcript

  1. 1. Psoriasiform Lesions
  2. 2. <ul><li>Some things common </li></ul>
  3. 3. Epidermal hyperplasia
  4. 6. <ul><li>Elongation of rete ridges </li></ul>
  5. 8. Psoriasis
  6. 9. <ul><li>Psoriasis </li></ul><ul><li>Greek word for 'itch' </li></ul>
  7. 10. <ul><li>“ chronic </li></ul><ul><li>non-infectious </li></ul><ul><li>erythematous plaques & papules </li></ul><ul><li>silvery scales </li></ul><ul><li>extensor distribution” </li></ul>
  8. 11. <ul><li>Psoriasis vulgaris </li></ul><ul><li>(common) </li></ul>Chronic Relapsing Papulosquamous dermatitis
  9. 12. <ul><li>Incidence : 2 % </li></ul><ul><li>All Races </li></ul><ul><li>More in western people </li></ul><ul><li>Mean age - 25 yrs </li></ul>
  10. 13. <ul><li>Chr - 6P21.3 </li></ul><ul><li>Associated with - HLA-CW0602 </li></ul><ul><li>(PCR) </li></ul>
  11. 14. How the patient presents ?
  12. 15. <ul><li>Erythematous plaques </li></ul><ul><li>with </li></ul><ul><li>Silver scaling </li></ul>
  13. 16. <ul><li>When the scales are removed … </li></ul>
  14. 17. <ul><li>Auspitz’s sign </li></ul>It bleeds
  15. 18. Capillaries Scratch
  16. 19. <ul><li>Which sites are involved ? </li></ul>
  17. 29. <ul><li>Scalp , </li></ul><ul><li>Lips no involved </li></ul><ul><li>Oral lesions are rare </li></ul>
  18. 30. <ul><li>5 % cases --- Polyarthritis </li></ul>
  19. 31. <ul><li>Do we know the Cause ? </li></ul>
  20. 32. <ul><li>Trigger factors </li></ul><ul><li>Trauma </li></ul><ul><li>Infection </li></ul><ul><li>Drugs : Lithium, iodine , B blockers, </li></ul><ul><li>Carbamazepine, NSAIDS, ACE inhibitors </li></ul><ul><li>Climate </li></ul><ul><li>Hormone, </li></ul><ul><li>Stress </li></ul><ul><li>Alcohol </li></ul><ul><li>Smoking </li></ul>
  21. 33. <ul><li>Lesions after Trauma </li></ul><ul><li>(Koebner phenomenon) </li></ul><ul><li>30 % cases. </li></ul>
  22. 34. <ul><li>What is the Pathogenesis ? </li></ul>
  23. 35. Y Y Y Its an Immune reaction
  24. 36. <ul><li>“Problem in signal transduction” </li></ul>Initiation
  25. 37. <ul><li>Cytokine </li></ul><ul><li>transcription regulation </li></ul><ul><li>problems </li></ul>
  26. 38. Stimulation of immunity by super antigen
  27. 39. <ul><li>Problem in signal transduction in between the cells </li></ul><ul><li>Cytokine transcription regulation problems </li></ul><ul><li>Stimulation of immunity by super antigen </li></ul>Initiation
  28. 40. Blood vessels in the papillary dermis Disease process starts here
  29. 41. <ul><li>Blood vessels in the papillary dermis </li></ul>Dilatation and tortuosity
  30. 42. <ul><li>Angiogenesis </li></ul><ul><li>(TGF alfa, IL 8 ) </li></ul><ul><li>Size of microcirculation Expands </li></ul><ul><li>New vessels bring T lymphocytes </li></ul>
  31. 43. <ul><li>Lymphocyte recruitment in papillary dermis </li></ul><ul><li>(PAF, LB4) </li></ul><ul><li>Lymphocytes come and bind to endothelial </li></ul><ul><li>cells in venules of papillary dermis </li></ul>
  32. 44. <ul><li>Even the expression of </li></ul><ul><li>adhesion molecules is </li></ul><ul><li>increased (E selectin) </li></ul>
  33. 45. E selectin correlates with the disease process UV rays decrease adhesion molecules! ( PUVA therapy !!)
  34. 46. <ul><li>Now the Lymphocytes come out </li></ul><ul><li>of the venules (C5a) </li></ul>
  35. 47. <ul><li>CD4 or CD8 ? </li></ul><ul><li>CD4 in the dermis </li></ul><ul><li>CD8 migrate to the epidermis </li></ul>
  36. 48. Mechanism <ul><li>T cell activation by super antigen </li></ul><ul><li>Release of huge quantity of cytokines </li></ul>
  37. 49. <ul><li> Transit time change </li></ul>53 days
  38. 50. in Psoriasis 7 days
  39. 51. <ul><li>Histopathology </li></ul>
  40. 52. <ul><li>Early changes </li></ul><ul><li>Dilatation and congestion of vessels </li></ul><ul><li>Mild perivascular lymphocytic infiltration </li></ul>

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