This document provides information about psoriasis, including its definition, symptoms, risks, and treatment options. Psoriasis is a chronic skin condition characterized by abnormal skin cell growth that results in thick, scaly patches. It has several clinical subtypes defined by the location and appearance of lesions. Psoriasis has been associated with increased risks of cardiovascular disease, diabetes, hypertension, and some cancers. Treatment depends on the severity and includes topical creams and ointments as well as light therapy.

1. Running Head : THE SILVERY SCALE
PSORIASIS AND THEIR DISCUSSION
NUR FARRA NAJWA BINTI ABDUL AZIM
KOLEJ MARA KUALA NERANG
FOUNDATION IN SCIENCE UniKL
ROYAL COLLEGE OF MEDICINE, PERAK

2. PSORIASIS
Table of Contents
Introduction................................................................................................................................3
Definition...................................................................................................................................5
Symptoms...................................................................................................................................6
Psoriasis vulgaris....................................................................................................................6
Psoriatic erythroderma ...........................................................................................................6
Pustular psoriasis....................................................................................................................6
Palmoplantar pustulosis ......................................................................................................6
Acrodermatitis continua......................................................................................................6
Pustulosis palmaris et plantaris...........................................................................................6
Annular pustular psoriasis ..................................................................................................7
Inverse psoriasis .....................................................................................................................7
Guttate psoriasis .....................................................................................................................7
Oral psoriasis..........................................................................................................................8
Seborrheic-like psoriasis ........................................................................................................8
Psoriatic arthritis. ...................................................................................................................8
Nail changes. ..........................................................................................................................9
Risks.........................................................................................................................................10
Diseases................................................................................................................................11
Diabetes and cardiovascular diseases. ..............................................................................11
Hypertension.....................................................................................................................11
Stroke................................................................................................................................12
Cancer. ..............................................................................................................................12
Treatment. ................................................................................................................................13
Topical Treatment. ...............................................................................................................13
Light Treatment....................................................................................................................14
Prevention follow.....................................................................................................................15
Conclusion ...............................................................................................................................16
Reference. ................................................................................................................................17
Appendix A..............................................................................................................................19
Appendix B ..............................................................................................................................20
Appendix C ..............................................................................................................................21

3. PSORIASIS
Appendix D..............................................................................................................................22
Appendix E ..............................................................................................................................23
Appendix F...............................................................................................................................24
Appendix G..............................................................................................................................25
Appendix H..............................................................................................................................26

4. PSORIASIS
Introduction
Psoriasis is characterized by an abnormally excessive and rapid growth of
the epidermal layer of the skin. Abnormal production of skin cells (especially during wound
or repair) and an overabundance of skin cells result from the sequence of pathological events
in psoriasis. Skin cells are replaced every 3–5 days in psoriasis rather than the usual 28–30
days. These changes are believed to stem from the premature maturation
of keratinocytes induced by an inflammatory cascade in the dermis involving dendritic
cells, macrophages, and T cells (three subtypes of white blood cells). (Appendix A)
A diagnosis of psoriasis is usually based on the appearance of the skin. Skin characteristics
typical for psoriasis are scaly, erythematous plaques, papules, or patches of skin that may be
painful and itch. No special blood tests or diagnostic procedures are needed to make the
diagnosis. (Abad-Santos F. August 2013).
The differential diagnosis of psoriasis includes dermatological conditions similar in
appearance such as discoid eczema, seborrhoeic eczema, pityriasis rosea (may be confused
with guttate psoriasis), nail fungus (may be confused with nail psoriasis). Dermatologic
manifestations of systemic illnesses such as the rash of secondary syphilis may also be
confused with psoriasis.

5. PSORIASIS
Definition
Psoriasis is a medical condition that occurs when skin cells grow too quickly and a common
skin problem. Damaged signals in the immune system cause new skin cells to form in days
rather than weeks. The body does not shed these excess skin cells, so the cells pile up on the
surface of the skin and lesions form. It causes a thick, rough, dry build up of your outer layer
of skin. The thick areas of skin are called plaques. They can develop anywhere on the skin.
They usually occur on the scalp, elbows, knees, and buttocks.
Psoriasis occurs more often in adults with both men and women at about the same
rate. In many cases, there is a family his-tory of psoriasis, and certain genes have been linked
to the disease.
Psoriasis is a chronic disease, which means you will likely have it all your life. The
extent and severity of the disease vary widely. Early treatment of the plaques may help stop
the problem from becoming more severe. People of all ages can have psoriasis. It is not
contagious. (Abad-Santos F. August 2013).
Psoriasis affects approximately 2% of the U.S. population. Age of onset occurs in two
peaks: ages 20-30 and ages 50-60, but can be seen at any age. Waxes and wanes during a
patient’s lifetime, is often modified by treatment initiation and cessation and has few
spontaneous remissions. There is a strong genetic component. About 30% of patients with
psoriasis have a first-degree relative with the disease.

6. PSORIASIS
Symptoms
Psoriasis vulgaris
Is the most common form and affects 85%–90% of people with psoriasis. (also known
as chronic stationary psoriasis or plaque-like psoriasis). Plaque psoriasis typically appears as
raised areas of inflamed skin covered with silvery-white scaly skin. (Appendix B). These
areas are called plaques and are most commonly found on the elbows, knees, scalp, and back.
Psoriatic erythroderma
Involves widespread inflammation and exfoliation of the skin over most of the body
surface. (Appendix C) It may be accompanied by severe itching, swelling and pain. It is
often the result of an exacerbation of unstable plaque psoriasis, particularly following the
abrupt withdrawal of systemic glucocorticoids. This form of psoriasis can be fatal as the
extreme inflammation and exfoliation disrupt the body's ability to regulate temperature and
perform barrier functions. (Fitzgerald, Oliver ,2007)
Pustular psoriasis
Appears as raised bumps filled with non-infectious pus (pustules). (Appendix D) The
skin under and surrounding the pustules is red and tender.
Palmoplantar pustulosis. Pustular psoriasis can be localized, commonly to the hands
and feet. (Appendix E)
Acrodermatitis continua. A form of localized psoriasis limited to the fingers and
toes that may spread to the hands and feet.
Pustulosis palmaris et plantarisis. Another form of localized pustular psoriasis
similar to acrodermatitis continua with pustules erupting from red, tender, scaly skin found
on the palms of the hands and the soles of the feet.

7. PSORIASIS
Annular pustular psoriasis (APP). A rare form of generalized pustular psoriasis, is
the most common type seen during childhood. APP tends to occur in women more frequently
than in men, and is usually less severe than other forms of generalized pustular psoriasis such
as impetigo herpetiformis. This form of psoriasis is characterized by ring-shaped plaques
with pustules around the edges and yellow crusting. APP most often affects the torso, neck,
arms, and legs. (Fitzgerald, Oliver ,2007)
Inverse psoriasis.
Appears as smooth, inflamed patches of skin. (also known as flexural psoriasis) The
patches frequently affect skin folds, particularly around the genitals (between the thigh and
groin), the armpits, in the skin folds of an overweight abdomen (known aspanniculus),
between the buttocks in the inter-gluteal cleft, and under the breasts in the inframammary
fold. (Appendix F)
Heat, trauma, and infection are thought to play a role in the development of this a
typical form of psoriasis. Napkin psoriasis is a subtype of psoriasis common in infants
characterized by red papules with silver scale in the diaper area that may extend to the torso
or limbs. Napkin psoriasis is often misdiagnosed as napkin dermatitis. (Griffiths CE ,January
2012)
Guttate psoriasis.
Characterized by numerous small, scaly, red or pink, teardrop-shaped lesions
(papules). (Appendix G. These numerous spots of psoriasis appear over large areas of the
body, primarily the trunk, but also the limbs and scalp. Guttate psoriasis is often triggered by
a streptococcal infection, typically streptococcal pharyngitis. (Abad-Santos F. August 2013).

8. PSORIASIS
Oral psoriasis.
A very rare, in contrast to lichen planus, another common papulosquamous disorder
that commonly involves both the skin and mouth. When psoriasis involves the oral mucosa
(the lining of the mouth), it may be asymptomatic, but it may appear as white or grey-yellow
plaques.
Seborrheic-like psoriasis.
Common form of psoriasis with clinical aspects of psoriasis and seborrheic dermatitis,
and may be difficult to distinguish from the latter. This form of psoriasis typically manifests
as red plaques with greasy scales in areas of higher sebum production such as
the scalp, forehead, skin folds next to the nose, skin surrounding the mouth, skin on the chest
above the sternum, and in skin folds.
Psoriatic arthritis.
A form of chronic inflammatory arthritis that has a highly variable clinical
presentation and frequently occurs in association with skin and nail psoriasis. It typically
involves painful inflammation of the joints and surrounding connective tissue and can occur
in any joint, but most commonly affects the joints of the fingers and toes. (Griffiths CE
,January 2012)
This can result in a sausage-shaped swelling of the fingers and toes known
as dactylitis. Psoriatic arthritis can also affect the hips, knees, spine (spondylitis),
and sacroiliac joint (sacroiliitis). About 30% of individuals with psoriasis will develop
psoriatic arthritis. Skin manifestations of psoriasis tend to occur before arthritic
manifestations in about 75% of cases.

9. PSORIASIS
Nail changes.
Psoriasis can affect the nails and produces a variety of changes in the appearance of
finger and toe nails. (Appendix H) Nail psoriasis occurs in 40-45% of people with psoriasis
affecting the skin and has a lifetime incidence of 80-90% in those with psoriatic arthritis.
These changes include pitting of the nails (pinhead-sized depressions in the nail is
seen in 70% with nail psoriasis), whitening of the nail, small areas of bleeding from
capillaries under the nail, yellow-reddish discoloration of the nails known as the oil drop or
salmon spot, thickening of the skin under the nail (subungual hyperkeratosis), loosening and
separation of the nail (onycholysis), and crumbling of the nail.

10. PSORIASIS
Risks.
Most people with psoriasis experience nothing more than mild skin lesions that can be
treated effectively with topical therapies. Psoriasis is known to have a negative impact on
the quality of life of both the affected person and the individual's family members. Depending
on the severity and location of outbreaks, individuals may experience significant physical
discomfort and some disability. Itching and pain can interfere with basic functions, such as
self-care and sleep.(Griffiths CE ,January 2012)
Participation in sporting activities, certain occupations, and caring for family
members can become difficult activities for those with plaques located on
their hands and feet. Plaques on the scalp can be particularly embarrassing, as flaky plaque in
the hair can be mistaken for dandruff.
Individuals with psoriasis may feel self-conscious about their appearance and have a
poor self-image that stems from fear of public rejection and psychosexual concerns. Psoriasis
has been associated with low self-esteem and depression is more common among those with
the condition. People with psoriasis often feel prejudiced against due to the commonly held
incorrect belief that psoriasis is contagious.
Psychological distress can lead to significant depression and social isolation, a high
rate of thoughts about suicide has been associated with psoriasis. Many tools exist to measure
the quality of life of patients with psoriasis and other dermatological disorders. Clinical
research has indicated individuals often experience a diminished quality of life. Children with
psoriasis may encounter bullying.

11. PSORIASIS
Diseases.
Psoriasis has been associated with obesity and several other cardiovascular and
metabolic disturbances. The incidence of diabetes is 27% higher in people affected by
psoriasis than in those without the condition. Severe psoriasis may be even more strongly
associated with the development of diabetes than mild psoriasis.
Diabetes and cardiovascular diseases. Younger people with psoriasis may also be at
increased risk for developing diabetes. Individuals with psoriasis or psoriatic arthritis have a
slightly higher risk of heart disease and heart attacks when compared to the general
population. (Abad-Santos F. August 2013).
Cardiovascular disease risk appeared to be correlated with the severity of psoriasis
and its duration. There is no strong evidence to suggest that psoriasis is associated with an
increased risk of death from cardiovascular events. Methotrexate may provide a degree of
protection for the heart.
Hypertension. The odds of having hypertension are 1.58 times higher in people with
psoriasis than those without the condition. These odds are even higher with severe cases of
psoriasis. A similar association was noted in people who have psoriatic arthritis—the odds of
having hypertension were found to be 2.07 times greater when compared to odds of the
general population. (Bhushan, R.,May 2008)
The link between psoriasis and hypertension is not currently understood. Mechanisms
hypothesized to be involved in this relationship include the following: dysregulation of
the renin-angiotensin system, elevated levels of endothelin 1 in the blood, and
increased oxidative stress. The incidence of the heart rhythm abnormality atrial fibrillation is
1.31 times higher in people with mild psoriasis and 1.63 times higher in people with severe
psoriasis.

12. PSORIASIS
Stroke. There may be a slightly increased risk of stroke associated with psoriasis,
especially in severe cases. Treating high levels of cholesterol with statins has been associated
with decreased psoriasis severity, and has also been associated with improvements in other
cardiovascular disease risk factors such as markers of inflammation.
These cardio-protective effects are attributed to ability of statins to improve blood
lipid profile and because of their anti-inflammatory effects. Statin use in those with psoriasis
and hyperlipidemia was associated with decreased levels of high-sensitivity C-reactive
protein and tnfα as well as decreased activity of the immune protein LFA-1. Compared to
individuals without psoriasis, those affected by psoriasis are more likely to satisfy the criteria
for metabolic syndrome. (Abad-Santos F. August 2013).
Cancer. Psoriasis has been associated with a 16% increase in overall relative risk for
non-skin cancer. People with psoriasis have a 52% increased risk cancers of the lung and
bronchus, a 205% increase in the risk of developing cancers of the upper gastrointestinal
tract, a 31% increase in the risk of developing cancers of the urinary tract, a 90% increase in
the risk of developing liver cancer, and a 46% increase in the risk of developing pancreatic
cancer. (Bhushan, R.,May 2008)
The risk for development of non-melanoma skin cancers is also increased. Psoriasis
increases the risk of developing squamous cell carcinoma of the skin by 431% and increases
the risk of basal cell carcinoma by 100%. There is no increased risk of melanoma associated
with psoriasis.

13. PSORIASIS
Treatment.
Treatment depends on:
 How serious the disease is .
 The size of the psoriasis patches .
 The type of psoriasis .
 How the patient reacts to certain treatments.
A variety of medicines are available, such as:
 Steroid cream or ointment.
 Salicylic acid cream or ointment.
 Tar preparation (commonly ointment or shampoo).
 Anthralin cream or ointment.
 Vitamin-D-like cream or ointment (calcipotriene).
All treatments do not work the same for everyone. Your health care provider may
switch treatments if one does not work for you, if there is a bad reaction, or if the treatment
stops working. (Bhushan, R.,May 2008)
Topical Treatment.
Treatments applied right on the skin (creams, ointments) may help. These treatments
can:
 Help reduce inflammation and skin cell turnover .
 Suppress the immune system .
 Help the skin peel and unclog pores .
 Soothe the skin.

14. PSORIASIS
Light Treatment.
An effective way to decrease cell production, but depends on the type and severity of
psoriasis. Some of the different light therapy approaches are listed below, and can be
combined to increase effectiveness or decrease side effects.
Ultraviolet B (UV-B): Usually combined with one or more topical treatments. It is
extremely effective for treating moderate-to-severe plaque psoriasis. However, with
long-term use there is a risk of skin cancer, just as there is from natural sunlight.
Narrow-band Ultraviolet B: Does not require oral medications before each treat-
ment, nor is it suspected to carry as high a potential for skin cancer.
PUVA: A combination of light-sensitizing medications and ultraviolet A light, is
effective in suppressing the growth of skin cells in severe psoriasis. How-ever, long-
term use of PUVA — 250 treatments or more — may increase the risk of skin cancer.
The higher risk begins about 15 years after the first PUVA treatment.
Goeckerman Treatment: Used to treat severe psoriasis. Treatment involves daily
ultraviolet light exposure and application of a tar over the whole body. Treatment
takes place over approximately three weeks.
Exposure to Natural Sunlight: Many people with psoriasis have found natural
sunlight exposure helps clear their skin. Precautions need to be taken to avoid sun-
burn.

15. PSORIASIS
Prevention follow.
Psoriasis may not cured at once. Thus people need to follow step advise by medical
officer. The problem faced by psoriasis people is being understand and they also need to
follow the advise from the more expert. (Mark Dahl, 2008)
To help reduce flare-ups:
• Avoid skin injury and skin infections.
• Avoid stress.
• Exercise daily according to your health care provider's recommendation and
maintain a normal weight.
• Avoid excessive alcohol.
• Follow your provider's recommendations for keeping your skin soft. Ask
your provider to suggest soaps, lotions, and cosmetics.
Because the cause of psoriasis is not known, it is not yet possible to prevent it.
However, you may be able to prevent serious outbreaks by treating small plaques when you
first see them. Follow your health care provider's instructions for treatment. You worth your
life as normal people.

16. PSORIASIS
Conclusion
Psoriasis is estimated to affect 2-4% of the population of the western world. The rate
of psoriasis varies according to age, gender, region and ethnicity; a combination of
environmental and genetic factors is thought to be responsible for these differences. It can
occur at any age, although it most commonly appears for the first time between the ages of 15
and 25 years. (Mark Dahl, 2008)
Approximately one third of psoriasis patients report being diagnosed before age 20.
Psoriasis affects both sexes equally. People with inflammatory bowel disease such as Crohn's
disease or ulcerative colitis are at an increased risk of developing psoriasis. Psoriasis is more
common in countries farther from the equator. Persons of white European ancestry are more
likely to have psoriasis and the condition is relatively uncommon in African Americans and
extremely uncommon in Native Americans.
Health care providers are encouraged to actively seek signs and symptoms of psoriatic
arthritis at each visit. Topical treatment alone is used when the psoriasis is localized
Topical medications for psoriasis are more effective when used with occlusion, which allows
for better penetration. Patients with moderate to severe disease often require systemic
treatment in addition to topical therapy. (Mark Dahl, 2008)
Oral steroids should never be used in psoriasis. Systemic treatment includes
phototherapy, oral medications and biologic agents. A successful treatment plan should
include patient education as well as provider awareness of the patient’s experience. Psoriasis
is a lifelong disease and can affect all aspects of a patient’s quality of life

17. PSORIASIS
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18. PSORIASIS
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19. PSORIASIS
Appendix A

20. PSORIASIS
Appendix B

21. PSORIASIS
Appendix C

22. PSORIASIS
Appendix D

23. PSORIASIS
Appendix E

24. PSORIASIS
Appendix F

25. PSORIASIS
Appendix G

26. PSORIASIS
Appendix H