More Related Content
What's hot
What's hot (20)
Similar to Psoriasis
Similar to Psoriasis (20)
More from Dr ABU SURAIH SAKHRI
More from Dr ABU SURAIH SAKHRI (20)
Recently uploaded
Recently uploaded (20)
Psoriasis
- 1. PSOARIASIS
- 2. Definition • Inflammatory & Proliferative disease • Well defined , red , scaly plaques • Extensor prominences & scalp • Genetic & Environmental • Variable duration
- 3. Epidemiology Prevalence 1.5 – 3 % Incidence 60 / 100000 in an year Seasonal variation 68% winter Morphological variants 10% Age of onset – bimodal Two peaks – 16-22 & 57-60 Sex – equal in males &females
- 4. Aetiology • GENETIC & ENVIRONMENTAL • More in 1st & 2nd degree relatives • 64% monozygotic twins • 15% dizygotic twins • 41% both parent • 14% one parent • 02% no parent
- 5. Genetic………… • Type-1 • Hereditary • HLA CW6 • Early onset • Severe • Type-2 • Sporadic • No HLA • Late onset • Mild
- 6. Environmental • Trauma - koebner & reverse koebner • Infection - strepto , HIV • Drugs - beta blockers , NSAIDS , lithium , chloroquin , withdrawal of steroid • Metabolic - hypocalcemia , pregnancy • Psychogenic , alcohol , smoking and AIDS • Winter and Sunlight
- 7. Pathogenic mechanism • Epidermal hyper proliferation • Dilatation & proliferation of dermal b.v • Accumulation of inflammatory cells esp neutrophils & T lymphocytes
- 8. Chronic plaque psoriasis • Well defined , red , dry , scaly , plaques • Scales - abundant , loose , silvery-white • Woronoffs ring – hypopigmented halo • Auspitz sign - multiple , minute , bleeding points – Grattage • Koebner phenomenon - 7-14 days
- 14. Guttate psoriasis • Children & young adults • Acute streptococcal infection • Multiple, round to oval, 2 mm 1 cm • Trunk & proximal limbs • Good prognosis
- 16. Erythrodermic psoriasis • Erythema & scaling > 90 % BSA • Sudden withdrawal steroid, local irritant • Cutaneous vasodilatation heat loss • Hyperpyrexia and increased BMR • Loss of protein, iron, vit B12, folate • Anaemia , hypocalcemia , hypoalbuminemia • Dermatogenic enteropathy • Dermopathic lymphadenitis
- 18. Psoriasis unguis • 25 - 50 % cases • Pitting • Discoloration • Subungual hyperkeratosis • Onycholysis • Splinter haemorrhage • Oil drop sign
- 19. Pustular psoriasis • Localised & Generalised • Localised pustular psoriasis Palmoplantar pustulosis Acrodermatitis continua
- 20. Palmoplantar pustulosis • Chronic condition • Red , scaly plaques • Studded with sterile pustules • Palms & soles • Thenar , hypothenar eminence • Instep , medial & lateral border
- 22. Acrodermatitis continua • Chronic , sterile , pustular eruption • Tips of fingers & toes • Common in children • Red scaly plaque studded with pustules • Nail dystrophy • Osteolysis of distal phalanx
- 23. Generalised pustular psoriasis • Acute GPP • GPP of pregnancy • Infantile & juvenile GPP • Annular & linear GPP • Psoriasis with pustule
- 25. Acute generalised pustular • HLA B27 • Most severe GPP • Sudden onset • High fever , malaise , joint pain • Multiple , erythematous patches • Tiny superficial , sterile pustules
- 26. GPP of Pregnancy • Last trimester of pregnancy • Starts in flexures • Symmetrical & grouped • Severe constitutional symptoms • Still birth, neonatal death • Recurrence common
- 27. Infantile & juvenile GPP • 25 % onset in 1st year • More in males • Usually benign • Spontaneous remission • Juvenile – onset 2 -10 years
- 28. Annular GPP • Subacute or chronic • Systemic symptoms absent • Red scaly annular plaque • Pustules at the periphery
- 29. Localised form of GPP ●Psoriasis with pustules ●Unstable psoriasis ●Tiny superficial pustules ●In & around psoriatic plaque
- 30. Psoriatic arthritis • Oligoarticular arthritis • Classical psoriatic arthritis • Rheumatoid type • Arthritis mutilans • Axial arthritis
- 31. Psoriatic arthritis • Seronegative inflammatory arthritis • Rheumatoid factor negative • HLA B27,CW6 ,B13 ,B17 ,DR3 • 65 % cases skin lesion precede arthritis • 19 % cases arthritis precede • 16 % cases both together
- 33. Differential diagnosis • Seborrheic dermatitis • Eczema - legs & hands • Lichen simplex chronicus • Candidiasis & tinea • Pityriasis rubra pilaris • Syphilis & drug eruptions
- 36. Candidiasis
- 37. Tinea
- 39. Treatment • Topical • Systemic • others
- 40. Topical • Emollients • Corticosteroid • Coal tar • Dithranol • Calcipotriol • Topical photochemotherapy • Tazarotene
- 41. systemic • Methotrexate • Phototherapy • Retinoids • Cyclosporin • Hydroxyurea • biologicals
- 42. Others • Excimer laser • Photodynamic therapy
- 43. Coal tar • Antimitotic / antiproliferative • Stable , scalp , palmoplantar • Crude coal tar , liquor picis carbonis • Folliculitis , acne , phototoxicity • ACD , ICD ,carcinogenicity
- 44. Dithranol • Anti inflammatory , antiproliferative • Stable plaque psoriasis • Palmoplantar • Erythema , irritation • Staining of cloth
- 45. calcipotriol • Synthetic analogue 1-25 dihydroxy cholecalciferol • Stable plaque psoriasis • Max wkly application 100g • Skin irritation hypercalcemia
- 46. Topical corticosteroid • Scalp,face,neck,flexures,genitalia • Palms & soles • Limited plaque psoriasis
- 47. Side effects • Skin atrophy,striae • Telangiectasia • Hypertrichosis • Hypopigmentation • Glaucoma • Tachyphylaxis • Pituitary adrenal suppression
- 48. Topical PUVA • Palmoplantar psoriasis • Palmoplantar pustular psoriasis • Localised recalcitrant • Nail psoriasis • Oral PUVA cotraindicated • Side effects - phototoxicity ,ocular ,skin cancers
- 49. tazarotene • Topical retinoid • 0.05 – 0.1 % • Pruritus , burning , erythema , desquamation , contact dermatitis
- 50. Methotrexate • Antiproliferative – inhibit DHFR • Immunosuppressant • Anti inflammatory
- 51. Indication • Erythrodermic psoriasis • Psoriatic arthritis • Pustular psoriasis • Psoriasis adversely affect ability maintain employment • Extensive plaque psoriasis >20% BSA • No response to phototherapy / retinoids
- 52. contraindication • Pregnancy & lactation • Renal dysfunction • Abnormal liver function • Reproductive age gp • Excessive alcohol consumption • Hematological disease • Active peptic ulcer
- 53. Adverse effects • BM suppression • Hepatotoxicity • GIT- ulcerative stomatitis • Pulmonary – pneumonitis ,fibrosis • Teratogen ,abortifacient • Cutaneous – ulceration , alopecia ,painful erosion of psoriatic plaque • MTX osteopathy –pain ,osteoporosis and compression fracture tibia
- 54. Oral retinoids • Acitretin , etretinate • Pustular , erythrodermic ,severe plaque • Side effects – mucocutaneous, ocular, teratogenic ,hyperlipidemia,elevated liver enzymes , depression , pseudo tumor cerebri ,musculoskeletal
- 55. phototherapy • Narrow band UVB • PUVA –Psoralen + UVA • Re PUVA –retinoid + PUVA
- 56. Biological therapy • Antibodies , fusion proteins • Etanercept – Pso arthritis • Infliximab – blocks TNF - alpha • Alefacept – first therapy • Efalizumab , adalimumab • Opp infection ,lymphoproliferative diseases,SCC ,high cost
- 57. THANK YOU