My conference in 4th year- dermatology department

1. In the name of
TRUTH

2. PSORIASIS
The Non Infectious, Chronic, Inflammatory, common
“Itching Condition”
Afzalipoor university of medical sciences
dermatology department

3. What is psoriasis?
• Named for the Greek word psōra meaning "itch“
• It is characterized by well defined Erythematous
plaques and inflamed lesions with
large, adherent, silvery-white scales( red, scaly skin
plaques.)

8. What is psoriasis?
• Named for the Greek word psōra meaning "itch“
• It is characterized by well defined Erythematous plaques
and inflamed lesions with large, adherent, silvery-white
scales( red, scaly skin patches.)
• Psoriasis is an T-cell mediated, non contagious skin
disorder. It is a mistake of immune system that makes
faulty signal which leads to overproduction of skin cell.
• no known cause.
• controllable but not curable.
• Psoriasis commonly affects the skin of the
elbows, knees, and scalp.

9. Epidemiology
• Prevalence: 1-3%
• M=F
• Although psoriasis can be seen in people of
any age, from babies to seniors, most
commonly patients are first diagnosed in their
early adult years.
• picked age of incidence is late second decade
of life and late 40s.

10. What Causes Psoriasis?
• The exact cause of psoriasis remains
unknown. There may be a combination of risk
factors, including genetic predisposition and
environmental factors. It is common for
psoriasis to be found in members of the same
family.

11. Difference Between normal Skin
Psoriasis Skin

12. Common Trigger Factors For Psoriasis
•
•
•
•
•
•
•
•
•
Infections (e.g. streptococcal, viral(HIV), candida)
Skin trauma (Koebner phenomenon)
Psychological stress
Drugs (e.g. lithium, beta
blockers, antimalarial, stopping usage of
corticosteroids)
Sunburn
winter
Metabolic factors (e.g. calcium deficiency)
Hormonal factors (e.g. pregnancy)
Smoking & Taking AlcoholDrinking

13. symptomes
Scaling
94
Itching
79
Skin redness
71
Tightness of skin
31
Bleeding
29
Burning sensation
21
Fatigue
19
Other
5
0
20
40
60
80
100

14. types
•
•
•
•
•
•
Plaque (Most Popular)
Guttate
Flexural (Inverse)
Pustular
Erythrodermic
Others Like Nail, Palm, Scalp

15. 1-Plaque Psoriasis(psoriasis vulgaris)
• Most common type
• Features pink, well-defined plaques with
silvery scale
• Lesions may be single or numerous
• Classically affects elbows, knees, trunk and
scalps.(nail?)
• Characteristic features: dark red(uncontroled lesions)
– Auspitz sign

18. 2-Guttate Psoriasis
• Numerous and small lesions – ~ 1 cm diameter
• Monomorphic, pink plaque. Usually there is a fine
scale on the droplike lesion that is much finer than
the scales in plaque psoriasis
• Commonly found on trunk and proximal limbs
• Often preceded by an pharyngitis streptococcal
infection, viral infection and stopping usage of
systemic corticosteroids(less common).

21. 3-Flexural Psoriasis(inverse)
• bright red, smooth (not scaly) patches found in the
folds of the skin.
• The most common areas are gluteal cleft, axillae and
submammary regions.
• May cause diagnostic difficulty when genital or
perianal region is affected in isolation
• Associated with candida infection.

24. 4- Pustular Psoriasis
• Two forms: localised – generalised
• LOCALISED:
 More common form. and nail involvement is common.
 Presents as deep-seated lesions with multiple small pustules
on palms and soles-- they become dark brown and mostly
painfull.
 Relative to usage of tobacco and cigarette.
• Generalised:
 Uncommon but very severe.
 Associated with fever, malaise , tenderness and also drugs.
 widespread pustules across inflamed body surface

27. 5- Erythrodermic psoriasis
• the least common but severe.
• Generalised erythema covering entire skin surface
• May evolve slowly from chronic plaque psoriasis or
appear as eruptive phenomenon.
• Patients may become febrile, hypo/hyperthermic and
dehydrated plus shaking and skin pain.
• Can be associated with drugs.
• Complications include cardiac
failure, infections, malabsorption and anaemia.

29. Nail Psoriasis
• Can take several forms:
 Pitting: discrete, well-circumscribed depressions on nail
surface
 Subungual hyperkeratosis: silvery white crusting under
free edge of nail with some thickening of nail plate
 Onycholysis: nail separates from nail bed at free edge
 ‘Oil-drop sign’: pink/red colour change on nail surface

30. pitting

31. Oil drop - deformity

32. il drop

33. Onychlysis- deformity

34. onycholysis

36. Scalp Psoriasis
• The scalp may have fine, dry, scaly skin or have
heavily crusted plaque areas (thick hyperkeratotic
plaques)
• May extend beyond hairline
• Sometimes psoriasis of the scalp is confused with
seborrheic dermatitis. A key difference is that in
seborrheic dermatitis, the scales are greasy
looking, not dry.

38. Psoriatic Arthritis
• RF Negative.
• Psoriatic arthritis is a specific condition in which a
person has both psoriasis and arthritis. Psoriatic
arthritis is an autoimmune disease.
1. Symmetric oligoarticular 70%
2. Spondylitis 20%
3. Distal interphalangeal 10%
4. Mutilan 5%

39. Laboratory findings:
• Acantosis
• Hyperkeratosis
• hypergranulosis
• Monro microabccess
+ HIV assessment/ anti streptolysin O/
KOH test

40. Differential diagnosis
•
•
•
•
Dermatitis seborrheic
Dyshidrotic eczema(hands and feet)
Tinea
Pityriasis rosea

41. Treatments:
• Topical therapy
• Phototherapy
• Systemic therapy

42. topical
•
•
•
•
•
•
•
Coal tar
Corticosteroids (I-V)
Calcipotrience
Anthralin(drithocreme)
Tazarotene(tazorac)
Salicylic acid
Bath solution

43. phototherapy
• UVB photo therapy
• PUVA (ultraviolet A) (psoralen+UVA)

44. systemic
•
•
•
•
Methotrexate
Cyclosporine
Acitretin
Biologic drugs(immune moderator)
 Etanercept
 Adalimumab
 Infliximab
 Alefacept
 ustekinumab