This document summarizes information about psoriasis, including its epidemiology, genetics, clinical presentations, pathogenesis, and relationship to cardiovascular disease risk factors. Some key points:
- Psoriasis prevalence varies globally, from 0.05-4.7% depending on the population. Genetic factors play a role in its development and susceptibility loci have been identified.
- Clinical presentations include plaque, guttate, pustular, erythrodermic, and nail psoriasis. Psoriatic arthritis affects 5-8% of patients.
- Psoriasis is considered a T-cell mediated immune disease involving Th1 and Th17 responses and inflammatory cytokines like TNF-
Psoriasis is a chronic, inflammatory skin condition characterized by red scaly patches that is genetically determined. It has various clinical types including plaque, guttate, pustular and erythrodermic psoriasis. Treatment involves topical therapies like emollients, dithranol and topical steroids. For moderate to severe cases, phototherapy using PUVA or systemic therapies like methotrexate are used. Management in health posts focuses initially on topical therapies with referral for extensive or pustular psoriasis requiring further treatment.
The document discusses psoriasis, including its epidemiology, pathophysiology, clinical presentations, diagnosis, differential diagnosis, and management. Psoriasis is a chronic, inflammatory skin condition characterized by red scaly plaques. It has a genetic component and can be triggered by various environmental factors. Clinical diagnosis is usually based on appearance of lesions. Topical therapies are first-line treatment for mild-moderate disease, while phototherapy and systemic therapies may be used for more severe cases. Proper management requires a tailored approach based on individual disease characteristics and goals of improving quality of life and long-term disease control.
Seborrheic dermatitis (SD) is a common chronic skin condition characterized by redness and scaling in areas with many sebaceous glands like the face, scalp, and skin folds. It causes mild flaking of the scalp known as dandruff. Lesions can be itchy or painful and look deep red or purple with pimple-like bumps or blisters. Treatment involves topical anti-fungal creams, steroid creams, or oral anti-fungal medication for deep infections.
This document discusses psoriasis, including its epidemiology, pathogenesis, clinical features, diagnosis, and treatment. Psoriasis is a chronic inflammatory skin condition that causes red, scaly plaques and affects the skin and joints. It occurs equally in both sexes and most commonly appears for the first time between ages 15-25. The pathogenesis involves hyperproliferation of skin cells and an immune response characterized by inflammatory cells in the skin. Diagnosis is usually based on appearance, and biopsy may be used to confirm. Treatment includes topical therapies like steroids, vitamin D analogues, and UVB, as well as systemic therapies like PUVA, methotrexate, ciclosporin,
This document discusses psoriasis, presenting objectives to discuss its introduction, describe its aetiology, classify its types, and diagnose it. Psoriasis is an inflammatory skin disease causing rapid skin cell growth, forming thick patches of red sores and scales. It has various types including plaque, guttate, inverse and pustular psoriasis. While its exact cause is unknown, genetics and environmental triggers are believed to play a role. Diagnosis is usually based on visual inspection, and may include a skin biopsy.
Eczema, also known as dermatitis, is a common skin condition affecting 20% of patients referred to clinics. It is characterized by redness, swelling, blistering, crusting, and flaking in areas with poorly defined borders. Histologically, eczema shows inflammation of the epidermis and dermis. The causes include allergic and irritant contact dermatitis. Treatment depends on the severity and includes emollients, topical corticosteroids, wet wrap dressings, systemic antibiotics, and avoidance of exacerbating factors. Atopic eczema, the most common form, has a genetic component and usually starts in childhood.
This case involves a 25-year-old woman who presented to the emergency department with shortness of breath and an expanding rash. She has a history of asthma and allergies to aspirin and shellfish. On exam, she was tachypnic, hypertensive, and had periorbital edema and scattered wheals. Her symptoms and history are concerning for anaphylaxis.
Sandhigata Vata is the type of pathogenesis involved in various disease conditions affecting the joints, e.g. osteoarthritis, rheumatoid arthritis, etc. and causing pain in affected joints.
Psoriasis is a chronic, inflammatory skin condition characterized by red scaly patches that is genetically determined. It has various clinical types including plaque, guttate, pustular and erythrodermic psoriasis. Treatment involves topical therapies like emollients, dithranol and topical steroids. For moderate to severe cases, phototherapy using PUVA or systemic therapies like methotrexate are used. Management in health posts focuses initially on topical therapies with referral for extensive or pustular psoriasis requiring further treatment.
The document discusses psoriasis, including its epidemiology, pathophysiology, clinical presentations, diagnosis, differential diagnosis, and management. Psoriasis is a chronic, inflammatory skin condition characterized by red scaly plaques. It has a genetic component and can be triggered by various environmental factors. Clinical diagnosis is usually based on appearance of lesions. Topical therapies are first-line treatment for mild-moderate disease, while phototherapy and systemic therapies may be used for more severe cases. Proper management requires a tailored approach based on individual disease characteristics and goals of improving quality of life and long-term disease control.
Seborrheic dermatitis (SD) is a common chronic skin condition characterized by redness and scaling in areas with many sebaceous glands like the face, scalp, and skin folds. It causes mild flaking of the scalp known as dandruff. Lesions can be itchy or painful and look deep red or purple with pimple-like bumps or blisters. Treatment involves topical anti-fungal creams, steroid creams, or oral anti-fungal medication for deep infections.
This document discusses psoriasis, including its epidemiology, pathogenesis, clinical features, diagnosis, and treatment. Psoriasis is a chronic inflammatory skin condition that causes red, scaly plaques and affects the skin and joints. It occurs equally in both sexes and most commonly appears for the first time between ages 15-25. The pathogenesis involves hyperproliferation of skin cells and an immune response characterized by inflammatory cells in the skin. Diagnosis is usually based on appearance, and biopsy may be used to confirm. Treatment includes topical therapies like steroids, vitamin D analogues, and UVB, as well as systemic therapies like PUVA, methotrexate, ciclosporin,
This document discusses psoriasis, presenting objectives to discuss its introduction, describe its aetiology, classify its types, and diagnose it. Psoriasis is an inflammatory skin disease causing rapid skin cell growth, forming thick patches of red sores and scales. It has various types including plaque, guttate, inverse and pustular psoriasis. While its exact cause is unknown, genetics and environmental triggers are believed to play a role. Diagnosis is usually based on visual inspection, and may include a skin biopsy.
Eczema, also known as dermatitis, is a common skin condition affecting 20% of patients referred to clinics. It is characterized by redness, swelling, blistering, crusting, and flaking in areas with poorly defined borders. Histologically, eczema shows inflammation of the epidermis and dermis. The causes include allergic and irritant contact dermatitis. Treatment depends on the severity and includes emollients, topical corticosteroids, wet wrap dressings, systemic antibiotics, and avoidance of exacerbating factors. Atopic eczema, the most common form, has a genetic component and usually starts in childhood.
This case involves a 25-year-old woman who presented to the emergency department with shortness of breath and an expanding rash. She has a history of asthma and allergies to aspirin and shellfish. On exam, she was tachypnic, hypertensive, and had periorbital edema and scattered wheals. Her symptoms and history are concerning for anaphylaxis.
Sandhigata Vata is the type of pathogenesis involved in various disease conditions affecting the joints, e.g. osteoarthritis, rheumatoid arthritis, etc. and causing pain in affected joints.
Case presentation in Dermatology erythrodermic psoriasisraheef
- Ahmad, a 50-year-old male, presented with generalized redness and scaling of his skin that began 3 days prior. He had a history of plaque psoriasis 5 years earlier.
- On examination, he had widespread erythema and thick scaling affecting over 90% of his skin surface, thick scaling of his scalp, and nail dystrophy.
- He was diagnosed with erythrodermic psoriasis based on his history of psoriasis, presentation of widespread redness and scaling, and physical examination findings. Erythrodermic psoriasis is a potentially life-threatening exacerbation of psoriasis involving over 90% of the skin surface.
Balanoposthitis is inflammation of the glans penis and foreskin in uncircumcised males. It is commonly caused by infections, particularly Candida albicans or other fungi. Other causes include viruses like HSV, bacteria like Gardnerella vaginalis, irritants, trauma, fixed drug eruptions, premalignant conditions, and various cutaneous and mucocutaneous diseases. Symptoms include papules, pustules, vesicles, erosions, edema, phimosis, and foul discharge. Diagnosis involves examination, tests like KOH mounts or cultures, and biopsies. Treatment involves hygiene, antibiotics, antifungals, corticosteroids, circumcision for severe
This document discusses different conditions affecting the nails including paronychia, acute paronychia, chronic paronychia, and subungual hematoma. It describes the anatomy of the nail including the nail plate, matrix, lunula, cuticle, and nail bed. Acute paronychia is usually caused by minor nail injuries allowing bacterial infection, while chronic paronychia is often due to Candida infection. Treatment involves draining pus or blood and using antibiotics or antifungals. Subungual hematoma causes intense pain due to blood collecting under the nail requiring drainage through cautery or needle.
This document discusses Yapana Basti, a type of Panchakarma treatment. It defines Yapana Basti, explains its properties and benefits, lists its indications and contraindications. It also describes the proper administration and management of Yapana Basti, as well as potential complications. Additionally, it provides overviews of two related treatments - Yuktarata Basti and Siddha Basti.
Pityriasis rosea is a common, self-limiting skin rash characterized by oval lesions on the trunk and extremities. It is likely caused by a virus such as human herpesvirus-6 or -7. The rash begins with a single large 'herald patch' and spreads within 2-6 weeks. While usually resolving within 3 months, it causes moderate to severe itching. Treatment focuses on relieving itching with topical corticosteroids or antihistamines, with antivirals or phototherapy used in severe cases.
Warts are benign skin growths caused by human papillomavirus (HPV) infection. They commonly appear on hands and feet. There are several types of warts including common, plantar, flat, and filiform warts which vary in appearance and location on the body. Warts can be diagnosed through visual examination and may require a biopsy for confirmation. Treatment options chosen by dermatologists depend on the patient and wart type, and may include salicylic acid, cryotherapy, laser therapy, or immunotherapy. While warts often resolve on their own in children, treatment aims to remove warts that are painful, numerous or spreading. Self-care involves over-the-counter salicylic acid while seeing
This document describes various head massage and oil application techniques used in Ayurveda. It defines murdhni taila/murdha taila as applying oil to the head. It lists the main techniques as: shiro abhyanga (head massage with oil), shiro seka (pouring medicated liquids on the head), shiro pichu (applying a cloth soaked in oil to the head), and shiro basti (retaining oil on the scalp for a period of time). For each technique, it provides details on indications, contraindications, procedures, and therapeutic effects.
Psoriasis is a chronic inflammatory skin condition that causes red scaly patches, most commonly on the elbows, knees, scalp and back. It occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells. There are several types of psoriasis including plaque, guttate, inverse and pustular. It is caused by a combination of genetic and environmental factors and can be triggered by stress, skin injury and certain medications. Treatment depends on the severity but may include topical creams and ointments, phototherapy and systemic drugs.
Scabies is a skin infection caused by the Sarcoptes scabiei mite. It causes an itchy rash and affects nearly 130 million people worldwide, with prevalence rates in India ranging from 13-59% in rural and urban areas respectively. Scabies presents as itchy papules and vesicles located typically on hands, wrists, feet, and genitalia. It can develop into more severe forms like nodular or crusted scabies in immunocompromised individuals. Treatment involves topical scabicides like permethrin or oral ivermectin. Proper hygiene and avoiding shared items can help prevent transmission.
Vitiligo is a hypopigmentation disorder characterized by depigmented patches on the skin. It is caused by a loss of melanocytes in the affected areas. There are several proposed mechanisms including genetic predisposition, autoimmune attack on melanocytes, and neural mechanisms. Clinically, it presents as well-circumscribed milky white macules that may coalesce. Treatment involves phototherapy with PUVA or narrowband UVB, topical corticosteroids for localized lesions, and systemic corticosteroids for more widespread or rapidly progressive disease. Surgical interventions like melanocyte transplantation can be used for sites resistant to medical therapy.
The document describes 11 subtypes of Kshudra Kushtha skin disease in Ayurveda: Ek-kushtha, Charmakhya, Kitibh, Vipaadika, Alasak, Dadru, Charmadal, Paama, Visphotak, Shataaru, and Vicharchika. Each subtype is defined by its characteristic symptoms and signs, and by the doshas (Vata, Pitta, or Kapha) that are vitiated or aggravated in that subtype.
This document discusses a common skin disorder characterized by keratinous plugs in hair follicles. It typically appears in childhood and adolescence on the extensor surfaces. The lesions appear as small gray or white plugs that obstruct hair follicles. Treatments include moisturizers and keratolytic agents. The document also discusses palmoplantar keratoderma, a thickening of the palms and soles that can be inherited or acquired, and presents in three patterns: diffuse, focal, or punctate. Complications can include pain, difficulty walking, and infection.
The document provides details on various types of Kshudra Kusthas (minor skin diseases) described in Ayurveda and compares them to modern skin diseases. It describes 7 types of Kshudra Kusthas - Eka Kushta, Charmakyam, Kitibha Kushta, Vipadika, Alasaka, Dadru Mandala, and Charmadala. For each, it provides the dosha involvement, signs and symptoms. It then compares each to similar modern skin conditions such as psoriasis, scleroderma, tenia infections, herpes, impetigo, and provides details on symptoms and characteristics.
Psoriasis is a chronic inflammatory skin disease that causes red scaly patches to appear on the skin. It occurs when skin cells multiply up to 10 times faster than normal. The two main types are plaque psoriasis, which causes raised, red patches covered with silvery scales, and guttate psoriasis, which appears as numerous small spots. Psoriasis has no cure but can be managed with topical creams and ointments, phototherapy, or systemic medications.
Erythroderma is defined as the scaling erythematous dermatitis involving 90% or more of the cutaneous surface.
Also known as exfoliative dermatitis
Idiopathic exfoliative dermatitis – also known as the “red man syndrome”, is characterized by marked palmoplantar keratoderma, dermatopathic lymphadenopathy,increased IgE.
Increased skin perfusion leads to
Temperature dysregulation >
Resulting in skin loss and hypothermia >
High output state >
Cardiac failure
BMR raises to compensate for heat loss
Increased dehydration due to transpiration (similar to burns)
All lead to negative nitrogen balance and characterized by edema, hypoalbuminemia, loss of muscle mass.
Psoriasis is a chronic inflammatory skin disease characterized by red, scaly plaques. Ayurvedic management includes external therapies like oils and pastes, panchakarma procedures like snehana and swedana to clear doshas, and internal herbal formulations to address underlying imbalances and support tissue regeneration. Treatment protocols are tailored based on disease severity, duration and site of involvement, with mild cases treated initially with external applications and lifestyle changes, while more severe or longstanding psoriasis may require deeper panchakarma and herbal rasayana. The overall goals are to relieve symptoms, prevent relapse, and improve quality of life through a holistic approach addressing both medical and psychological aspects.
1. The document is a presentation on Shwitra (vitiligo) by Dr. Akshay Shetty that defines the condition and discusses its synonyms, causes, types, symptoms, and treatability.
2. It classifies Shwitra into three types based on dosha involvement and stage of the disease. Symptoms vary in color depending on the dhatu affected.
3. Shwitra with coalesced patches, red hair above patches, or a duration over one year are considered not curable, while those with pale thin skin and elevated patches between less than one year may be treatable.
The document discusses Nadivrana or sinus. It defines it as a track formed due to collection of pus from an untreated wound or inflammation that bursts through deep tissues. It describes 5 types based on dosha involvement. Clinical features, treatment and management are explained for each type. Special conditions like involvement of marma or weak patients are also covered. Ksharasutra application is described as an alternative to surgery in some cases. Varti therapy is also mentioned for sinus wound management. In conclusion, a sinus is defined as a chronic non-healing discharging track and fistula is defined as when the track connects two epithelial surfaces.
Lichen planus is a chronic inflammatory skin condition that causes itchy, purple-colored papules and plaques. It is thought to be an autoimmune reaction targeting skin cells. The lesions typically appear on the wrists, legs, and oral mucosa. On microscopy, distinctive saw-tooth shaped keratinocytes (Civatte bodies) and band-like inflammatory infiltrate are seen. Treatment involves topical corticosteroids and immunomodulators. While usually self-limiting, lichen planus can lead to scarring and has a small risk of malignant transformation, especially in oral lesions.
Lichen planus is a chronic autoimmune disease that affects the skin and mucous membranes. It is characterized by pruritic polygonal papules and plaques that are flat topped and violaceous. The disease commonly affects middle aged women more than men. Oral lichen planus presents as white lacy lesions inside the mouth, while skin lesions typically occur on the wrists and legs. Treatment focuses on reducing symptoms through topical corticosteroids and immunosuppressants. While usually self-limiting, oral lichen planus poses a small risk of malignant transformation over the long term.
Case presentation in Dermatology erythrodermic psoriasisraheef
- Ahmad, a 50-year-old male, presented with generalized redness and scaling of his skin that began 3 days prior. He had a history of plaque psoriasis 5 years earlier.
- On examination, he had widespread erythema and thick scaling affecting over 90% of his skin surface, thick scaling of his scalp, and nail dystrophy.
- He was diagnosed with erythrodermic psoriasis based on his history of psoriasis, presentation of widespread redness and scaling, and physical examination findings. Erythrodermic psoriasis is a potentially life-threatening exacerbation of psoriasis involving over 90% of the skin surface.
Balanoposthitis is inflammation of the glans penis and foreskin in uncircumcised males. It is commonly caused by infections, particularly Candida albicans or other fungi. Other causes include viruses like HSV, bacteria like Gardnerella vaginalis, irritants, trauma, fixed drug eruptions, premalignant conditions, and various cutaneous and mucocutaneous diseases. Symptoms include papules, pustules, vesicles, erosions, edema, phimosis, and foul discharge. Diagnosis involves examination, tests like KOH mounts or cultures, and biopsies. Treatment involves hygiene, antibiotics, antifungals, corticosteroids, circumcision for severe
This document discusses different conditions affecting the nails including paronychia, acute paronychia, chronic paronychia, and subungual hematoma. It describes the anatomy of the nail including the nail plate, matrix, lunula, cuticle, and nail bed. Acute paronychia is usually caused by minor nail injuries allowing bacterial infection, while chronic paronychia is often due to Candida infection. Treatment involves draining pus or blood and using antibiotics or antifungals. Subungual hematoma causes intense pain due to blood collecting under the nail requiring drainage through cautery or needle.
This document discusses Yapana Basti, a type of Panchakarma treatment. It defines Yapana Basti, explains its properties and benefits, lists its indications and contraindications. It also describes the proper administration and management of Yapana Basti, as well as potential complications. Additionally, it provides overviews of two related treatments - Yuktarata Basti and Siddha Basti.
Pityriasis rosea is a common, self-limiting skin rash characterized by oval lesions on the trunk and extremities. It is likely caused by a virus such as human herpesvirus-6 or -7. The rash begins with a single large 'herald patch' and spreads within 2-6 weeks. While usually resolving within 3 months, it causes moderate to severe itching. Treatment focuses on relieving itching with topical corticosteroids or antihistamines, with antivirals or phototherapy used in severe cases.
Warts are benign skin growths caused by human papillomavirus (HPV) infection. They commonly appear on hands and feet. There are several types of warts including common, plantar, flat, and filiform warts which vary in appearance and location on the body. Warts can be diagnosed through visual examination and may require a biopsy for confirmation. Treatment options chosen by dermatologists depend on the patient and wart type, and may include salicylic acid, cryotherapy, laser therapy, or immunotherapy. While warts often resolve on their own in children, treatment aims to remove warts that are painful, numerous or spreading. Self-care involves over-the-counter salicylic acid while seeing
This document describes various head massage and oil application techniques used in Ayurveda. It defines murdhni taila/murdha taila as applying oil to the head. It lists the main techniques as: shiro abhyanga (head massage with oil), shiro seka (pouring medicated liquids on the head), shiro pichu (applying a cloth soaked in oil to the head), and shiro basti (retaining oil on the scalp for a period of time). For each technique, it provides details on indications, contraindications, procedures, and therapeutic effects.
Psoriasis is a chronic inflammatory skin condition that causes red scaly patches, most commonly on the elbows, knees, scalp and back. It occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells. There are several types of psoriasis including plaque, guttate, inverse and pustular. It is caused by a combination of genetic and environmental factors and can be triggered by stress, skin injury and certain medications. Treatment depends on the severity but may include topical creams and ointments, phototherapy and systemic drugs.
Scabies is a skin infection caused by the Sarcoptes scabiei mite. It causes an itchy rash and affects nearly 130 million people worldwide, with prevalence rates in India ranging from 13-59% in rural and urban areas respectively. Scabies presents as itchy papules and vesicles located typically on hands, wrists, feet, and genitalia. It can develop into more severe forms like nodular or crusted scabies in immunocompromised individuals. Treatment involves topical scabicides like permethrin or oral ivermectin. Proper hygiene and avoiding shared items can help prevent transmission.
Vitiligo is a hypopigmentation disorder characterized by depigmented patches on the skin. It is caused by a loss of melanocytes in the affected areas. There are several proposed mechanisms including genetic predisposition, autoimmune attack on melanocytes, and neural mechanisms. Clinically, it presents as well-circumscribed milky white macules that may coalesce. Treatment involves phototherapy with PUVA or narrowband UVB, topical corticosteroids for localized lesions, and systemic corticosteroids for more widespread or rapidly progressive disease. Surgical interventions like melanocyte transplantation can be used for sites resistant to medical therapy.
The document describes 11 subtypes of Kshudra Kushtha skin disease in Ayurveda: Ek-kushtha, Charmakhya, Kitibh, Vipaadika, Alasak, Dadru, Charmadal, Paama, Visphotak, Shataaru, and Vicharchika. Each subtype is defined by its characteristic symptoms and signs, and by the doshas (Vata, Pitta, or Kapha) that are vitiated or aggravated in that subtype.
This document discusses a common skin disorder characterized by keratinous plugs in hair follicles. It typically appears in childhood and adolescence on the extensor surfaces. The lesions appear as small gray or white plugs that obstruct hair follicles. Treatments include moisturizers and keratolytic agents. The document also discusses palmoplantar keratoderma, a thickening of the palms and soles that can be inherited or acquired, and presents in three patterns: diffuse, focal, or punctate. Complications can include pain, difficulty walking, and infection.
The document provides details on various types of Kshudra Kusthas (minor skin diseases) described in Ayurveda and compares them to modern skin diseases. It describes 7 types of Kshudra Kusthas - Eka Kushta, Charmakyam, Kitibha Kushta, Vipadika, Alasaka, Dadru Mandala, and Charmadala. For each, it provides the dosha involvement, signs and symptoms. It then compares each to similar modern skin conditions such as psoriasis, scleroderma, tenia infections, herpes, impetigo, and provides details on symptoms and characteristics.
Psoriasis is a chronic inflammatory skin disease that causes red scaly patches to appear on the skin. It occurs when skin cells multiply up to 10 times faster than normal. The two main types are plaque psoriasis, which causes raised, red patches covered with silvery scales, and guttate psoriasis, which appears as numerous small spots. Psoriasis has no cure but can be managed with topical creams and ointments, phototherapy, or systemic medications.
Erythroderma is defined as the scaling erythematous dermatitis involving 90% or more of the cutaneous surface.
Also known as exfoliative dermatitis
Idiopathic exfoliative dermatitis – also known as the “red man syndrome”, is characterized by marked palmoplantar keratoderma, dermatopathic lymphadenopathy,increased IgE.
Increased skin perfusion leads to
Temperature dysregulation >
Resulting in skin loss and hypothermia >
High output state >
Cardiac failure
BMR raises to compensate for heat loss
Increased dehydration due to transpiration (similar to burns)
All lead to negative nitrogen balance and characterized by edema, hypoalbuminemia, loss of muscle mass.
Psoriasis is a chronic inflammatory skin disease characterized by red, scaly plaques. Ayurvedic management includes external therapies like oils and pastes, panchakarma procedures like snehana and swedana to clear doshas, and internal herbal formulations to address underlying imbalances and support tissue regeneration. Treatment protocols are tailored based on disease severity, duration and site of involvement, with mild cases treated initially with external applications and lifestyle changes, while more severe or longstanding psoriasis may require deeper panchakarma and herbal rasayana. The overall goals are to relieve symptoms, prevent relapse, and improve quality of life through a holistic approach addressing both medical and psychological aspects.
1. The document is a presentation on Shwitra (vitiligo) by Dr. Akshay Shetty that defines the condition and discusses its synonyms, causes, types, symptoms, and treatability.
2. It classifies Shwitra into three types based on dosha involvement and stage of the disease. Symptoms vary in color depending on the dhatu affected.
3. Shwitra with coalesced patches, red hair above patches, or a duration over one year are considered not curable, while those with pale thin skin and elevated patches between less than one year may be treatable.
The document discusses Nadivrana or sinus. It defines it as a track formed due to collection of pus from an untreated wound or inflammation that bursts through deep tissues. It describes 5 types based on dosha involvement. Clinical features, treatment and management are explained for each type. Special conditions like involvement of marma or weak patients are also covered. Ksharasutra application is described as an alternative to surgery in some cases. Varti therapy is also mentioned for sinus wound management. In conclusion, a sinus is defined as a chronic non-healing discharging track and fistula is defined as when the track connects two epithelial surfaces.
Lichen planus is a chronic inflammatory skin condition that causes itchy, purple-colored papules and plaques. It is thought to be an autoimmune reaction targeting skin cells. The lesions typically appear on the wrists, legs, and oral mucosa. On microscopy, distinctive saw-tooth shaped keratinocytes (Civatte bodies) and band-like inflammatory infiltrate are seen. Treatment involves topical corticosteroids and immunomodulators. While usually self-limiting, lichen planus can lead to scarring and has a small risk of malignant transformation, especially in oral lesions.
Lichen planus is a chronic autoimmune disease that affects the skin and mucous membranes. It is characterized by pruritic polygonal papules and plaques that are flat topped and violaceous. The disease commonly affects middle aged women more than men. Oral lichen planus presents as white lacy lesions inside the mouth, while skin lesions typically occur on the wrists and legs. Treatment focuses on reducing symptoms through topical corticosteroids and immunosuppressants. While usually self-limiting, oral lichen planus poses a small risk of malignant transformation over the long term.
O documento discute a doença da psoríase, incluindo suas causas, tipos, sintomas, tratamentos e organizações de apoio. A psoríase é uma doença crônica da pele causada por fatores genéticos e ambientais que afeta o sistema imunológico. Os tratamentos incluem terapias tópicas, fototerapia, medicamentos imunobiológicos e apoio de organizações como a PSOPortugal.
Psoríase » sbd sociedade brasileira de dermatologiaAndré Fidelis
A psoríase é uma doença crônica e não contagiosa da pele causada por uma reação exagerada do sistema imunológico. Provoca lesões vermelhas e escamosas que podem ser muito incômodas. O tratamento varia desde cuidados tópicos para casos leves até medicação oral ou injetável para casos graves.
A empresa de tecnologia anunciou um novo smartphone com câmera aprimorada, maior tela e bateria de longa duração. O dispositivo também possui um processador mais rápido e armazenamento expansível. O novo telefone será lançado em outubro por um preço inicial de US$799.
La psoriasis es una enfermedad inflamatoria crónica de la piel que produce lesiones escamosas e inflamadas. Se estima que entre el 1 y 3% de la población la padece, y puede aparecer a cualquier edad aunque suele hacerlo entre los 15 y 35 años. Tiene una etiología multifactorial relacionada con factores genéticos y ambientales como traumatismos, infecciones, fármacos, estrés y factores climáticos. Existen varios tipos de psoriasis según la morfología
Este documento discute a psoríase que pode afetar os pés e as mãos. Ele explica que a psoríase pode aparecer nos dedos, planta e tornozelo dos pés, e nas costas e palmas das mãos. Também destaca a importância de cuidados diários como hidratação e proteção das áreas afetadas.
Este documento apresenta o consenso brasileiro de 2012 sobre psoríase e fornece um algoritmo de tratamento. Ele define psoríase, discute sua epidemiologia, manifestações clínicas e comorbidades associadas. Além disso, fornece diretrizes gerais para a avaliação e tratamento de pacientes com psoríase de acordo com a gravidade da doença.
Atopic dermatitis is a chronic, highly pruritic skin disease that is common in childhood. It involves the cheeks, hands, feet and flexural areas. Seborrheic dermatitis affects sebaceous areas in adults and commonly presents as flaky, greasy scales on the scalp. Eczema has endogenous and exogenous forms. Endogenous eczema includes atopic dermatitis while exogenous eczema includes irritant and allergic contact dermatitis caused by external triggers. Proper treatment of eczema focuses on moisturization, reducing irritation and treating secondary infections.
This document provides an overview of metoprolol, a beta1-selective adrenergic receptor blocker used to treat hypertension, angina, arrhythmias, and migraine headaches. It discusses metoprolol's mechanism of action, pharmacokinetics, indications and uses, adverse effects, drug interactions, formulations, and dosage information. The document also references current research on metoprolol and beta blockers in general.
Eczema is an inflammatory skin condition characterized by redness, blistering, weeping, and crusting. It has both acute and chronic stages. There are many types of eczema classified by etiology as endogenous, exogenous, or combined. Common types include atopic dermatitis, contact dermatitis, seborrheic dermatitis, dyshidrotic eczema, and stasis dermatitis. Eczema is diagnosed clinically and treatment involves identifying triggers, moisturizing, topical corticosteroids, oral antihistamines, and managing complications.
INTRODUCTION OF PSORIASIS, EPIDEMIOLOGY OF PSORIASIS, CLINICAL FEATURES OF PSORIASIS, PROGNOSIS OF PSORIASIS, HISTOPATHOLOGY OF PSORIASIS, TRIGGERING FACTORS OF PSORIASIS, PATHOGENESIS OF PSORIASIS
The contents :
Skin over view
Types of skin lesions
Hypersensitivity reactions and the skin
Eczema over view
Approach to a Skin Rash
Atopic dermatitis
MCQ Questions
Metolar-XR (Metoprolol Capsules) is used for the treatment of hypertension (blood pressure), long-term treatment of angina pectoris, treatment of stable, symptomatic heart failure of ischemic, hypertensive or cardiomyopathic origin as well as for migraine prophylaxis.
This document discusses various types of dermatitis and eczema. It begins with an introduction noting that dermatitis and eczema refer to inflammation of the skin. Eczema progresses through acute, subacute, and chronic stages. Prevalence in the US is 10-12% in children and 0.9% in adults, rising internationally. Atopic eczema is a chronic pruritic inflammation affecting the epidermis and dermis, commonly presenting in infants and children. Contact dermatitis results from allergic or irritant reactions to substances touching the skin. Other conditions discussed include lichen simplex chronicus, discoid eczema, seborrhoeic dermatitis, and
Eczema is a chronic inflammatory skin condition characterized by dry, itchy, scaly, and sometimes infected skin. The underlying cause is a defective skin barrier that allows too much moisture to escape, resulting in dryness. Proper treatment involves frequent use of emollients to restore the skin barrier, along with intermittent use of topical corticosteroids when flare-ups occur. Patient education is important to ensure correct application of treatments and avoidance of exacerbating factors.
Psoriasis and Management in Primary CareKochi Chia
1. Psoriasis is a chronic, immune-mediated skin disorder characterized by patches of abnormal skin that are typically red, itchy, and scaly. It occurs worldwide and has various clinical subtypes defined by the appearance of the rashes.
2. The pathogenesis of psoriasis involves an interplay between immune system dysfunction, epidermal keratinocyte hyperproliferation, and vascular changes. Genetic and environmental factors contribute to its development.
3. Psoriasis is associated with increased risks of comorbidities like psoriatic arthritis, cardiovascular disease, and metabolic syndrome. Treatment involves topical agents for mild cases and progresses to phototherapy, systemic drugs, and bi
Know more about Psoriasis ,Types and TreatmentsiCliniq
Psoriasis is a prototypic papulosquamous skin
diseases characterised by erythematous papules. It is a chronic inflammatory skin disease with increased epidermal proliferation related to dysregulation of the immune system.
It needs long time medication to get it control, the permanent is not found yet.
To Get guidance to treat Psoriasis from a doctor --> https://www.icliniq.com/ask-a-doctor-online/dermatologist/psoriasis
Psoriasis is a chronic inflammatory skin disease characterized by well-defined erythematous plaques covered with silvery-white scales. It affects extensor surfaces, scalp, nails and intertriginous areas. The disease has a genetic predisposition and can be triggered by infections, medications, stress and trauma. Pathogenesis involves activation of the immune system including T cells which secrete cytokines leading to abnormal keratinocyte proliferation. Presentations include plaque, guttate, pustular and erythrodermic subtypes. Management involves topical agents, phototherapy and systemic medications such as retinoids, methotrexate and biologics that target cytokines like TNF-α. Complications include psor
Psoriasis is a chronic, inflammatory skin condition characterized by red, scaly patches that are sometimes itchy and painful. It occurs when skin cells multiply up to 10 times faster than normal. The most common type is plaque psoriasis, which causes raised, red patches covered with silvery scales. Psoriasis has no cure but can be managed with treatments targeting the immune system. It affects about 2-3% of the population worldwide and has genetic and environmental triggers.
This document provides an overview of psoriasis and other papulosequamous skin diseases. It describes psoriasis as a chronic inflammatory skin disorder characterized by red papules and plaques covered with silvery scales, most commonly occurring on the elbows and scalp. The cause is believed to be an immune system dysfunction interacting with genetic and environmental factors. Symptoms include itchy lesions that may worsen with stress or injury to the skin. Treatment involves long-term, individualized regimens due to the chronic nature of the disease.
This document discusses psoriasis, a chronic skin condition characterized by red patches covered with silvery scales. It defines psoriasis and outlines its various types including plaque, guttate, flexural, and pustular psoriasis. The causes of psoriasis including genetics and immune system dysfunction are described. Characteristics, incidence rates, clinical features, and treatment approaches for different psoriasis types are summarized.
Psoriasis is a chronic inflammatory skin condition characterized by well-defined erythematous plaques bearing thick silvery scales. It affects 1-3% of the population and has an unpredictable chronic course with exacerbations and remissions. Common triggers include trauma, infection, and stress. Histopathology shows parakeratosis, epidermal thickening, and dermal inflammatory infiltrate. The most common form is stable plaque psoriasis presenting as salmon-pink plaques on the elbows and knees. Treatment includes topical corticosteroids and vitamin D analogues, phototherapy, and systemic medications for severe cases.
Psoriasis is a long lasting, non contagious autoimmune disease characterized by raised areas of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small, localized patches to complete body coverage. Injury to the skin can trigger psoriatic skin changes at that spot, which is known as the Koebner phenomenon. Psoriasis is belong to generally from autoimmune chronic inflammatory skin disease, so in this type of disease modern medicine had very minimal scope for curing condition, on the contrary it may leads to suppression of disease which manifest strongly afterwards. Homoeopathy is system of medicine which is able to cure this type of disorders from the root. Dr. Aishvariya Atulbhai Pathak "Psoriasis & Miracles with Homoeopathy" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-7 , December 2022, URL: https://www.ijtsrd.com/papers/ijtsrd52434.pdf Paper URL: https://www.ijtsrd.com/medicine/dermatology/52434/psoriasis-and-miracles-with-homoeopathy/dr-aishvariya-atulbhai-pathak
This document summarizes several common inflammatory skin conditions:
Psoriasis is a chronic inflammatory disease involving the immune system that causes red scaly plaques. Treatment includes topical agents and phototherapy. Lichen planus presents as pruritic purple polygonal papules that may involve oral mucosa. Pityriasis rosea typically causes a herald patch followed by scattered oval papules that resolve within 5 weeks.
Systemic sclerosis, or scleroderma, is a rare autoimmune disease characterized by fibrosis of the skin and internal organs. It can be classified as either limited or diffuse cutaneous systemic sclerosis based on the extent of skin involvement. Common clinical features include Raynaud's phenomenon, skin thickening, gastrointestinal issues, lung fibrosis or pulmonary arterial hypertension, renal crisis, and calcinosis. The cause is unknown but likely involves environmental triggers in genetically susceptible individuals leading to endothelial cell dysfunction, inflammation, and excessive collagen deposition in affected tissues.
This document provides an overview of sarcoidosis, including its definition, epidemiology, etiology, pathology, clinical features, diagnosis and natural course. Sarcoidosis is a multisystem disorder characterized by noncaseating granulomas and can affect many organs, most commonly the lungs (90%). It has the highest prevalence in Scandinavian countries. While the cause is unknown, it is thought to involve an abnormal immune response to environmental factors in genetically predisposed individuals. Tissue biopsy showing noncaseating granulomas is required for diagnosis, along with supportive tests such as BAL and serum ACE levels. The natural course is variable, with 70% experiencing spontaneous remission and 16% having progressive disease.
Pityriasis rosea is a common skin condition that mainly affects children and young adults. It is characterized by the appearance of multiple pink, oval lesions on the trunk that have a distinctive scale. The rash begins with a single larger 'herald' plaque, followed by many smaller plaques over the next few weeks. While the cause is unknown, it is generally not contagious and most cases resolve spontaneously within 2-10 weeks without treatment. Topical steroids or calamine lotion can help relieve itching.
Psoriasis is an autoimmune disease that causes skin cells to grow rapidly, resulting in scaling and inflammation. There are five main types, with plaque psoriasis being the most common. It is not contagious. Psoriasis has genetic and environmental triggers and can affect the skin, nails and joints. Diagnosis is usually based on visual inspection, and treatment depends on severity, ranging from topical agents for mild cases to phototherapy or systemic drugs for more severe psoriasis. Psoriasis has no cure and typically lasts a lifetime, but treatment can control symptoms.
Psoriasis is a chronic skin condition characterized by inflamed plaques and scales. It affects 1-3% of populations and has a genetic component. The causes involve an immune reaction and abnormal skin cell growth. Symptoms range from small red spots to widespread inflammation. Treatments include topical creams and light therapy. For severe cases, oral medications like retinoids, methotrexate and biologics may be used. Psoriasis has no cure and requires long-term management of symptoms.
Systemic lupus erythematosus (SLE) is a rare, multisystem autoimmune disease that can affect many parts of the body. It is most common in women ages 20-30. Symptoms include arthritis, skin rashes, fatigue, and kidney problems. Investigations include blood tests to check for autoantibodies. Treatment involves medications to reduce inflammation and suppress the immune system such as hydroxychloroquine, steroids, and immunosuppressants. Managing SLE requires a tailored treatment plan to control symptoms and prevent organ damage.
This document provides an overview of psoriasis, a common chronic inflammatory disease of the skin. It discusses the disease's aetiology, epidemiology, pathogenesis, clinical features, investigations, differential diagnosis, and treatment options. Psoriasis is characterized by well-defined red scaly plaques in areas like the scalp, elbows and knees. It is caused by a complex interplay of genetic and environmental factors that lead to hyperproliferation of skin cells. Diagnosis is based on clinical features and histology. Treatment involves topical therapies like corticosteroids and phototherapy, as well as systemic therapies such as methotrexate, retinoids and biologics.
1. Juvenile dermatomyositis differs from adult DM in that it lacks calcinosis cutis, malignancy, and has less sex predominance and vasculitis. Adults can develop malignancy and positive anti-synthetase antibodies.
2. Two medications that can induce dermatomyositis are statins and hydroxyurea. Two features that differ DM lesions from LE are their violaceous hue and pruritus.
3. Indications for treatment of hemangiomas include obscuring vision, compromising airway, ulceration and pain, and being in a cosmetically sensitive area. The approach for starting propranolol includes testing for contraindications and slowly
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. Psoriasis –epidemiology
Kanada
4,7%
USA 1,4-
4,6%
Indianie Płd
Am. 0%
Australia
2,6%
Aborygeni 0%
Szwecja
2,3%
Rosja
2,0%
Chiny
0,05-0,8%
Japonia
0,29%
Hiszpania
3,7%
Low incidence: West Africans, Japanese, very low: incidence or absence
in North and South American Indians
males = females
3. Psoriasis –epidemiology
Peak incidence - 22.5 years of age
Late onset (type II) ≈ age 55
Early onset (type I) predicts a more severe and
long- lasting disease, positive family history
4. Psoriasis - history
460-377 p.n.e – Hipokrates first description
129-99 p.n.e – Galen: term „psora” = pruritus
1841 - Ferdinand von Hebra: separated psoriasis from lepra
5. Psoriasis – genetic background
1963 r. Gunnar Lomhold
1972 r. – HLA: susceptibility
markers
1970 - 1990 –
twin studies
8. Genetics of psoriasis( GWAS, Genome wide association scans )
candidate genes
James T. Elder. Genes Immun, 2009, 10, 201.
9. Polygenic trait
one parent has psoriasis - 8% of offspring
develop psoriasis
both parents have psoriasis - 41% of
children develop psoriasis
Psoriasis - complex
disease
10. Physical trauma (Koebner phenomenon)
isomorphic sign - the psoriatic papules occur in the site of the mechanical trauma within a couple of days
Infections acute streptococcal infection - guttate psoriasis
Stress as high as 40% in adults and higher in children
Drugs systemic glucocorticoids, oral lithium, antimalarial drugs,
interferon, beta blockers (flares existing psoriasis or psoriasiform drug
eruption)
Alcohol ingestion, smoking, obesity
PSORIASIS - environmental factors
11. Nestle F. N Engl J Med, 2009, 361, 496.
Immunopathogenesis of psoriasis – history
1980’:immunological background
1990-2000’:
psoriasis - Th1 /Th17
mediated disease
1961r. van Scott epidermal
hiperproliferation
12. Immunopathogenesis of psoriasis
Nestle F. N Engl J Med, 2009, 361, 496.
Innate, adaptive immunity
Keratynocytes
Macrophages
Dendytic cells
Lymphocytes T
14. Clinical phenotypes
A. Localised forms B. Generalised forms
Psoriasis of folds Plaque
Seborhoic psoriasis Guttata
Psoriasis capitis Generalised plaque
Psoriasis palmo-plantaris (non-pustular)
Erytrodermia
Psoriasis plaque (limbs)
Psoriasis plaque (trunk)
Psoriasis – phenotype classification
International Psoriasis Council 2007
16. Auspitz sign - the appearance of bleeding spots when psoriasis scales are scraped off
The candle grease sign (the removal of the scale reveals the skin with a glossy grease-
like appearance
19. Sharply marginated, dull-red plaques
with loosely adherent, lamellar,
silvery-white scales
Plaques coalesce to form polycyclic,
geographic lesions and may partially
regress, resulting in annular,
serpiginous, and arciform patterns
Lamellar scaling can easily be
removed, or, when the lesion is
extremely chronic, it adheres tightly to
the underlying inflammatory and
infiltrated skin, resulting in
hyperkeratosis
Psoriasis -chronic stable type
20. Finger nails and toenails
frequently involved
(arthritis)
pitting
subungual
hyperkeratosis,
onycholysis
yellowish-brown spots
under the nail plate—
the oil spot
(pathognomonic)
Psoriasis – nails
21. One of the most common forms of the
disease-occurring in 50-80% of patients,
it is often the first clinical manifestation
of the dermatosis. They are usually
located at the border between the
glabrous skin and the hairy scalp,
forming the so called "psoriatic crown".
Plaques, sharply marginated, with thick
adherent scales Scattered discrete or
diffuse involvement of entire scalp,
Scalp psoriasis may be part of
generalized psoriasis or coexist with
isolated plaques, or the scalp may be
only site involved.
Psoriasis – scalp
23. not scaly but macerated, bright red and fissured
the sharp demarcation - distinction from intertrigo, candidiasis, contact dermatitis, tinea,
this form is seen rarely in clinical practice. It occurs in 3 to 6.8% of all patients with
psoriasis, and if it is the only clinical presentation it may cause difficulties in getting the
correct diagnosis. Scales are not found in the psoriasis of the skin folds, but maceration
and secondary infections are seen.
Chronic Psoriasis of the Perianal and Genital Regions and of the
Body Folds – Inverse Psoriasis
24. Acute Guttate Type
• Salmon-pink papules (guttate: Latin gutta, "drop"), 2.0 mm
to 1.0 cm with or without scales
• Scattered discrete lesions generally concentrated on the
trunk, less on the face and scalp, usually sparing palms and
soles
• Guttate lesions may resolve spontaneously within a few
weeks but usually become recurrent and may evolve into
chronic, stable psoriasis
27. Psoriasis palmo-plantaris
Palms and Soles
may be the only areas involved
massive silvery white or yellowish
hyperkeratosis and scaling not
easily removed
there may be cracking and painful
fissures and bleeding
29. Pustulosis palmo-plantaris (PPP)
Pustules in stages of
evolution, 2–5 mm, deep-
seated, yellow, develop into
dusky-red macules and
crusts; present in areas of
erythema and scaling or
normal skin
Limited to palms and soles,
may be only a localized patch
on the sole or hand, or
involve both hands and feet
33. Generalized Acute Pustular Psoriasis
(Von Zumbusch)
Fever, generalized weakness, severe malaise
Rare
The constellation of fiery-red erythema followed by formation of pustules
occurs over a period of less than 1 day
Patient frightened, "toxic.„
Nikolsky phenomenon - positive
Pustules are sterile
The eruption generalized
34. Psoriatic erytroderma
psoriasis is one of the most
common causes of
erythrodermia in adults, it can
arise anew or complicate
chronic plaque psoriasis (often
if the treatment is not
appropriate). Inflammation
with dandruff-like scaling
involving the whole skin
surface, accompanied by
elevated leukocyte count,
elevated ESR, and
lymphadenopathy
35. Psoriatic arthritis
seronegative spondyloarthropathies, which
include ankylosing spondylitis, enteropathic
arthritis, and reactive arthritis
Incidence is 5–8%. Rare before age 20
May be present (in 10% of individuals) without
any visible psoriasis; if so, search for a family
history !
36. Psoriatic arthritis
Types
"Distal"—seronegative, without subcutaneous
nodules, involving, asymmetrically, a few
distal interphalangeal joints of the hands and
feet: an asymmetric oligoarthritis.
Enthesitis—inflammation of ligament
insertion into bone.
Multilating psoriatic arthritis with bone
erosion and ultimately leading to osteolysis or
ankylosis.
"Axial"—especially involving the sacroiliac,
hip, and cervical areas with ankylosing
spondylitis.
37. Psoriatic arthritis
Skin symptoms and signs
Swelling, redness, tenderness of involved joints
or site of enthesitis (e.g., insertion of Achilles
tendon in calcaneus)
Dactylitis—sausage fingers, May or may not be
associated with psoriasis elsewhere.
Often psoriatic involvement of fingertips and
periungual skin. Massive nail involvement by
psoriasis is frequent
Arthritis may lead to arthritis mutilans:
destruction of interphalangeal joints results in
telescope fingers with mutilation of hand and
considerable functional impairment
39. CISD
I. Common ganetic background
II. Pathogenesis/efficacy of pathogenesis based
treatment
III. CVD risk
40. I. CISD – common genetic background
Gen Chromosom Skojarzone choroby
IL-12B 5q Łuszczyca, Ch. Crohna
IL-23R 1p Łuszczyca, Ch. Crohna,
ZZSK, łzs
CDKAL1 6p Łuszczyca, Ch. Crohna,
cukrzyca typu 1
PTPN22 18p Łuszczyca, RZS, SLE,
cukrzyca typu 2
Region genów rodziny IL-4
IL-13
5q Łuszczyca, Ch. Crohna
41. II. CISD -common pathogenesis
Th1/Th17 mediated immunological responce
Role of TNF-α
Role of DC
Endothelium dysfunction
Oxidative stres
Inflammatory markers in circulation
42. Psoriasis / atheromatosis – common pathogenesis
Spach F. Br J Dermatol 2008, 159, 10.
łuszczyca miażdżyca
44. Psoriasis comorbidities increasing risk of CVD
Metabolic syndrom
Associated with systemic inflammatory disease
Obestity
Diabetes
Hiperlipidemia
Hypertension
45. Psoriasis and obesity
Hamminga EA i inni. Med. Hypoth 2006, 67, 76.
Johnson A i inni. Br J Dermatol 2008, 159, 342.
Obesity 2x increases psoriasis risk
BMI correlates with psoriasis severity
46. Psoriasis and diabetes
Psoriatics have diabetes more often
Role of TNF-α in insuline resistence
Significant correlation of resistine in
blood with psoriasis severity
Cohen A. J Am Acad Dermatol, 2007, 56, 629.
47. Psoriasis and atherogenic dyslipidemia
Rocha-Pereira i inni. Clin Chim Acta 2001, 303, 33.
↑ LDL, VLDL, TG, cholesterol, ↓HDL in psoriatics
LDL correlates with psoriasis severity
Oxydative stres accelerates atherogenesis
Side effect of antipsoriatics drugs on lipide profile
49. Psychosocial impact of psoriasis
Stygmatisation
J Am Acad Dermatol. 1999 Sep;41(3 Pt 1):401-7.
50. Depression: 60 %
Suicidal tendency: 7,2 %
Psychosocial impact of psoriasis
Esposito M. Dermatology, 2006, 212,123. Gupta M. Br J Dermatol 1998, 139, 846.
51. thickening of the epidermis
(acanthosis) and thinning of
epidermis over elongated dermal
papillae
Increased mitosis of keratinocytes,
fibroblasts, and endothelial cells
Parakeratotic hyperkeratosis (nuclei
retained in the stratum corneum)
Inflammatory cells in the dermis
(lymphocytes and monocytes) and in
the epidermis (lymphocytes and
polymorphonuclear cells), forming
microabscesses of Munro in the
stratum corneum.
Psoriasis - laboratory examinations
dermatopathology
52. Psoriasis - laboratory examinations
Serology
Increased antistreptolysin titer in acute
guttate psoriasis with antecedent
streptococcal infection. Sudden onset
of psoriasis may be associated with HIV
infection
Culture
Throat culture for group A -hemolytic
streptococcus infection.
53. Psoriasis treatment – factors
selection of treatment
1.Age: childhood, adolescence, young adulthood, middle age, >60 years
2.Type of psoriasis: guttate, plaque, palmar and palmopustular,
generalized pustular psoriasis, erythrodermic psoriasis
3.Site and extent of involvement: localized to palms and soles, scalp,
anogenital area, scattered plaques but <5% involvement; generalized and
>30% involvement
4.Previous treatment: ionizing radiation, systemic glucocorticoids,
photochemotherapy (PUVA), cyclosporine (CS), methotrexate (MTX)
5.Associated medical disorders (e.g., HIV disease, CVD).
54. Psoriasis – local treatment
emolients and keratolytics
anthralin
vitamine D analogues
topical steroids
topical retinoids
56. Anthralin (dithranol)
usual concenrations 0.1-2%
efficacy- good in a short term
side efects: irritation
hypersensitivity, staining of
nails and hair
contraindication: acute or
actively inflamed psoriasis
57. Calcipotriene (vitamine D derivative)
benefit in mild to moderate psoriasis
combination of calcipotrene with topical steroids
provides better clearance and maintenance
may cause skin irritation
should not be used by patients with
hypercalcemia or vitamine D toxicity
58. Topical steroids
short period of up to 4 weeks for flexural
or facial psoriasis
long-term use must be avoided - side
effects:
- atrophy
- striae
-teleangiectasia
- skin fragility
- dyspigmentation
- systemic side effects
!
61. oral ingestion of 8-methoxypsoralen (8-MOP)
(0.6 mg 8-MOP per kilogram body weight) or, 5-
MOP (1.2 mg/kg body weight) and exposure to
doses of UVA that are adjusted to the sensitivity
of the patient.
three times a week.
most patients clear after 19 to 25 treatments,
and the amount of UVA needed ranges from 100
to 245 J/cm2.
Long-term side effects:
PUVA keratoses and squamous cell carcinomas
Oral PUVA Photochemotherapy
62. Oral retinoids in psoriasis
• Acitretin usual range 25-50mg/day very effective in inducing
desquamation but only moderately effective in suppressing
psoriatic plaques (an exception is pustular psoriasis
• They are highly effective when combined according to established
protocols with 311-nm UVB or PUVA (called Re-PUVA)
• Contraception is mandatory during treatment and for 2 years after
it is completed
• Combinations of oral retinoids and PUVA improve the efficacy of
each and permit a reduction of the dose and duration of each if
refractory to treatment
63. Psoriasis – retinoids- side effects
• teratogenic - women of childbearing age should use
contraception during and for two years after therapy!!!
• ro-dermatitis: eyes, ears, nose and throat: cheilitis, dry eyes
and nose, conjunctivitis
• abnormal liver function tests, hipertriglyceridemia,
hiperglycemia
• muscosceletal: arthralgia, myalgia
• central nervous system: dizziness, fatigue, headache
64. Psoriasis - retinoids - patient information
therapeutic effect after 2-4 week
avoid pregnancy for one month before and 2 years after treatment
avoid tetracycline
don’t donate blood one year (teratogenic effect)
avoid excessive sunlight
!
65. Cyclosporine in psoriasis
CS treatment is highly effective at a dose of
3–5 mg/kg per day. As the patient responds,
the dose is tapered to the lowest effective
maintenance dose. Monitoring blood
pressure and serum creatinine is mandatory
because of the known nephrotoxicity of the
drug. CS should be employed only in patients
without risk factors.
!
67. Methotrexate Therapy
Schedule of Methotrexate: the single-dose MTX once weekly
(12.5-25 mg/ week)
80% improvement but total clearing only in some, and higher
doses increase the risk of toxicity. Higher doses may be
needed in overweight patients
CBC, Liver Function
Contraindications:
anemia, thrombocytopenia or leukopenia
nursing mothers, pregnancy (avoid conception for 6 month after
stopping men and women)
gastric or duodenal ulcer
69. alkohol intake
abnormal liver parameters
liver disease in anamnesis
positive familial anamnesis into genetic liver diseases
diabetes
obesity
significant exposure into chemical substances
no folic acid suplemmentation
hiperlipidemia
Risk factors of liver damage in patients treated with mtx
70. Liver damage after Mtx in psoriatics
Fibrosis cirrhosis
Histological features of NAHS
(non-alkoholic hepatic steatosis)
71. Liver toxicity in patient treated with mtx – cumulative dose
Patients with risk factors
1,5 g Mtx
Patients with no risk
factors
3,5-4 g Mtx
74. Specifity
Short and long term efficacy
↓ organ toxicity
↓risk of drug interactions
Cardioprotective action
Biologics in psoriasis
75. Risk of infection
Risk of neoplasms ?
moAb antibodies
Long-term efficacy?
Costs
Biologics in psoriasis
76. Psoriasis - prevention
no effective preventive measures to be taken against the
development of psoriasis
flare-ups may be potentially reduced by modification
of risk factors – infections, stress, drugs, smoking, alkohol
interaction alert!
beta-blockers for hypertensives may cause the flare of psoriasis
77. Psoriasis prognosis
debilitating disease due to psychosocial impact
genaralized pustular psoriasis and erythrodermic
psoriasis may be life-threatening if untreated
course of disease is chronic and may be refractory to
treatment
5-8% of patients with psoriasis may develop psoriatic
arthropathy
78. Th1 i Th17 in psoriasis
pathogenesis
Psoriasis as a systemic disease
decreasing QL
81. Lichen planus – epidemiology
Worldwide occurrence; incidence < 1%, all races
Age of Onset: 30–60 years
Sex
Females > males
Hypertrophic LP more common in blacks
82. LP-onset
Acute (days) or insidious (over
weeks). Lesions last months to
years, asymptomatic or pruritic;
sometimes severe pruritus.
Mucous membrane lesions are
painful, especially when ulcerated
83. LP-etiology
Idiopathic in most cases but cell-mediated
immunity plays a major role. Majority of
lymphocytes in the infiltrate are CD8+ and
CD45Ro+ (memory) cells. Drugs, metals (gold,
mercury), or infection [hepatitis C virus (HCV)]
result in alteration in cell-mediated immunity.
There could be HLA-associated genetic
susceptibility that would explain a
predisposition in certain persons. Lichenoid
lesions of chronic graft-versus-host disease
(GVHD) of skin are indistinguishable from
those of LP
84. Lichen planus - distribution: predilection for flexural
aspects of arms and legs, can become generalized
85. LP – clinical manifestation
Papules, flat-topped, 1 to 10 mm, sharply
defined, shiny. Violaceous, with white lines
(Wickham striae), seen best with hand lens
after application of mineral oil. Polygonal or
oval. Grouped, annular, or disseminated
scattered discrete lesions when generalized. In
dark-skinned individuals, postinflammatory
hyperpigmentation is common. May present
on lips and in a linear arrangement after
trauma (Koebner or isomorphic
phenomenon).
86. LP - variants
Hypertrophic
Atrophic
Follicular
Individual keratotic-follicular papules and plaques that lead to cicatricial alopecia.
Spinous follicular lesions, typical skin and mucous membrane LP, and cicatricial
alopecia of the scalp are called Graham Little syndrome
Vesicular
Vesicular or bullous lesions may develop within LP patches or independent of them
within normal-appearing skin.
Pigmentosus
Hyperpigmented, dark-brown macules in sun-exposed areas and flexural folds. In
Latin Americans and other dark-skinned populations. Significant similarity with ashy
dermatosis
Actinicus
Papular LP lesions arise in sun-exposed sites, especially the dorsa of hands and arms
Ulcerative
LP may lead to therapy-resistant ulcers, particularly on the soles
87. LP - Mucous Membranes
Oral
40–60% of individuals with LP
Reticular LP
Reticulate (netlike) pattern of lacy white hyperkeratosis on
buccal mucosa lips, tongue, gingiva; the most common pattern
of oral LP
Erosive or Ulcerative LP
Superficial erosion with/without overlying fibrin clot; occurs
on tongue and buccal mucosa); shiny red painful erosion of
gingiva (desquamative gingivitis) or lips
Carcinoma may very rarely develop in mouth lesions.
Genitalia
Papular, annular, or erosive lesions arise on penis (especially
glans), scrotum, labia majora, labia minora, vagina.
89. LP-treatment
Cyclosporine
Oral prednisone is effective for individuals with
symptomatic pruritus, painful erosions, dysphagia, or
cosmetic disfigurement. A short, tapered course is
preferred
Systemic Retinoids (Acitretin)
1 mg/kg per day is helpful as adjunctive measure in severe
(oral, hypertrophic) cases, but usually additional topical
treatment is required.
PUVA Photochemotherapy
In individuals with generalized LP or cases resistant to
topical therapy.
Editor's Notes
łuszczyca jest prawdopodobnie jedna z najdłuzej znanych ludzkosci chorób
Pierwszy udokumentowany opis zmian skórnych odpowiadajacych łuszczycy odnaleziono w starym testamencie.
Z czasow starożytnych pochodzi łacińska nazwa choroby – psoriasis – od słowa psora oznaczający swiąd
Przez wieki łuszczyca traktowana była jako choroba nieczystych, schorzenie potencjalnie zakaźne i wynikajace z zaniedbań higienicznych. i bardzo często utozsamiana z trądem. Ten stereotyp funkcjonujacy czasem do dzisiaj został zerwany dzieki słynnum dermatologom Robert Willan jako pierwszy opisał łuszczycę jako odrebną jednostkęchorobowa zaś FV H ostatecznie oddzielił chorobę od tradu
Proces zapalny zarówno w łuszczycy jak i miażdżycy jest zależny od limfocytów Th1.
Kaskada zjawisk patogenetycznych w obu stanach wykazuje duży stopień podobieństwa.
APC aktywuja dziewicze LT na których dochodzi do ekspresji LFA-1
Aktywowane LT migruja do nn i przylegaja do sródbłonka i przedostaja się poza naczynia przy udziale LFA-1 i ICAM
Aktywowane LT wchodza w interakcje zKC, makrofagami KD i kkmgł
Reaktywowane TL wydzielają cytokiny i chemokiny tworzące zaplne srodowisko w którym tworzy się blaszka łuszczycowa i blaszka miazdzycowa
Zjawisko otyłości przybiera w krajach rozwiniętych skalę epidemii
Endotelina – 1peptyd wydzielany przez komórki sródbłonka ale też KC o silnych właściwosciach aterogennych zweza naczynia, działa proagregacyjnie
Zaburzenia depresyjne mogą mieć zróznicowany obraz od postaci poronnych po ciężkie zaburzenia przebiegające z myslami i tendencjami samobójczymi