Psoriasis is a chronic inflammatory skin condition characterized by red patches covered with silvery scales. It occurs more commonly in ages 15-30 and is triggered by factors like infection, trauma, stress, and certain medications. The scales form due to abnormal rapid skin cell production. Treatment includes topical corticosteroids and coal tar, oral medications like retinoids, and phototherapy using UV light. Phototherapy involves using UVB or PUVA (psoralen plus UVA), which requires protective eyewear and sun avoidance after treatment. Management aims to reduce skin cell production and flare-ups through a combination of treatments tailored to each individual case.

1. Psoriasis
Dr. Kaushik Patel, MPT
Assistant professor,
SPB Physiotherapy college

2. •This is one of the commonest and most intractable
disorder of the skin.
• It is an autoimmune disease that appears on the skin.
Definition
It is a chronic inflammatory disease of the skin
characterized by clearly define dry, rounded red patches
with silvery scales on the surface.

4. Etiology-
Age – Common age of first occurrence is 15-30 years
Can occur as young as 2 years and can start as
late as 80 years.
Sex – Both sex are equally affected.
Climate – The condition is worse in damp, cold
climates.

5. Predisposing factors
Heredity – There is an inherited defect in the skin which
result in psoriasis developing in certain
circumstances
Infection - It has been known to develop after,
e.g. URTI
Trauma - Lesions tend to develop at sites of trauma,
e.g. mechanical friction, cuts, stings

6. Anxiety – psoriasis often appears in relation to mental
stress
Drugs- some drug, chloroquine may precipitate the
condition
Diabetes – some patients with diabetes develop the
condition
Arthropathy -

7. Causes –
•The membrane of the skin cells in patients who
develop psoriasis contain abnormal protein which
manifest as abnormal surface antigen.
•Antibody from in response to these ‘ foreign” bodies.
•When this antibody lock onto the antigens, a complex
reaction takes place at the dermo-epidermal junction
and psoriasis lesion are produced

8. •In normal skin the maturing of epidermal cells takes
21- 29 days.
•In psoriasis this is accelerated to 4 days.
•what causes the abnormal protein to from and what
triggers the antibody – antigen reaction is not known
but it is probably related to the predisposing factors
already listed.

9. Pathological changes
Epidermis
•There is increased reproduction in the stratum
germinatum (growing layer)
•The stratum spinosum is thicker due to an increase
number of cell plus oedema
•The stratum granulosum is absent
•The strata lucidum and corneum are replaced by
several layers of nucleated, incompletely keratinized,
soft cells

10. •There is no time for the normal changes to take place
through the skin layers.
•They cell surface are sticky and do not fall of like
normal keratin.
•Accumulation of these cell forms scales which over 2-
3 weeks dry out and fall off in big flakes

11. Dermis
•Capillaries is dilated with increase blood flow
•Papillae are elongated
•There are changes of inflammation
Healing
•The center of the patch heals first causing circular
lesions.
•Normal recovery take place without scaring

12. Clinical features
1. Sharply defined red and pink areas termed plaques
2. Silvery scales due to light reflecting from the
swollen stratum spinosum
3. Distribution
Elbow, knee, scalp and sacrum are covered in
thickly scaled patches
Plaque of varying sizes appear anywhere on the
body

14. Nail become pitted, ridged or separated from the nail bed.
Skin contact areas can be badly affected – between fingers,
axilla, groin, between toes, under breast, behind ear.
The face is rarely affected
The size of plaques and distribution varies so that different
types are described
These are – 1-Gutted 2-Pustular
3-Erythrodermic

16. 1-Gutted
•Commonest and least severe with good prognosis
•Small multiple plaques are scattered evenly over trunk
and limbs and appears suddenly
2- Pustular
•Affect the scalp and body folds, although palm and
sole can badly affected
•There is more severe inflammation and pustule are
formed .
•The fluid inside the pustule is sterile and must note be
confused with the infected pustules of acne

17. 3- Erythrodrmic
•The plaques join up and there is extensive erythema.
•The extensive distribution of blood to the skin can
cause cardiac failure and loss of temperature regulation

19. Treatment
This may be considered under
1.Generel management
2.Topical
3.Systemic
4.Physiotherapy

20. General management
•A sympathetic approach
•Any anxiety or worry should be identified and the
patient encourage to relax or seek appropriate help
•Reassurance that it is not infectious or disfiguring
must be given to the patient and family
•Dieting may be tried if there appears to be any
allergy factor.

21. Topical treatment
•Simple bland aqueous cream
•Coal tar application with salicylic acid and zinc oxide
in paraffin may be used alone or with UVR
•Dithranol in lassar’s paste is used for resistant
psoriasis.
•UVR with theraktin may be given in conjunction with
dithranol
•Corticosteroid cream

22. Systemic
•Retinoid – A variant of vitamin A
- Side effect – dryness and cracking of mouth alopecia,
pruritis and not given in pregnancy
•Cytotoxic drugs- Methotrexate
Side effect – Damage to the bone marrow, intestinal and
liver tissue.

23. Physiotherapy
•Psoriasis can be treated successfully with UVR
•Two sources are used –
1. Theraktin and
2. PUVA

24. The Theraktin
•The spectrum of UVR emitted is 390-280 nm and peak
emission is around 313 nm therefore this constitute
UVB
•It may be used alone or in conjuction with coal tar or
diathranol
Treatment –
Suberythemal dose is given daily or three times a week

25. •When lesion start to flatten and heal the same time is
repeated and frequency of treatment reduced to
twice weekly, one weekly then once a fortnight
•The course of treatment may be spread over 8- 12
weeks

26. PUVA
•This is psoralens plus UVA and is used fro resistant
psoriasis
•The one used for psoriasis is 8 methoxy psoralyn
(8MOP)
•UVA is produced from fluorescent tubes, mounted
upright in a hexagonal shaped cabinet inside which
patient stand throughout the treatment
•The spectrum of UVR emitted is 330-390 nm and peak
at 360 nm

27. Method
•The patient takes 3-6 tablets of psoralen preferably
with milk 2 hours before exposure.
•Tablet dose is according to weight of the body
•UVA is calculate according to skin type in joules

28. Patient weight (kg) Dose (mg)
30 10
30-50 20
51-65 30
66-80 40
81-90 50
90-and over 60

29. Skin type start increase
I. Always burn, never tan ½ ½
II. Always burn, then slight tan ½ ½
III. Sometime burn, always tan 1 1
IV. Never burn, always tan 1 1
V. Lightly pigmented 1 ½ 1 ½
VI. Black 1 ½ 1 ½

30. Duration of treatment
•This may be 5 min at first for skin type I and II
•And progress by 1 minute up to 15 minutes
•It may be start at 6 minutes and progress by 2 minute
up to 20 minutes for skin type III and IV .
•It may start at & 7 minute and progress by 3 minutes
up to 25 minute for type V and VI

31. •The patient attends three times a week until healing
starts, then frequency of treatment is reduced to twice,
once week once per fortnight or monthly “holding
session”

32. Precaution
Do not take psoralens on empty stomach
There is a real danger of cataract therefore used protective
goggles
Psoralen sunglasses must be worn from the time of taking
the psoralene to at least 12 hours after.
Patient are advised to wear protective glasses out of the
doors for at least 24 hours after taking the psoralene and
also whilst watching TV or in florescent lighting

33.  The skin must be covered in bright sunlight and a hat
worn for 24 hrs after treatment
 Stop using all ointment during PUVA
 If the skin is dry simple oil or lubricating lotion may
be used
 Do not become pregnant or father a child
 Contraceptive measure are essential during PUVA
treatment
A check up is essential every month after completion
of treatment

34. Mechanism of action
•8-MOP bind to DNA and is activated by UVA
•The psoralen binds to DNA , producing cross-inking
which inhibits epithelial synthesis and cell division,.
•In essence therefore ,the accelerated reproduction of
epidermis in psoriasis is reduced

35. Long term management
It may take up to 10 weeks to clear the skin and a
further 4-5 weeks of maintenance dose may be
given depending on individual response.

36. Thank
you…