Psoriasis is classified as a chronic immune-medicated disease and is a skin condition that effects the first layer of the epidermis [skin].

This condition is different than eczema with affects that outer side of the a joint.

Is chronic and reoccurring – which means that it can be difficult to treat.

It can be caused by an Immune System sending out faulty signals that speed the growth of the skin cells

Between 10-40% of those having Psoriasis also has psoriatic arthritis which affects the joints like Arthritis.

There is likely to be a genetic component, though psoriasis is not completely understood.

Inflammation is a large aspect of what is happening both to the skin layers and Joints when involved.

 

Types:

1.)  Plaque
2.)  Inverse
3.)  Guttate
4.)  Pustular
5.)  Erythrodermic

Most common type is Plaque

  • Commonly seen as red and white regions of scaly patches.
  • Can be a silvery-white appearance
  • Often found on elbows and knees
  • Can also affect scalp, hands, fingers, legs, abdomen.

 


Classifications:

Nonpustular

Psoriasis Vulgaris

  • Plaque-like psoriasis
  • Affects 80-90% of those with psoriasis
  • Raised areas of inflamed skin called plaques

Psoriatic erythroderma

  • Widespread inflammation and exfoliation of skin
  • Covers most of the body surface
  • Severe itching
  • Often swelling is associated
  • Can be seen with abrupt stopping of systemic treatment
  • This form of psoriasis can be fatal

 

Pustular

Pustular psoriasis

  • Appears as raised bumps that are filled with pustules. [Not infections]
  • Skin around pustules is red and often tender
  • Often seen on hands and feet (palmoplantar pustulosis)
  • Can be seen on any part of the body
  • Types:
    * Annular pustular psoriasis
    * Acrodermatitis continua
    * Generalized pustular psoriasis
    * Pustulosis palmaris et plantaris
    * Impetigo herpetiforms

 

Other Types

Drug-induced psoriasis

Inverse psoriasis

  • Smoothed inflamed patches of skin.
  • Seen in skin folds – often around genitals, armpits, abdomen, folds of breasts
  • Aggravated by friction and Sweat

Guttate psoriasis

  • Many of small and scaly lesions
  • Can be red or pink in color
  • Often seen on back, trunk, limbs and scalp
  • Often follows a streptococcal pharyngitis infection.

 

 

 

Psoriatic Arthritis

  • Can affect any joint
  • Most common joints affected: fingers and toes.
  • Fingers can appear thick as sausages.

 

Nail psoriasis

  • Large changes in the appearance of finger and toenails
  • Changes include: color, pitting, lines across nail, thickening of nail, crumbling of nail.

 

Symptoms:

  • Dry skin
  • Rashes
  • Plaques [rashes with silver or white appearance]
  • Joint pain
  • Fatigue
  • Flaky skin
  • Redness on skin
  • Nail changes
  • Rashes in hair/scalp

Secondary Symptoms

  • Depression
  • Elevated Blood pressure
  • Physical Discomfort
  • Embarrassment

 

Diagnosis

* Typically done on appearance of skin
* No specific blood tests are done
* Skin biopsy can be helpful to rule out other disorders
* Auspitz’s sign – scraping of plaques causes pinpoint bleeding from the skin below

 


Treatment

Topical

Help with Dryness

.  Bath solutions
.  Mineral oil
.  Petroleum jelly
.  Moisturizers

Help with plaques

.  Coal tar
Dithranol [anthralin]
Desoximetasone [Topicort] – Steroid
Flucinonide – Steroid
Calcipotriol – Vitamin D3 analogues
.  Topical Retinoids

 

Phototherapy

Forms of sunlight

Wavelengths of 311-313 nm are most effective

Special lamps are used

Psoralen and Ultraviolet A phototherapy

 

Systemic Agents

** Pregnancy must be avoided in many of these treatments

* Re-occurrence of psoriasis after medications are stopped are often seen

Methotrexate – Immunosuppressant Drugs
Cyclosporine – Immunosuppressant Drugs
Retinoids – Synthetic form of Vitamin A

.   Biologics

Efalizumab – Target T-cells
Alefacept – Target T-cells

Infliximab – Monoclonal Antibodies
Adalimumab – Monoclonal Antibodies
Certolizumab pegol – Monoclonal Antibodies
Golimumab – Monoclonal Antibodies

Etanercept

Others

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