Caused by an immune system sending out faulty signals that speed the growth of the skin cells
Is classified as a chronic immune-medicated disease.
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.
Is a skin condition that effects the first layer of the epidermis [skin].
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.
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
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