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SHRI GANASAYA NAMAHA

SHRI GANASAYA NAMAHA. AN UPDATE ON PSORIASIS. BY DR. MAHESH MATHUR, MD,DVD,DCP (UK). DEFINITION. COMMON, CHRONIC GENETICALLY DETERMINED INFLAMATORY & PROLIFERATIVE

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SHRI GANASAYA NAMAHA

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  1. SHRI GANASAYA NAMAHA

  2. AN UPDATE ONPSORIASIS BY DR. MAHESH MATHUR, MD,DVD,DCP (UK)

  3. DEFINITION • COMMON, CHRONIC • GENETICALLY DETERMINED • INFLAMATORY & PROLIFERATIVE • CHARACTERISED BY - Well defined, - Dull red - Silvery white scaling - involving extensor aspect of body - great variability in extent of disease, morphology of lesions & duration of disease.

  4. EPIDEMIOLOGY • INCIDANCE & PREVELANCE 1.5 TO 4.8% • AGE OF ONSET - can occur at any age- 5 TO 9 YEARS IN FEMALE- TYPE -I 15 TO 19 YEARS IN MALE- TYPE-1 30 TO 40 YEARS- TYPE II RACEAL DIFFERENCE

  5. AETIOLOGY & PATHOGENISIS • INHERITED – NO SINGLE PATTERN, MULTIFACTORIAL MHC CLASS 1 –CW6- 80% ASSOCATION WITH TYPE I PSORIAIS • FAMILIAL - TWIN SUDY – MONOZYGOT PAIR 73% DIZYGOTC PAIR 20 % 50% SIBLINGS IN PROBAND WHEN BOTH PARANTS ARE AFFECTED

  6. PROVOCATION & EXACERBATION • TRAUMA • INFECTION • ENDOCRIN FACTO- Pregnancy, Menopause • SUN LIGHT • METABOLIC • DRUGS - lithium, beta blocker, antimalarials,systamic steroids • PSYCOGENIC • ALCOHOL • AIDS

  7. PATHOGENESIS • T CELL MEDIATED • KERATINCYTE PROLIFERATION • HLA CW 6

  8. IS IT AN IMMUNOLOGICAL DISEASE ?

  9. YES….. • CD4+ T CELLS IN DERMIS • CD8+ CELLS INFILTRATING IN EPIDERMIS – MHC I RESTRICTED • MACROPHAGES & NEUTROPHILS INFILTRATION • IL1,IL6,IL8,TGF alfa,LTC4, C5a • IMMUNO THERAPY BY • METHOTRAXTE

  10. T CELL MEDIATED

  11. PATHOLOGY & PATHOGENESIS • KERATINOCYTE PROLIFERATIVE ACTIVITY- • VASODILATATION OF DERMAL VASSELS * EIGHT FOLD SHORTENING OF EPIDERMAL CELL CYCLE * 36 ~311 h IN NORMAL *TWOFOLD INCRESE IN PROLIFERATIVE CELL POPULATION *100% OF GERMINATIVE CELLS ENTER IN GROWTH FRACTION- 35,000 CELLS/ SQ.mm~1218 CELLS/SQ.mm

  12. PATHOGENESIS

  13. CLINICAL PRESENTATION • CLINCAL VARIENT • PLAQUE PSORIASIS • GUTATE PSORIASIS • FLEXURAL • NAPKIN PSORIASIS • UNSTABLE - • PUSTULAR- LOCALISED & GENEREALISED • ERYTHRODERMIC • ARTHROPATHIC PSORIASIS

  14. PLAQUE PSORIASIS

  15. PLAQUE PSORIASIS

  16. PLAQUE PSORIASIS

  17. AUSPITZ SIGN

  18. PSORIASIS OF PALM

  19. PLAQUE PSORIASIS

  20. PLAQUE PSORIASIS

  21. PLAQUE PSORIASIS

  22. PSORIASIS OF SCALP

  23. SCALP PSORIASIS

  24. SCALP PSORIASIS

  25. CLINICAL PICTURE

  26. FLEXURAL PSORIASIS

  27. PUSTURAL PSORIASIS • LOCALISED - -THENER EMENECES & INSETP OF FOOT, - MORE IN FEMALES, -NO ASSOCIATION OF HLA ANTIGENS • GENERALISED - • FEVER,MALASE, SEVER CONSTITUTIONAL SYMPTOMS, • PUSTULAR ERYTHEMA, FLUXERAL INVOLMENT, TETANY,HYPOALBUMINAEMIA WITHDRAWAL OF STEROIDS,PREGNANCY

  28. PUSTULAR PSORIASIS

  29. GENEREALIZED PUSTULAR PSORIASIS

  30. GUTTATE PSORIASIS • POST STREPTOCOCAL BETA HAEMOLITICUS INFECTION • USUALLY CHILDREN • NO TYPICAL SCALES • RESOLVE SPONTENOUSLY

  31. GUTTATE PSORIASIS

  32. EXTENSIVE PSORIASIS

  33. ERYTHRODERMIC PSORIASIS HYPOTHERMIA WATER & ELECTROLITE BALANCE LOSS OF PROTEIN ANEMIA HYPERDYNAMIC CIRCULATION

  34. NAIL PSORIASIS NAIL PITTINGS ONYCHOLYSIS SUBUNGUAL HYPERKERATOSIS NAIL DYSTROPHIES

  35. NAIL PSORIASIS • NAL PITTINGS

  36. NAIL PSORIASIS • ONYCOLYSIS

  37. NAIL PSORIAIS

  38. NAIL PSORIASIS

  39. PSORIATIC ARTHRITIS • SERONEGATIVE ATHRITIS • INCIDENCE- 1.5 TO 3% • MALE FEMALE RETIO EQUAL • HLA ASSOCIATION HLA B27,A26,B38,DR4,DR3 • SKIN LESION PRECEDS IN 65% CASES • AGE OF ONSET- 40TO 60 YEARS

  40. CLINICAL TYPES - PREDOMINANTLY PERIPHERAL MONO OR OLIGO ARTHRITS - DISTAL INTERPHALINGIAL ARTHRITIS -SYMMETRICAL RHEUMATOID LIKE ARTHRITS - ARTHRITIS MUTILANS -AXIAL ARTHRITIS

  41. PSORIATIC ARTHROPATHY

  42. PSORIASIS ARTHROPATHY

  43. PSORIATIC ARTHRITIS

  44. ARTHRITIS MUTILANS

  45. Which of the following statements regarding Psoriasis is correct? • The prevalence in the UK is 10% • Psoriasis is more common at lower geographical altitudes • Guttate psoriasis is the most common form of the disease • 1% of patients have associated psoriatic arthropathy • Psoriatic arthropathy precedes cutaneous lesions in 29% of cases

  46. HISTOPATHOLOGY

  47. HISTOPATHOLOGY • MICRO MUNRO ABSCES FORMATION IN EPIDERMIS

  48. Which of the following statements regarding Psoriasis is most true? • Diagnosis requires histological confirmation • Guttate psoriasis often arises after staphylococcal infection • T-cells play a prominent role in the pathogenesis of psoriasis • Ciclosporin is ineffective in the treatment of psoriasis • Twin studies have identified no genetic basis for psoriasis

  49. MANAGEMENT • GENERAL • TOPICAL - GAOECKERMAN’S REGIMEN – 3 TO 6 % COAL TAR WITH UVA -INGRAM’S REGIMEN -0.05 TO O.1% DIATHRANOL -TOPICAL VIT.D - I Alfa,25-DIHYDROXY VIT.D 3 • CALCITRIOL • CALCIPOTRIOL 50 MICROGRAMS/GRAMS • TACALCITOL – 4 MICROGRAMS/GRAMS -TOPICAL CORTICO STEROIDS -TAZAROTENE -TACROLIMUS

  50. PUVA THERAPY • ULTRA VIOLATE (UV) RAYS – B 311nm • UVA WITH PSORALINS - PUVA SYSTAMIC – 0.6mg/kg LOCAL AS BATH 0.1 to 1 % solution

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