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Psoriasis

Discover what psoriasis is, its causes, and the various symptoms and types of this common autoimmune skin disease. Learn about available treatment options and how to manage the condition.

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Psoriasis

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  1. Psoriasis Lianjun Chen Huashan Hospital

  2. WHAT IS PSORIASIS? • A common, life-long, genetic, autoimmune skin disease • Characterized by well circumscribed areas of thick, red, scaly skin • From the Greek “psoros” meaning “rough, scabby” • Term first used (along with “lepra”) by Hippocrates (460-377 B.C.) in Corpus Hippocraticum • von Hebra first to distinguish psoriasis from leprosy in 1841

  3. Morbidity rate • Natural population: 0.1%~3%. Estimated 1.25 hundred million patients in the world • China(1984): 0.123%. • European country: 1.5%-3%. • America: 2.6%. • Hongkong:0.3%(2005 )

  4. Prevalence • Equal frequency in males and females • May occur at any age from infancy to the 10th decade of life • First signs of psoriasis • Females mean age of 27 years • Males mean age of 29 years

  5. Prevalence • Two Peaks of Occurrence • One at 20-30 years • One at 50-60 years • Psoriasis in children • Low – between 0.5 and 1.1% in children 16 years old and younger • Mean age of onset - between 8 and 12.5 years

  6. Etiopathogenisis 1.Theory of heredity  Family positive of psoriasis is 4~91％, 11.9~32% in china  Concordance rate in twins: monozygotic twins> binovular twins  High frequency in HLA-A1,B17,Cw6,DR7, a multifactorial inheritance disease

  7. PSORS9 4q31-q32 zhang Xuejun,2002

  8. Psoriasis, an inherited disease If you have psoriasis, what is the risk to: • Your unrelated neighbor? About 2% • Your sibling? 15-20% • Your identical twin? 65-70% • Your child? 25%-50%

  9. Etiopathogenisis 2.Theory of infection bacterial infection(esp.streptococcus) fungal infection bacteria fungi (streptococcus、superantigen) (yeast fungus) lymphocytes activated alternative complement pathway clonal proliferation functional disorder of immune system

  10. Etiopathogenisis 3.Abnormal immune function : cellular immunity function reduce partly early skin lesions are infiltrated predominantly by lymphocytes autoantibody deposit in the horny layer Th1/Th2 disequilibrium theory(Th1 dominant skin disease)

  11. Etiopathogenisis 4.Dysmetabolism: cAMP metabolic block of arachidonic acid、 cGMP polyamines shortened epidermal cell transit time, hyperplasia 5.others: psychosis,neuroendocrine,climate,medicine , et al may induce or aggravate the disease.

  12. Clinical Presentation • Erythematous papules/patches/plaques with silvery scales • Symmetric • Pruritic/ Painful（sometimes） • Pitting Nails • Arthritis in 10-20% of patients • Exacerbate in winter ,improve in summer

  13. Clinical Types • Psoriasis Vulgaris • Psoriasis Arthropathica • Psoriasis Pustulosa • Psoriasis Erythrodermica

  14. Psoriasis Vulgaris • red papule/plaque • silvery white scales • film phenomenon • pinpoint bleeding Auspitz’s sign

  15. P S O R I A S I S Disorganized N O R M A L STRATUM CORNEUM Neutrophil accumulation STRATUM GRANULOSUM STRATUM SPINOSUM Immaturity Proliferation STRATUM BASALE DERMIS

  16. Predilection site

  17. CLASSIC ANATOMIC LOCATIONS FOR PSORIASIS • Scalp (80%) • Elbows (78%) • Legs (74%) • Knees (57%) • Nails (10-55%) • Gluteal cleft • Palms/soles (12%)

  18. Guttate Psoriasis • Characterized by numerous 0.5 to 1.5 cm papules and plaques • Early age of onset • Most common form in children • Streptococcal throat infection often a trigger • Spontaneous remissions in children • Often chronic in adults

  19. Psoriasis guttata

  20. Chronic Plaque Psoriasis

  21. Psoriatic Plaque

  22. Geographic Psoriasis

  23. Rhagades and thickness scales in palms and soles

  24. Fascicle-like hair

  25. Psoriasis of genitalia scantiness of scale

  26. Flexural psoriasis (Psoriasis of vulvae,red plaque with little scaling)

  27. PSORIATIC NAIL CHANGES • Onycholysis • “Oil drops” • “Salmon patches” • Pitting • Subungual debris • Onychodystrophy • Splinter hemorrhages

  28. Thimble pitting in nails

  29. TRIGGERS FOR PSORIASIS • Direct skin injury (Koebner phenomenon) • Discontinuation of systemic corticosteroids • Cold weather • Streptococcal pharyngitis • Emotional stress • Alcohol intake • Smoking • HIV • Medications

  30. DRUGS THAT CAN EXACERBATE PSORIASIS • *Beta blockers • *Lithium • *IFN-alpha • Antimalarials • ACE inhibitors • *Rebound with withdraw of prednisone and cyclosporine

  31. STAGE OF PSORIASIS • Active stage: large amounts of new lesions,red and pruritus • Resting stage: dark red lesions without new eruption • Regression stage: erythema fade, flatten and disappear

  32. Koebner Phenomenon • Mechanical injury,insect bite,cold injury, sun shine et al • Normal skin of patients in active stage express typical new lesions • Clinical significance: suggest disease in active stage

  33. Course of psoriasis • exacerbate in winter ,improve in summer • chronic and persistent • clear spontaneously, recur frequently

  34. Diagnosis and differential diagnosis • Diagnosis: lesions,types and stages • Differential diagnosis: • pityriasis rosea • secondary syphilis • Seborrheic dermatitis • chronic eczema

  35. Generalized Pustular Psoriasis • Unusual manifestation of psoriasis • Can have a gradual or an acute onset • Characterized by waves of pustules on erythematous skin often after short episodes of fever of 39˚ to 40˚C • Weight loss • Muscle Weakness • Hypocalcemia • Leukocytosis • Elevated ESR

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