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Psoriasis

Psoriasis. Dr Abbas Pardakhty , 2011 Kerman Faculty of Pharmacy. Prevalence. Psoriasis occurs in 2% of the world’s population Prevalence in the U.S may be as high as 4.6% Highest in Caucasians In Africans, African Americans and Asians between 0.4% and 0.7%. 3. Prevalence.

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Psoriasis

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  1. Psoriasis Dr Abbas Pardakhty, 2011 Kerman Faculty of Pharmacy

  2. Prevalence Psoriasis occurs in 2% of the world’s population Prevalence in the U.S may be as high as 4.6% Highest in Caucasians In Africans, African Americans and Asians between 0.4% and 0.7% 3

  3. 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 4

  4. 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 5

  5. Prevalence Two-thirds of patients have mild disease One-third have moderate to severe disease Early onset (prior to age 15) Associated with more severe disease More likely to have a positive family history Life-long disease Remitting and relapsing unpredictably Spontaneous remissions of up to 5 years have been reported in approximately 5% of patients 6

  6. Genetics and Pathogenesis Psoriasis and the Immune System The major histocompatibility complex (MHC) Short arm of chromosome 6 Histocompatibility Antigens (HLA) HLA (human leukocyte antigen)-Cw6 HLA-B13, -B17, -B37, -Bw16 T-lymphocyte-mediated mechanism 7

  7. Psoriasis as a Systemic Disease Koebner Phenomenon Elevated ESR Increased uric acid levels → gout Mild anemia Elevated α2-macroglobulin Elevated IgA levels Increased quantities of Immune Complexes 8

  8. Psoriasis as a Systemic Disease Psoriatic arthropathy Aggravation of psoriasis by systemic factors Medication Focal infections Stress Life-threatening forms of psoriasis 9

  9. Physical trauma: These injuries include endogenous and exogenous causes such as photosensitivity, dermatitis, herpes zoster, abrasions, burns, bites, shaving, surgery, and tattoos, among others. • Infection: Streptococcal pharyngitis and HIV type 1 appear to be triggers

  10. Clinical Variants of Psoriasis 12

  11. Clinical Types • Guttate • Chronic Plaque • Flexural • Pustular • Nail Psoriasis • Erythroderma • Arthropathy

  12. Characteristic Lesion of Psoriasis Sharply demarcated erythematous plaque with micaceous silvery white scale Histopathology Thickening of the epidermis Tortuous and dilated blood vessels Inflammatory infiltrate primarily of lymphocytes 15

  13. Psoriatic Plaque 16

  14. Severity of Disease Three Cardinal Signs of Psoriatic Lesions Plaque elevation Erythema Scale Body Surface Area 17

  15. Chronic Plaque Psoriasis Most Common Variant Plaques may be as large as 20 cm Symmetrical disease Sites of Predilection Elbows Knees Presacrum Scalp Hands and Feet 18

  16. Chronic Plaque Psoriasis 19

  17. Chronic Plaque Psoriasis 20

  18. Chronic Plaque Psoriasis May be widespread – up to 90% BSA Genitalia involved in up to 30% of patients Most patients have nail changes Nail pitting “Oil Spots” Involvement of the entire nail bed Onychodystrophy Loss of nail plate 21

  19. Widespread Chronic Plaque Psoriasis 22

  20. Chronic Psoriasis 23

  21. Psoriasis of the Nail 24

  22. Psoriasis of the Nail 25

  23. Symptoms of Chronic Plaque Psoriasis Pruritus Pain Excessive heat loss Patient Complaints Unsightliness of the lesions Low self-esteem Feelings of being socially outcast Excessive scale 26

  24. 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 27

  25. Guttate Psoriasis 28

  26. Life–Threatening Forms of Psoriasis Generalized Pustular Psoriasis Erythrodermic Psoriasis 29

  27. 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 30

  28. Generalized Pustular Psoriasis Cause is obscure Triggering Factors Infection Pregnancy Lithium Hypocalcemia secondary to hypoalbuminemia Irritant contact dermatitis Withdrawal of glucocorticosteroids, primarily systemic 31

  29. Generalized Pustular Psoriasis 32

  30. Erythrodermic Psoriasis Classic lesion is lost Entire skin surface becomes markedly erythematous with desquamative scaling. Often only clues to underlying psoriasis are the nail changes and usually facial sparing 33

  31. Erythrodermic Psoriasis Triggering Factors Systemic Infection Withdrawal of high potency topical or oral steroids Withdrawal of Methotrexate Phototoxicity Irritant contact dermatitis 34

  32. Erythrodermic Psoriasis 36

  33. Psoriasis Treatment

  34. Session 3

  35. Psoriasis treatment • Topical • Systemic • Phototherapy

  36. Vehicle-Penetration Enhancer-Viscosity Enhancer Rx Psoriasis Lotion (100 mL) Coal tar solution 5 mL Salicylic acid 5 g Urea 10 g Triamcinoloneacetonide 160 mg Propylene glycol qs 100 mL Dissolve the urea and salicylic acid in about 75 mL of propylene glycol; this may take 30 to 45 minutes. Add the triamcinoloneacetonide and mix well. Incorporate the coal tar solution and mix well. Add sufficient propylene glycol to make 100 mL and thoroughly mix. Package and label. Coal tar Solution: coal tar 20%, polysorbate 80 5%, in alcohol (96%),

  37. Coal tar and Salicylic acid ointment • Coal tar 2g • SA 2g • Emulsifying wax 11.4g • Polysorbate 80 4g • Liquid paraffin 7.6g • White soft paraffin 19g • Coconut oil 50g

  38. Tar-based shampoos (Neutrogena T/Gel). Coal tar, a byproduct of the coal manufacturing process, helps conditions such as dandruff, seborrheic dermatitis and psoriasis by slowing cell turnover. abpardakhty@kmu.ac.ir 46

  39. Neutrogena T/Gel abpardakhty@kmu.ac.ir 1% Coal Tar 47

  40. Coal tar shampoo abpardakhty@kmu.ac.ir Dandruff Seborrheic dermatitis Psoriasis Wash first time Remain the foam for 5 min at second time Photosensitizer 48

  41. Polytar abpardakhty@kmu.ac.ir Wet the scalp and hair. Apply the medicine to the scalp, massage into a lather, and allow it to remain on the scalp for 5 minutes. Rinse thoroughly and repeat. Wash your hands after using Coal Tar Shampoo. If you miss a dose of Coal Tar Shampoo, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once. 49

  42. سالیسیلیک اسید abpardakhty@kmu.ac.ir منع مصرف در: کودکان زیر دو سال خانمهای باردار دیابت آبله مرغان، زونا و آنفلوآنزا بیماران دارای اختلالات گردش خون 50

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