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Understanding Psoriasis: A Chronic Skin Disease Explained

Psoriasis is a chronic, papulosquamous skin disease characterized by widespread erythematous papules and plaques with micaceous scales, affecting areas such as the extensor surfaces of limbs, scalp, and buttocks. This condition arises from accelerated epidermal cell reproduction resulting in scaling. Genetic and environmental factors contribute to its prevalence, primarily affecting individuals aged 15-35 and often seen in Caucasian males. Treatment varies from topical to systemic therapies, including the use of biologicals, aimed at managing symptoms and minimizing outbreaks.

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Understanding Psoriasis: A Chronic Skin Disease Explained

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  1. Definition * Chronic papulosqamous disease of unknown etiology characterised by multiple erythematous papules & plaques with micaceous scales mainly involving extensor aspect of legs,elbows,lower buttocks,scalp due to accelerated epidermopoiesis In simple words, * A Chronic (longlasting) skin disease characterized by scaling and inflammation. Scaling occurs when cells in the outer layer of skin reproduce faster than normal and pile upon the skin’s surface

  2. Etiology • Genetic factors • - Autosomal dominant with incomplete penetrance. • - Increased prevalence of HLACw6. • - 9 locations on different chromosomes that are associated wit psoriasis. • Major determinant is PSORS1,which is located on chromosome 9 in MHC.3genes in PSORS1 locus have a strong association with psoriasis vulgaris. • Environmental factors

  3. Who is infected? • About 1 to 2% of the U.S population or 5.5 million people get infected. • Mostly common between the age 15 to 35 years old. • Mostly frequently occurs are male Caucasians population. • It is also inherited

  4. Triggering Factors * Stress * Alcohol * Drugs - AntiHT(beta blockers) - Lithium - Antimalarials(chloroquine) - NSAID's-(Aspirin,Ibuprofen) * Infection * Sunlight * Climate * Metabolic Factors like Pregnancy * Trauma & surgery

  5. Clinical Picture • Predominantly affects extensor aspects of extremities & lumbosacral area of trunk • Erythematous papules and plaques wit white micaceous scales • Classically lesions demonstrate AUSPITZ sign • Method of doing this test is called GRATTAGE Test • +ve koebners phenomenon • Associated nail & joint involvement

  6. Pathology • Skin -> 1.Epidermis • 2.Dermis • 3.Hypodermis • Skincells are created in the dermis and is moved to through the epidermis to the skin surface. • Process takes 28-30 days • In psoriasis patients hyperpoliferation takes place • Transit time is shortened to 4-5 days, thus scales appear in the skin

  7. Types of Psoriasis • Psoriasis vulgaris • Guttate psoriasis • Palmoplander psoriasis • Flexular psoriasis • Psoriatic arthrcpathy • Erthrodermic psoriasis • Psoriasis of nails

  8. Types of Psoriasis According to the site of involvement it is specified as • Scalp psoriasis • Palmoplantar psoriasis • Nail psoriasis • Acropustolosis

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  12. HPE • Hyperkeratosis • Parakeratosis • Acanthosis • Papillomatosis • Munromicroabscesses • Suprapapillary thinnin of epidermis

  13. Diagnosis • Clinical Features - Primary Test • Grettage test - Diagnosis • Biopsy - Confirmation • How severe • 1. Mild -> affecting < 3% of skin • 2. Moderate -> affecting 3-10% of skin • 3. Severe -> depends on the following • Proportion of body surface affected • Disease activity • Response of previous therapies • Impact of disease on the person

  14. Differential Diagnosis • Secondary Syphilis • Lichen Planus • Pityriasis Rubra Pilaris • Seborrheic Dermatitis

  15. Types of Treatment Three types of treatment, also called 1-2-3 approach • Topical treatment • Systemic treatment • Photo therapy treatment

  16. Type of Treatment Topical Treatment Coal tar application over lesions * Icthyol salicylic ointment-6%ichthyol+35%salicylic acid used. * Goeckermans regime - daily application of tar, UVR exposure Dithramol * 0.1 to 1 %conc used * ointment based anthralin applied to lesions n washed off after 30 min to 2hr application time

  17. Type of Treatment Topical Treatment Calapotrial * It is a Vitamin d3 analogue * Effective 4 both short n long term treatment of psoriasis * Mainly used 4 resistant localized psoriatic patches * Highly expensive Tazarotene * 0.1% to 0.05%gel * Modified vitamin A molecule formulated as topical agent * Mainly used for treatment of nail psoriasis Topical steriods * Mild to moderate psoriasis * Clobetasol propionate,halobetasol used * Reduces the itching n redness

  18. Type of Treatment Systemic treatment • Methotrescale • * Antometabolie,folic acid antagonist • * Inhibits mitosis • * Drug of choice in psoriatic arthropathy • * Dose : 7.5mg to 15mg/week • Puva Therapy • * Psoarlen,photosensitising agent • * Pro drug that upon oral administration is distributed through out the body,bt is only activated by UVR in those sites that are exposed to uva • * Taken on alternate days • * Puva sol-psoralen +exposure to sunlight • * Patient need to wear UVR resistant glasses for 24 hrs after therapy

  19. Type of Treatment Systemic treatment • Oral retinoids • * Especially for pustular patients • * 0.5mg to 1mg/kg body wt • Cyclosporine • * Immunosuppressive • * Dose 2.5 to 5 mg/kg body wt per day • Biologicals • * Infliximab, etanercept • * Other drugs that can b used are hydroxy urea and sulfasalazine

  20. Type of Treatment Systemic treatment • Hydroxyurea • Antibiotics • * Doxycycline • * Polymorphonuclear chemotaxis • Rotating treatment • * All modalities of Rx used for wide spread severe patients • * Have side effects when used for long time • * So switch the medicine in 1-2 years

  21. Type of Treatment • Photo therapy treatment • UVB photo therapy • PUVA (ultraviolet A (UVA)

  22. Course of the Disease • Psoriasis is a lifelong condition. • Many of the most effective agents used to treat severe psoriasis carry an increased risk of significant morbidity including skin cancers, lymphoma and liver disease. • Controlling the signs and symptoms typically requires lifelong therapy.

  23. Thank you

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