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NAZRUL (PSORIASIS) September 18th .pdf


Original filename: NAZRUL (PSORIASIS) September 18th.pdf
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PSORIASIS
Def: Psoriasis is a genetically determined
chronic relapsing and remitting
inflammatory skin disorder which may
appear at any age and affect any part of the
skin surface, most usually characterized by
symmetrical, well-defined red plaques with
a thick silvery scales, but with a number of
morphological subtypes preferentially
localized to extensor surface.
Sometimes it is associated with joints and
nail disorders.

AETIOLOGY:
Not yet known. Affects 1-2% of white population.
Common among Indian subcontinental.
Rare among American black , West Indian
and Japanese.
One-third of patients have a positive family history.
Association with HLA-B13, B17, B27 & CW6.
Psoriasis may develop in sites of injury (Koebner
Phenomenon). Males & females are affected equally.
Age of onset with largest peak in the second decade
and another at about 50 years of age.

Bacterial (Streptococcal) in case of guttate psoriasis
& viral (HIV) in case of AIDS develop a very severe
and aggressive type of psoriasis.

Drugs like ß-blocker, antimalarial, lithium,
practolol and NSAID can produce or aggravate
psoriasiform lesion. Withdrawal of systemic
corticosteroids sometimes flare psoriasis.
Smoker and alcohol intaker are more affected
than general population.

Pathology:
There is epithelial hyperproliferation indicating
faster epidermal turnover. In the epidermis there
is acanthosis, hyperkeratosis, parakeratosis,
absence of granular layer, elongated clubbed and
fused rete ridges. Mitotic changes in suprabasal
layer. Munro microabseses in stratum corneum
& kogoj abscess in upper epidermis where there
is accumulation of neutrophils. In papillary
dermis dilated capillaries surrounded by
polymorphs & some mononuclear cells.

Clinical Variants:
SKIN & SCALP PS (PS VULGARIS):

Usually asymptomatic

Classic chronic plaque Ps:
Common sites (usually extensors & symmetrical) are
knees, elbows, sacrum and scalp.
Well-defined red plaque with white or silvery scales.
Course is chronic.

Guttate (Latin gutta) Ps.
Usually in adolescent. Often
precipitated by streptococcal sore
throat (2-4 weeks later).
Small red papules with thick white
scales specially on trunk & limbs.
Usually resolves within 8-12
weeks.

Sequel is:
Change to chronic plaque type.
Further attacks following streptococcal
infection.
Permanent remission.

Seborrhoeic or Flexural or Inverse Ps.
Psoriasis in the seborrhoeic areas of scalp, face,
ears, upper back, chest and body folds with less
typical erythematous scaly eczematous lesion. It is
very resistant to treatment.

Erythrodermic Ps.
Severe & widespread
plaque psoriasis
sometimes progress to
generalized skin
involvement, becomes
red & scaly.

They suffer from:
Heat loss due to increased blood supply
to the skin leading to hypothermia.
Water loss leads to dehydration.
Cardiac output failure may be due
to hyperdynamic circulation.
Deficiency states may develop due to
loss of protein & electrolytes via
exudates and shed scales.
Due to pruritus, malaise & discomfort
the patient becomes depressed.

Palmoplantar pustulosis (PPP):
Yelowish-white sterile pustules mainly
on central parts of palms and soles.

Older lesions take a brownish appearance and
shed scales, becomes inflamed and fissured.
Resistant to treatment and subject to relapses
with remission.

Generalized pustular Ps (GPP):
Named von zumbusch disease. Usually starts
suddenly with systemic upset, pyrexia and
arthralgia and with high polymorphoneuclear
leukocytosis.
Skin becomes erythrodermic &
develops sheets of sterile pustules over trunk and
limbs.


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