4. It is a chronic non-infectious inflammatory skin
disorder, characterized by well-defined
erythematous plaques bearing large adherent
silvery scales.
Psoriasis is a very common skin disease. One to
three per cent of most populations have
psoriasis
It can start at any age. Its course is
unpredictable but is usually chronic with
exacerbations and remissions.
5.
6. CAUSE AND PATHOGENESIS
The cause is unknown, but there is a large familial
predilection. Precipitating factors include:
• Trauma.
• Intercurrent infection (post-streptoccocal sore
throat )
• Certain drugs(β-blockers, anti-malarials
lithium).
• Stress and anxiety.
8. The main changes are the following.
1-Parakeratosis (nuclei retained in the cells of horny
layer).
2-Irregular thickening of the epidermis, but thinning
over dermal papillae is apparent clinically when
bleeding is caused by scratching and the removal of
scale (Auspitz’s sign).
3-Polymorphonuclear leucocyte microabscesses.
4-Dilated and tortuous capillary loops in the dermal
papillae.
5-T-lymphocyte infiltrate in upper dermis.
9.
10. CLINICAL PICUTRE
There are five main clinical presentations:
Stable plaque psoriasis: This the most common type,
consisting of the well-recognised salmon-pink plaques
with silvery scale arising on the elbows, knees and
back. The scalp is involved in ∼60% of patients. Nail
disease is common, with pitting of the nail plate,
onycholysis or subungual hyperkeratosis. Psoriasis of
the flexures (e.g. natal cleft, axillae, submammary
folds) looks red, shiny and symmetrical, but not scaly.
11.
12.
13.
14. Guttate psoriasis: This occurs more frequently in
children , and often follows a streptococcal sore
throat. The onset is rapid, and the lesions consist
of small rain drop-sized scaly plaques. Guttate
psoriasis responds well to phototherapy. The
majority of these patients later develop plaque
psoriasis.
15.
16. Erythrodermic psoriasis: This is one of the
dermatological emergencies . Over 90% of the body
surface becomes erythematous and scaly. It is
often accompanied by systemic upset due to the
high loss of heat and fluid from the inflamed skin.
.
17. Pustular psoriasis: This may be generalised or
localised. The rare generalised form is a dermatological
emergency, presenting with large numbers of sterile
pustules on an erythematous base. The patient is
unwell with swinging pyrexia, and requires hospital
admission. The localised form is less serious, though
extremely uncomfortable, and generally affects the
palms and the soles (palmoplantar pustulosis). This
condition particularly affects middle-aged female
smokers.
Psoriatic arthropath.
21. PSORIASIS DX
Psoriasis can be diagnosed clinicaly and biopsy
rarely needed. dermoscope can be very helpful.
Throat swabbing for β-haemolytic streptococci is
needed in guttate psoriasis.
Skin scrapings and nail clippings may be required to
exclude tinea.
Radiology and tests for rheumatoid factor are
helpful in assessing arthritis.
22. PSORIASIS TREATMENT
General measures Explanations and reassurances to
the patient and his family.
The disease is not contagious.
treatment must never be allowed to be more
troublesome than the disease itself.
At present there is no cure for psoriasis; all
treatments are suppressive and aimed at either
inducing a remission or making the condition more
tolerable.
No treatment, at present, alters the overall course
of the disease.
management of acute episodes.
Concomitant anxiety and depression should be
treated on their own merit.
23. Topical agents: Corticosteroids ,Dithranol, tar,
and vitamin D analogues (calcitriol, calcipotriol)
Local retinoids, all reduce plaques.
Phototherapy: UVB or psoralen (photo-
sensitiser) plus UVA (PUVA) are effective in
moderate to severe psoriasis, but carry a long-
term risk of skin cancer.
24.
25. Systemic treatment
A systemic approach should be considered if
extensive psoriasis (more than 20% of the body
surface) fails to improve with topicals and
phototherapy .As the potential side-effects are
great. The most commonly used systemic
treatments are , retinoids, methotrexate and
cyclosporin.
27. Definition :
It is idiopathic inflammatory disease of the
skin , mucous membrane ,hair and nails
LP is a common disease affects 1% of the
population .
There is no sex predilection.
28. Clinical presentation :
Lp presents as 5P
1-plane (flat topped )
2- polygonal
3- purple
4- pruritic
5- papules
Common involvement sites :flexural side of the
wrists ,back of the hands , glans penis , medial
side of thighs and lumbar region
The papules may coalesce into plaques.
After resolution of the lesions ,deep
pigmentation is left for several months
29.
30. Oral lesions :
Presented as :
1-White reticular streaks
2-erosive lesions (carry a risk of squamous cell
carcinoma transformation ). Erosive lichen occur
in patients with hepatitis c infection.
Nail lesions :can lead to scarring and loss of the
nails
Hair affection can lead to cicatricial alopecia
31.
32.
33. Investigations :
The diagnosis is usually obvious clinically.
The histology is characteristic , so a biopsy
will confirm the diagnosis if necessary.
In case of erosive oral lichen we must
exclude malignant transformation , and
hepatitis c infection .
34. Treatment
1- antihistamine to reduce itching.
2-Potent topical steroids (dermovate
ointment ) for localized disease.
3-Systemic steroid (0.5 mg per kg ) for short
course (for wide spread and extensive
involvement, nail destruction or painful and
erosive oral lichen planus after heptatis c
exclusion).
4-photochemotherapy (PUVA) or narrow-band
therapy UVB.
5-Acitretin /methotrxate
/hydroxychloroquine all can be beneficial.
36. Pityriasis Rosea :
Is a common ,self limited skin eruption occur
mainly in adults.
Occurs more in females .
Increase incidence in spring and autumn.
Etiology :
Some studies reported that HHV6 and HHV7
have a role , and PR occurs as a
hypersensitivity reaction to the viral infection
but it still not confirmatory .
37. C/P:
Most patients develop one plaque (the ‘herald’
or ‘mother’ plaque) before the other lesions. It
is larger (2–5 cm in diameter) than later lesions,
and is oval, erythematous and more scaly. After
several days many smaller plaques appear,
mainly on the trunk, but some also on the neck
and extremities. About half of the patients
complain of itching. An individual plaque is oval,
salmon pink and shows a delicate scaling,
adherent peripherally as a collarette. The
configuration of such plaques is often
characteristic along the lines of the rib called
christmas tree pattern.
38.
39.
40.
41. Dx : by clinical picture
Dermoscope very helpful to support the
diagnosis
Biopsy for atypical cases.
Rx :
Reassurance ,avoid trauma and rubbing.
Antihistamine for itching, and emolient.
Topical steroids for mild cases.
For sever cases : NB-UVB.
43. History
A 29-year-old man attends your clinic with a 4-
year history of a recurrent and itchy facial
eruption. He is currently studying for business
exams and feels the associated stress has
triggered the current flare.
He is otherwise well and on no medication.
Examination:
There are poorly defined erythematous patches with
overlying adherent greasy scale affecting his naso-
labial folds and extending onto his cheeks. His
eyebrows , scalp, nape of his neck and central chest
are similarly affected ( notice the distribution of
the skin lesions).
44. Questions
• What is your?
• What age groups are affected?
• How would you treat this patient?
45.
46. History
A 25-year-old man presents with a rash on his
knees ,elbow and dorsum of hands. This had
gradually worsened over three years. In addition
he had previously had dandruff and more recently
noticed his nails changing. His sister had a similar
rash over her elbows . The patient mentioned that
he had joints pain.
Examination
There are erythematous plaques on his knees
elbow and dorsum of hands with clearly defined
borders and overlying white silver scale thick scale
. There is fine scale throughout the scalp.
Examination of his finger nails reveal three nail
plates with pitting and onycholysis .
47.
48.
49. What is your diagnosis ?
Is his joint pain relevant ?
50.
51. 30 years old female patient , presented with
itchy skin lesions for 1 month duration . The
patient said that the skin lesions increasing
in number.
O/E : there was multiple plane violaceus
papules on flexural side of the wrist joint ,
trunk and post-inflammatory
hyperpigmentation.
What is your diagnosis ?
What are the sites that you must examine in
this patient?
52.
53.
54. History
An 18-year-old girl develops a widespread rash 5
days after a sore throat. She had similar attack
before 2 weeks .The patient had no other
symptoms.
Examination
There are multiple erythematous small discrete
plaques and papules with overlying scale
predominantly over her trunk but also affecting her
limbs. Her face and scalp have been spared. Her
nails are normal . Examination of her throat reveals
some erythema over her pharynx, but no pustules
are seen.
