2018 / 3 January

Psoriasis


Psoriasis a chronic, noncontagious, multifactorial inflammatory skin condition.

Classification

  • Plaque psoriasis or psoriasis vulgaris
    Most common
    Well-defined erythematous plaques with scales
    Typically over extensor surfaces
  • Inverse/intertriginous psoriasis
    Plaques with minimal scaling in skin folds (retroauricular, axillary, inframammary, inguinal, genital sites)
  • Pustular psoriasis
    Pustules rather than plaques
    Two primary variations: Von Zumbusch is the generalized form and acrodermatitis continua (feet and hands)
  • Erythrodermic psoriasis
    Generalized erythema covering almost entire body surface area
    A medical emergency
    It may be induced by withdrawal from oral corticosteroid
  • Guttate psoriasis
    1- 10 mm pink macules with scaling
    The second more common subtype
    It’s often seen in younger patients (children and young adults)

Physical findings of plaque psoriasis

  • Well-circumscribed, pink papules and flat-topped plaques with silvery scales
  • Common locations
    scalp
    trunk
    buttocks
    extensor surface of limbs
  • Positive Auspitz sign
    when scales are scraped off, there is pinpoint bleeding results from exposure of dermal papillae
  • Nail changes
    pitting
  • Koebner’s phenomenon
    psoriatic lesions appear at site of cutaneous physical trauma

Medications that may exacerbate psoriasis include beta blockers (such as propranolol), NSAIDs, ACE-inhibitors, anti-malarial drugs, and lithium.

Between 20-30% of patients with psoriasis have Psoriatic Arthritis. It usually mandates some form of systemic therapy, even if the skin involvement is relatively limited. It trends to after small joint rather than the axial skeleton.

Psoriatic nails clinical features: “oil spot”, distal onycholysis and subungual debris. At least 50% of patients with psoriasis have scalp involvement and psoriasis and seborrhea features may overlap (sebopsorisis).

No cure for psoriasis currently exist; however, different treatment modalities may be used to ameliorate signs/symptoms and improve quality of life.

  • Topical therapy: topical corticosteroids, vitamin A and D analogs, salicylic acid shampoos and foams, creams and lotions with urea, lactic acid and, ammonium lactate. Patients with mild, limited and early psoriasis.
  • Phototherapy: patients with widespread psoriasis (moderate to severe disease) Broadband or narrowband UVB or UVA light, following psolaren sensibilization (P+UVA).
  • Systemic Therapy: it could be with disease-modifying antirheumatic drugs (DMARDs) and biological agents, as well other medications such as Apremilast.

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