Psoriasis is a chronic, inflammatory skin condition caused by an immune system dysfunction and genetic factors. It is characterized by red, scaly plaques on the skin. The most common types are plaque and guttate psoriasis. Treatment involves topical creams and ointments containing corticosteroids, vitamin D analogues, or coal tar. For more severe cases, phototherapy or systemic medications like methotrexate may be used to suppress the immune system and slow skin cell growth. Psoriasis has no cure and treatment aims to induce remission of symptoms and improve quality of life.

1. PSORIASIS
HABAKUK LARRY OMONDI

2. Definition
• Comes from a Greek word meaning “ITCHING”
• An inflammatory autoimmune
papulosquamous eruption on skin
• increased epidermal proliferation resulting in
accumulation of stratum corneum.
• *Chronic, Benign, Non-contagious
• Predilection, extensor aspects of limbs, scalp

3. What causes it?
• Unknown
• Interplay of:
Genetics
Immune system
Environment

4. Complex disorder
• Immune system
Genes Environment

5. • A complex genetic disorder
- Possible genetic error in mitotic control
-1/3 have a family history of psoriasis
• Immune System: Activation of lymphocytes
-increase in inflammatory mediators
-growth of skin cell speed up

6. Genetic Basis for Psoriasis
FATHER MOTHER
One parents affected  ¼ (25%) of children will get it

7. Genetic Basis for Psoriasis
FATHER MOTHER
Two parents affected  2/4 (50%) of children will get it

8. Environment
• Infections
• Stress
• Changes in climate, such as cold weather
• Skin injuries, such as burns
• Certain medications
– lithium, beta blockers, anti-malarial drugs, and non-
steroidal anti-inflammatory drugs such as ibuprofen

9. Body involvement
• The scalp, knees,
elbows and torso
• The nails, palms, soles,
genitals and face
• Symmetrically = the
same place on the
right and left sides of
the body

10. Epidemiology

11. Cont…
• Family history
• Occur at any age
• Most common in people in their 20s and 40-
50s.
• Males=females

12. Classification
1. Discoid/Plaque psoriasis
Most common
Affects mostly: elbows, knees, gluteal cleft,
scalp, ears
Symmetrical
Nails may be pitted and/or thickened

13. Psoriatic plaque

14. Psoriatic Knee

15. Psoriatic scalp

16. Characteristics
1. Well demarcated
2. Thickened
3. Deep red plaques
4. Surmounted by silvery scales
5. Vary in size small(1-2cm) to large (entire
extensor surface)

17. 2. Eruptive/ Guttate psoriasis
• Most frequently in children
• Follows a beta hemolytic streptococcal
pharyngeal infection

18. Guttate psoriasis

19. Characteristics
1. Red
2. Oval/round
3. Scaly plaques
4. Upto 1cm in diameter
5. Mostly on trunk and proximal limbs

20. 3. Pustular psoriasis
• Localised/ generalised
• Localised esp on Palms and soles
• Can be annular in children
• Fever and malaise are common
• Also follows withdrawals from steroids

21. Localised
Palm Plantar

22. Generalised

23. Cont…
• Palmoplantar pustulosis
-common in adults
-manifests as crops of sterile yellow pustules
-0.1-0.5cm
-on palms and soles
-involute to red brown macules and scaling
• Erythematous plaques studded with pastules
appear at any site and become confluent

24. 4. Erythrodermic psoriasis
• Also exfoliative psoriasis/ redman syndrome
• Results from:
Pustular psoriasis
Triggered by infection
Overtreatment by tar
Sudden withdrawal of corticosteroids
• Pts at risk of: fluid & protein loss, poor temp
control and infection

25. Erythrodermic psoriasis
Widespread, Generalized erythema and scaling

26. 5. Rupioid Psoriasis
-Grossly hyperkeratonic
plaques
Rupia- very scaly,
heaped up and
secondarily infected
psoriatic lesion

27. 6. Inverse, flexural psoriasis
• Affects the flexural areas
• Lesions are moist and without scales
• Common in old people
• Sites mostly affected are:
Areola
Groin
Beneath breast

28. Beneath Breasts

29. Signs and Symptoms
1. Pruritus
2. Well demacated lesions
3. Silvery scale on red plaques
4. Knee-elbow-scalp distribution
5. Glans penis/vulva may be affected
6. Positive AUSPITZ sign(underlying pinpoints of
bleeding following scrapping)
7. Psoriatics often have pink/red intergluteal
fold

30. 8. Köbner Phenomenon

31. 9. Stippled nails and pitting and
onycholysis

32. 10. Psoriatic Arthritis- Affects mostly IP joints sparing
MC joints

33. Essentials of Diagnosis
1. Silvery scales on bright red plaques
2. Well demarcated plaques
3. Nail findings- pitting and onycholysis
4. Mild itching
5. Psoriatic arthritis

34. Investigations
1. FH- inc. leucocytes and ESR
2. Urine- Uric acid increases in 10-20%
3. Severe cases- anemia:B12, B9 and Fe
deficiency
4. Biopsy- Parakeratosis, hyperkeratosis,
Epidermal hyperplasia
5. Histology- Elongated rete ridges, inflamatory
cells(perivascular), munro microabsesses

35. Histology

36. Cont…

37. DDx
1. Tinea cruris
2. Candidiasis
3. Seborrheic dermatitis
4. Pityriasis rosea
5. Onychomycosis
6. Eczema

38. THERAPY

39. Treatment
• Is aimed at reducing cell turnover, underlying
inflammatory process and depends on the
areas of the body affected
• Current treatment also aims at altering the
immune response

40. Treatment cont…..
Available options are:
1. Topical
a) Emolient-decrease fissuring, cracking and
scalling. Forms-acqueous cream, urea cream
b) Tar – is the mainstay & available in rural
areas. E,g coal tar
c) Sulpur salycylate-scalp psoriasis(emulsion)

41. d) Dithranol-
E( Topical Calcipotriol (Vit. D3 derivative)-
indicated for chronic plaque psoriasis
f) topical Steroids – are useful for flexural and
scalp
Various preparations are available

42. Topical treatment cont…..
• Available preparations of steroids
include:
Betacort – (Bet. valerate 0.05%) mod. potent
Glovate – (Clob. Prop. 0.05%) very potent
Combinations eg Betasalic, Fucivate & Bulkot
Mixi Cream/oint (Beclomet. Dipro. 0.025%
plus Clotrm. 1% & Gentamy. 0.1%)

43. Treatment cont……
• Other adjuvant topical drugs include:
Keratolytics eg Salicylic acid, Benzoic acid urea,
etc
Emollients eg Vaselline, Xamana jelly, etc
• 2. Other measures – control of itching – use
antihistamines
Cetrizine (Zycet) Tabs, Syrup
Steramine (Betamet. 0.25mg &
Dexchlorpheniramine 2mg)

44. Adjuvant treatment
• For secondary infections-systemic or topical
antibiotics eg Dynocin, Cloxacillin, Cephalexin,
etc
• Topical include Fucimin (Sod. Fucidate 2%),
Silver Sulphadiazine, combined like Bulkot
Mixi or Fucivate, etc

45. Treatment cont…..
Systemic - used for very severe and extensive
forms of psoriasis.
• Methotrexate – 10-25mg IM/IV once weekly
• Azathioprine – 2mg/Kg P.O.
• Hydroxyurea
• Acitracin (Retinoids)-0.5-1mg/kg/day
• Cyclosporin-A – also used for suppression of
organ rejection-3mg/kg/day
• PUVA – photochemical therapy