1.
Psoriasiform Lesions

2.
<ul><li>Some things common </li></ul>

3.
Epidermal hyperplasia

6.
<ul><li>Elongation of rete ridges </li></ul>

8.
Psoriasis

9.
<ul><li>Psoriasis </li></ul><ul><li>Greek word for 'itch' </li></ul>

10.
<ul><li>“ chronic </li></ul><ul><li>non-infectious </li></ul><ul><li>erythematous plaques & papules </li></ul><ul><li>silvery scales </li></ul><ul><li>extensor distribution” </li></ul>

11.
<ul><li>Psoriasis vulgaris </li></ul><ul><li>(common) </li></ul>Chronic Relapsing Papulosquamous dermatitis

12.
<ul><li>Incidence : 2 % </li></ul><ul><li>All Races </li></ul><ul><li>More in western people </li></ul><ul><li>Mean age - 25 yrs </li></ul>

13.
<ul><li>Chr - 6P21.3 </li></ul><ul><li>Associated with - HLA-CW0602 </li></ul><ul><li>(PCR) </li></ul>

14.
How the patient presents ?

15.
<ul><li>Erythematous plaques </li></ul><ul><li>with </li></ul><ul><li>Silver scaling </li></ul>

16.
<ul><li>When the scales are removed … </li></ul>

17.
<ul><li>Auspitz’s sign </li></ul>It bleeds

18.
Capillaries Scratch

19.
<ul><li>Which sites are involved ? </li></ul>

29.
<ul><li>Scalp , </li></ul><ul><li>Lips no involved </li></ul><ul><li>Oral lesions are rare </li></ul>

30.
<ul><li>5 % cases --- Polyarthritis </li></ul>

31.
<ul><li>Do we know the Cause ? </li></ul>

32.
<ul><li>Trigger factors </li></ul><ul><li>Trauma </li></ul><ul><li>Infection </li></ul><ul><li>Drugs : Lithium, iodine , B blockers, </li></ul><ul><li>Carbamazepine, NSAIDS, ACE inhibitors </li></ul><ul><li>Climate </li></ul><ul><li>Hormone, </li></ul><ul><li>Stress </li></ul><ul><li>Alcohol </li></ul><ul><li>Smoking </li></ul>

33.
<ul><li>Lesions after Trauma </li></ul><ul><li>(Koebner phenomenon) </li></ul><ul><li>30 % cases. </li></ul>

34.
<ul><li>What is the Pathogenesis ? </li></ul>

35.
Y Y Y Its an Immune reaction

36.
<ul><li>“Problem in signal transduction” </li></ul>Initiation

37.
<ul><li>Cytokine </li></ul><ul><li>transcription regulation </li></ul><ul><li>problems </li></ul>

38.
Stimulation of immunity by super antigen

39.
<ul><li>Problem in signal transduction in between the cells </li></ul><ul><li>Cytokine transcription regulation problems </li></ul><ul><li>Stimulation of immunity by super antigen </li></ul>Initiation

40.
Blood vessels in the papillary dermis Disease process starts here

41.
<ul><li>Blood vessels in the papillary dermis </li></ul>Dilatation and tortuosity

42.
<ul><li>Angiogenesis </li></ul><ul><li>(TGF alfa, IL 8 ) </li></ul><ul><li>Size of microcirculation Expands </li></ul><ul><li>New vessels bring T lymphocytes </li></ul>

43.
<ul><li>Lymphocyte recruitment in papillary dermis </li></ul><ul><li>(PAF, LB4) </li></ul><ul><li>Lymphocytes come and bind to endothelial </li></ul><ul><li>cells in venules of papillary dermis </li></ul>

44.
<ul><li>Even the expression of </li></ul><ul><li>adhesion molecules is </li></ul><ul><li>increased (E selectin) </li></ul>

45.
E selectin correlates with the disease process UV rays decrease adhesion molecules! ( PUVA therapy !!)

46.
<ul><li>Now the Lymphocytes come out </li></ul><ul><li>of the venules (C5a) </li></ul>

47.
<ul><li>CD4 or CD8 ? </li></ul><ul><li>CD4 in the dermis </li></ul><ul><li>CD8 migrate to the epidermis </li></ul>

48.
Mechanism <ul><li>T cell activation by super antigen </li></ul><ul><li>Release of huge quantity of cytokines </li></ul>

49.
<ul><li> Transit time change </li></ul>53 days

50.
in Psoriasis 7 days

51.
<ul><li>Histopathology </li></ul>

52.
<ul><li>Early changes </li></ul><ul><li>Dilatation and congestion of vessels </li></ul><ul><li>Mild perivascular lymphocytic infiltration </li></ul>