Psoriasis: Difference between revisions
(Created page with "* A type of systemic papulosquamous dijusease * Epidemiology ** 2% of whites, less common in other skin colours ** 20 – 40 years *** Family history ** 50 – 100 years *** No family history * Etiology ** Polygenic inheritance (HLA) ** Triggers *** Streptococci <abbr>URTI</abbr> *** Irritation of skin *** Staph *** HIV *** Mechanical irritation *** Alcohol *** Stress *** Drugs **** Beta blockers **** Lithium **** Interferon **** Chloroquine * Pathophysiology ** Acanthos...") |
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* A type of systemic papulosquamous dijusease | <section begin="dermatology" />* A type of systemic papulosquamous dijusease | ||
* Epidemiology | * Epidemiology | ||
** 2% of whites, less common in other skin colours | ** 2% of whites, less common in other skin colours | ||
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** Metabolic syndrome | ** Metabolic syndrome | ||
** Kidney disease | ** Kidney disease | ||
<section end="dermatology" /> | |||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
Latest revision as of 11:29, 18 June 2024
- A type of systemic papulosquamous dijusease
- Epidemiology
- 2% of whites, less common in other skin colours
- 20 – 40 years
- Family history
- 50 – 100 years
- No family history
- Etiology
- Polygenic inheritance (HLA)
- Triggers
- Streptococci URTI
- Irritation of skin
- Staph
- HIV
- Mechanical irritation
- Alcohol
- Stress
- Drugs
- Beta blockers
- Lithium
- Interferon
- Chloroquine
- Pathophysiology
- Acanthosis
- Hyperplasia of stratum spinosum
- Elongated rete ridged
- Parakeratosis – nuclei retention
- Hyperkeratosis
- Munro microabscesses
- T-cell secreted cytokines
- Overexpression of beta-defensin -> no secondary superinfection
- Acanthosis
- Clinical features
- Symptom-free intervals with relapsing
- Lesions
- Well-demarcated
- Salmon-coloured erythematous, silvery scaling plaques
- Mainly on scalp, back and extensor surfaces
- Elbow
- Knees
- Scalp
- Gluteal cleft
- Pruritus
- Nail involvement
- Nail pitting (small depressions in nail)
- Oil drop sign – well-circumscribed yellow-red discoloration
- Brittle nails
- Onycholysis – separation of the nail plate
- Nail separates from the skin below -> becomes grey
- Psoriatic arthritis
- 5 – 30% of patients
- Very debilitating
- Distal and proximal interphalangeal joints
- Spine
- Diagnosis (CASPAR)
- > 3 of these
- Psoriasis
- Psoriatic nail problems
- Negative rheumatoid factor
- Dactylitis – sausage finger
- Radiological signs
- Treatment
- NSAIDs
- DMARDs
- Other forms
- Guttate psoriasis
- Drop-sized lesion
- In children after strep
- Inverse psoriasis
- Skin folds and flexor surfaces
- Guttate psoriasis
- Diagnosis (mostly clinical)
- Auspitz sign – pinpoint bleedings when scales are scraped off
- Koebner phenomenon – skin damage causes psoriasis to appear there
- Skin biopsy – rarely needed
- Parakeratosis
- Munro microabscesses
- Acanthosis
- Differential diagnosis
- Atopic dermatitis/atopic eczema
- Poorly demarcated
- Severe pruritus
- Exudative, not dry
- Flexor surfaces
- Seborrheic dermatitis
- Greasy-looking yellow scales
- On face and trunk
- Atopic dermatitis/atopic eczema
- Treatment
- Moisturizer
- Avoid nicotine, alcohol
- Topical
- Steroids
- Triamcinolone
- Fluocinonide
- Clobetasol
- Vitamin D derivatives
- Calcipotriene
- Tar preparations
- Retinoids
- Steroids
- Systemic
- MTX
- Retinoids
- Cyclosporine
- Biological therapy
- Adalimumab, infliximab, etanercept – TNF alpha
- Secukinumab – IL-17
- Briakinumab – IL-23
- Phototherapy
- UVB therapy
- Narrow-band UVB
- PUVA (psoralen + UVA)
- Psoralen increases photosensitivity of skin
- UVA radiation
- UVB therapy
- Complications
- Increased CV risk
- Metabolic syndrome
- Kidney disease