psoriasis
PSORIASIS

Psoriasis is a systemic chronic skin disorder characterized by excessive keratinocytes proliferation that results into thickened scaly plaques, itching and inflammatory changes in the epidermis and dermis. It is transmitted genetically but can be provoked by environmental factors.
It is found in approximately 2% of the population that primarily affects the skin and joints.
It is associated with other inflammatory disorders and autoimmune diseases (eg psoriatic arthritis, inflammatory bowel disease, coronary artery disease).
Generally, it begins as red, scaling papules that coalesce to form round-to-oval plaques. The rashes are often pruritic and may be painful.

Introduction

  • Psoriasis vulgaris is a systemic, chronic, inflammatory disorder that is transmitted genetically but can be provoked by environmental factors
    • Found in approximately 2% of the population
    • Primarily affects the skin & joints
    • Associated w/ other inflammatory disorders & autoimmune diseases (eg psoriatic arthritis, inflammatory bowel disease, coronary artery disease)
    • Characterized by recurrent exacerbations & remissions

Signs and Symptoms

General

  • Begins as red, scaling papules that coalesce to form round-to-oval plaques
  • Rashes are often pruritic & may be painful

Plaque Psoriasis

  • Most common form of psoriasis approximately affecting 80-90% of patients
  • Scaling, erythematous, well-demarcated & silvery plaques w/ various sizes ranging from 1 cm to several cms
  • Plaques are irregular, round to oval in shape & tend to be symmetrically distributed
  • Typically affected areas: elbows, knees, scalp, trunk, intergluteal cleft, buttocks, soles & palms
    • Occasionally, genitalia may also be affected 
  • Painful fissuring w/in plaques can occur when lesions are present over joint lines, palms & soles

Guttate Psoriasis

  • Common in persons <30 yr old & affects <2% of patients w/ psoriasis
  • Usually occurs after an upper respiratory infection w/ group A beta-hemolytic streptococci
  • Teardrop-shaped, salmon-pink papules usually w/in a fine scale measuring 1-10 mm
  • Usually found on the trunk & proximal extremities
  • May be the first manifestation of psoriasis in a healthy individual or an acute exacerbation of long-standing plaque

Pustular Psoriasis

  • Generalized
    • Also called von Zumbusch psoriasis
    • Characterized by sterile pustules on an erythematous base that cover large portions of the trunk & extremities
    • Pustules may coalesce & form large pools of pus in severe cases
    • Skin’s protective functions are lost & patient is susceptible to infection, loss of fluids & nutrients
    • Uncommon, severe form of psoriasis associated w/ systemic symptoms (eg fever, malaise); can be life-threatening 
  • Localized
    • Pustules are localized to the palms & soles of the feet; may also localize on top of plaque
    • Not life-threatening but debilitating because of difficulty in using hands or feet

Erythrodermic Psoriasis

  • Severe, generalized erythema affecting up to 100% of the body surface area (BSA) w/ various degrees of scaling
  • Skin’s protective functions are lost & patient is susceptible to infection, uncontrollable body temperature, loss of fluids & nutrients
  • Often associated w/ systemic symptoms (eg fever & malaise); can be life-threatening

Inverse Psoriasis

  • Lesions consist of erythematous plaques w/ minimal scales
  • Located in the skin folds (eg axillary, genital, perineal, intergluteal, inframammary areas)
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