Psoriasis

WhatIs ?

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WhatCauses ?

Clinical Presentations Of

Complication Of

Treatment Options For

Prevention Of

What Is Psoriasis?

Psoriasis is a chronic inflammatory skin condition that most patients start to present during their 20s or 50s. Psoriasis presents as scaly plaques that mostly affect scalp, knees, elbows, lower back & nail plates. Up to 30% of patients may develop joint pains.

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Psoriasis
What Causes Psoriasis?

The underlying cause of psoriasis is multifactorial. Genetics play a significant role in development of psoriasis. 35-90% of patients with psoriasis have a family history of psoriasis. If both parents, one parent or one sibling has psoriasis, the risk of psoriasis in the child would be 41%, 14%, 6% respectfully. Psoriasis is also due to activation of inflammatory mediators like T-cells, cytokines, innate immune system, dendritic cells as well as keratinocyte hyperproliferation.

Clinical Presentations Of Psoriasis
  • Plaque psoriasis presents as silver scaly well demarcated plaques that is more prominent over extensor aspects of the body, especially knees and elbows. While it can affect all body surface area, more common over scalp and lower back, tends to spare face in adults.
  • Different clinical presentation
    • Inverse psoriasis: well demarcated red plaques over body folds
    • Guttate psoriasis: small coin shaped scaly lesions, mostly after strep throat
    • Scalp psoriasis: asbestos-like scale over scalp area
    • Nail psoriasis: pitted presentation over nail plate
Complication Of Psoriasis

If patient with psoriasis receive oral steroid, they can develop generalized redness (erythroderma) which can affect patient temperature and electrolyte regulation

Treatment Options for Psoriasis
  • Prescription
    • Topical
      • Vitamin D analogs: calcipotriol
      • Topical steroid
      • Tazarotene 0.05% gel
      • Topical calcineurin inhibitors for facial and flexural psoriasis
      • Tar and anthralin
      • If thick scale: Salicylic acid 5–10% in Oil
    • Nb-UVB Phototherapy
    • Systemic
      • Methotrexate with folic acid
      • Acitretin (Soriatane)
      • Cyclosporine
      • Otezla
    • Biologics
      • TNF-alpha inhibitors
      • IL-17 inhibitors
      • IL-23 inhibitors
Prevention Of Psoriasis
    • Patients with history of psoriasis can develop new lesions within tattoo area or any traumatized skin area. Avoiding trauma to skin including sun burn or tattoo is very crucial
    • Obesity, increased in alcohol consumption, & smoking are associated with psoriasis
    • Several medication including lithium, interferons, beta-blockers, antimalarials, rapid taper of prednisone can exacerbate psoriasis
    • Patients with history of guttate psoriasis needs to get checked for strep throat infection. There are studies that indicated tonsillectomy can resolve guttae psoriasis in patients with recurrent strep throat (sore throat) infections
     

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Psoriasis is a chronic inflammatory skin condition that most patients start to present during their 20s or 50s. Psoriasis presents as scaly plaques that mostly affect scalp, knees, elbows, lower back & nail plates. Up to 30% of patients may develop joint pains.