Definition – A chronic non-inflammatory dermatosis characterized by well demarcated erythematous plaques topped with silvery scales.
Do any of your parents have Psoriasis? Then can you get it too?
There is a well known genetic predisposition to psoriasis. So, if you have psoriasis, yes, you can get it too. If your mother or father has psoriasis, then there is a 25% chance for you to get it too. Studies have been done all over the world and they have found that there is 73% concordance of the disease among identical twins. It means that there is a strong genetic predisposition.
What happens in Psoriasis?
In psoriasis, there is abnormal proliferation of the cells of the skin. Not only that, the keratinization is also defective. These results in abnormal skin lesions.
How to identify psoriasis
Psoriasis can be identified by the characteristics of the lesions and their distribution. The lesions can range from chronic plaques on the elbows to the acute generalized pustular form. But still it can be confused with several other diseases because they show the same lesion pattern.
· Psoriasiform drug eruptions
· Hyperkeratotic eczema
· Reiter’s disease
· Seborrhoeic dermatitis (scalp)
· Pityriasis rosea
· Candidiasis of flexures (on flexures)
· Fungal infections of the nails (nails)
The usual presentation patterns of Psoriasis
· Plaque –red plaques (ranging up to several centimeters) covered by waxy whitish scales on knees and elbows. If you remove these scales, it can bleed. These lesions sometimes can be pruritic.
· Guttate – In this form there are symmetrical, drops like lesions over the trunk and the limbs. These lesions usually occur in adolescents and young adults following streptococcal throat infections.
· Flexural – These lesions are found in axillae, submamary areas and natal clefts of elderly people.
· Localized forms – yellow to brown colour sterile pustules on the palms or soles. Commonly seen in middle aged females. Or it could present in nails, scalp or nappy areas. Psoriasis in the scalp can be confused with dandruff, but can be differentiated by its well demarked and more thickly scaled nature.
· Generalized pustular – small sterile yellowish pustules are seen all over the body. This is very rare but can be life threatening. The disease starts rapidly and the patient will have fever and malaise. This form requires hospital admission.
· Nail involvement – thimble pitting, onycholysis (separation of the distal edge of the nail from the nail bed), oily or salmon pink discoloration of the nail and building up of keratin under the distal nail edge..
· erythroderma
The Psoriatic condition may be complicated by arthropathy, erythroderma and Koebner phenomenon.
Treatment
Psoriasis is a condition which needs long term treatment. Treatment of psoriasis includes tropical therapy, systemic therapy..
· Tropical therapy
o Vitamin D analogues – These inhibit cell proliferation and stimulate keratinocyte differentiation.These preparations are well tolerated by patients as they do not have any bad smell or stain. In comparision to steroids, they do not cause skin atrophy, but they may cause some skin irritation. E.g: Dovonex, Curatoderm
o Topical corticosteroids – These are non irritative compared to vitamin D analogues.
o Coal tar preparations
o Dithranol
o Retinoids
o Keratolytics and scalp preparations
· Systemic Therapy
o Methotrexate
o Retinoids
o Ciclosporins
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