PSORIASIS
- Psoriasis is a chronic inflammatory disease of the skin in which the productions of epidermal cells of the basal layer occur at a rate that is approximately 6 -9 times faster than normal.
- The rapid reproduction of cells is accompanied by rapid transition of cells from the germinative layer of top of the stratum corneam
- The transition is reduced from the normal 30 -40 days to around 7days .this occurs anywhere in the body.
- There`s a genetic predisposition top psoriasis but the cause is idiopathic.
- It has a tendency to improve but keeps on recurring throughout life.
- Some of the factors triggering recurrence include,
- Bacterial infection e.g. pharyngitis
- Emotional trauma
- Mechanical trauma
- Drugs e.g. receptor antagorusta e.g. propranoloc
- Day to day fear and wear
- Seasonal and hormonal changes
- Emotional stress and anxiety
CLINICAL FEATURES
- Pruritus
- Lesion appear as red raised patches on skin covered with silver scales
- If scales are scooped away, a dark red base of the lesion is exposed producing multiple bleeding points.
- Parts mainly affected include the scalp ,flex oral areas of back and genitalia
- Bilateral symmetry affecting both sides of the body is a feature of psoriasis.
- In about ¼ of all the affected, the nails are affected and they present with pitting, discolouration, crumbling, beneath the free edges, dubbing and separation of the nail plate.
- Pastular lesion may occur if it occurs on the palms and soles.
DIAGNOSIS
- Based on clinical findings
- Rule out fungal infection
- MANAGEMENT
- Goal is to allow the rapid turnover of epidermis to promote resolution of the psoriatic lesions and control the natural cycles of the disease
- Remove all the aggravating factors
- There is no known cure
- Gentle removal of scales this can be accomplished by baths
- Oils such as olive oil, mineral oil or areeno oil, oatmeal bath or coal tar preparations (balnetar) can be added to water and a soft brush used to scrub the psoriatic plagues gently.
- After bathing the application of emollient creams containing alpha hydroxyl acids or salicylic acid will continue to soften thick scales.
- Cover the skin with tar or antralin
- Three types of therapy are standard; topical, systemic and intralesional
- Use of topical steroids e.g. betamethason covered with a heavy dressing to reduce the multiplication of cells
- Phototherapy /ultra –violet radiation
- Use of systemic cytotoxic drugs
COMPLICATIONS
- The pt may develop exfoliative psoriasis a condition in which the disease spreads entire body.
- Asymmetrical rheumatic factor, Associated with arithritis of multiple joints causing a crippling disability, the cause of this phenomenon is rarely understood.