Psoriasis?




Definition
It is a chronic, non infectious autoimmune skin disease characterized by well defend, slightly raised, dry erythematous macules with silvery scales and typical extensor distribution.

The main complaint in psoriasis, there is increased epidermal proliferation due to excessive division of cells in the basal layer and a shorter life cycle time.


Etiology/causation
  1. The exact etiology is unknown. A genetic predisposition is evidenced by positive family history in 25% patients and association of HLA B8 and A17
  2. Immunopathological: Many immunological abnormalities have been found by their role is uncertain
  3. Dermal: The increased epidermal cell proliferation of psoriasis is related to increased replication and metabolism of dermal fibroblasts


Factors causing flare ups
  1. Trauma: Injury or irrigation of normal skin induces lesions of psoriasis at the site. This is called Koebner's phenomenon
  2. Infection: B-haemophilus, Streptococcus
  3. Sunlight: 10% becomes worse
  4. Drugs: Antimalarial, beta-blockers
  5. Emotion: Anxiety


Pathology
  1. Parakeratosis
  2. Thinning of supra-papillae portion of the stratum malpigii
  3. Elongation of rete-pegs
  4. Micro abscess of 'Munro'
  5. Dilated and tortuous capillary in upper dermis
  6. Edema and round cell infiltration in the papillae and upper dermis


Symptoms / Signs
  1. Typical distribution is extensor type
  2. Common areas affected are scalp, back of elbows, front of knees, legs and lower part of the back and trunk
  3. In exhibits itself as a dry, well defined macules, papules and plaque of erythema with layer upon layer of silvery scales
  4. The complete removal of scale produces pinpoint bleeding which is typical of psoriasis
  5. Normally characterized by absence of itching but in topical countries patient complain of slight or moderate pruritus
  6. The lesion are slightly raised above the surface of skin but there is no induration
  7. Psoriatic lesion may develop along the scratch lines in the active phase, this is called Koebner's phenomenon
  8. On scalp : There is thick, scaly discretely distributed all over with intervening areas of normal skin.


Investigations
  1. History is typical
  2. Biopsy is rarely required


Differential diagnosis
  1. Atopic dermatitis
  2. Impetigo
  3. Reiter's syndrome


Treatment
  1. Explanation, reassurance and instructions are vital and must relate to the patient's or parent's intelligence
  2. The general health of patient should be maintained
  3. A moderate warm climate, frequent sun baths before the onset of winter and visits of Sulphur springs all are useful in bringing down the relapse rate


Homeopathic medicines
  1. Psoriasis of palm: Graphites, Heper Sulphur, Lycopodium, Petroleum
  2. Psoriasis of prepuce, nails: Graphites, Sepia
  3. Psoriasis of tongue: Sepia

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