Psoriasis

Definition l Psoriasis is a recurrent,chronic,inflammatory disease of the skin characterized by red papules or plaques covered by silvery white and multilayer scales.

Morbidity rate l Natural population: 0.1%~0.3% l China(1984): 0.123%

Etiopathogenisis 1.Theory of heredity Family positive of psoriasis is 4~91 ％, Family positive of psoriasis is 4~91 ％, 11.9~32% in china 11.9~32% in china Concordance rate in twins: Concordance rate in twins: monozygotic twins> binovular twins monozygotic twins> binovular twins High frequency in HLA-A1,B17,Cw6,DR7, High frequency in HLA-A1,B17,Cw6,DR7, a multifactorial inheritance disease a multifactorial inheritance disease

Etiopathogenisis 2.Theory of infection bacterial infection(esp.streptococcus) bacterial infection(esp.streptococcus) fungal infection fungal infection bacteria fungi bacteria fungi (streptococcus 、 superantigen) (yeast fungus) (streptococcus 、 superantigen) (yeast fungus) lymphocytes activated alternative lymphocytes activated alternative complement complement pathway pathway clonal proliferation clonal proliferation functional disorder of immune system functional disorder of immune system

Etiopathogenisis 3.Abnormal immune function : cellular immunity function reduce partly cellular immunity function reduce partly early skin lesions are infiltrated predominantly by early skin lesions are infiltrated predominantly by lymphocytes lymphocytes autoantibody deposit in the horny layer autoantibody deposit in the horny layer Th1/Th2 disequilibrium theory(Th1 dominant Th1/Th2 disequilibrium theory(Th1 dominant skin disease) skin disease)

Etiopathogenisis 4.Dysmetabolism: cAMPmetabolic block of arachidonic acid 、 cGMP polyamines shortened epidermal cell transit time, hyperplasia 5.others: psychosis,neuroendocrine,climate,medicine et al may induce or aggravate the disease.

Clinical features Psoriasis vulgaris Psoriasis vulgaris Psoriasis arthropathica Psoriasis arthropathica Psoriasis pustulosa Psoriasis pustulosa Psoriasis erythrodermica Psoriasis erythrodermica

p. vulgaris: red papule silvery white scales Film phenome- non Auspitz’s sign

Predilection site

Lesion morphology

Psoriasis guttata

Nummular psoriasis

Geographic psoriasis

distinctive features in different regions

Thimble pitting in nails

Rhagades and thickness scales in polms and soles

Fascicle-like hair

Psoriasis of genitalia scantiness of scale

Psoriasis of vulvae,red plaque with little scaling

Stages of psoriasis Active stage:large amounts of new lesions,red and pruritus Active stage:large amounts of new lesions,red and pruritus Resting stage:dark red lesions without Resting stage:dark red lesions without new eruption new eruption regression stage:erythema fade,flatten and disappear regression stage:erythema fade,flatten and disappear

Koebner phenomenon Mechanical injury,insect bite,cold injury, sun shine et al Normal skin of patients in active stage express typical lesions express typical lesions clinical significance:suggest in active stage clinical significance:suggest in active stage

Course of psoriasis exacerbate in winter,improve in summer exacerbate in winter,improve in summer chronic and persistent chronic and persistent clear spontaneously,recur frequently clear spontaneously,recur frequently

Diagnosis and differential diagnosis l Diagnosis:lesions,types and stages l Differential diagnosis:1.pityriasis rosea 2.secondary 2.secondary syphilis syphilis 3.seborrheic 3.seborrheic dermatitis dermatitis 4.chronic eczema 4.chronic eczema

Treatment 一.topical treatment: 1.general principle: irritative medicine can not be used in acute phase to avoid provoking erythroderma. irritative medicine can not be used in acute phase to avoid provoking erythroderma. stronger medicine can be applied in stable phase stronger medicine can be applied in stable phase transdermic absorption must be noticed during the general application transdermic absorption must be noticed during the general application reduce scales by using warm water and soap before treatment reduce scales by using warm water and soap before treatment

Treatment 2.medicine selection: Active stage:apply gentle medicine,for instance 15% carbamide lipoid,3% ～ 5% boric acid ointment,simple cream boric acid ointment,simple cream Stable or regression stage:use medicine with higher concentration,such as comples clobetasol propionate cream ， sulfur salicylic acid ointment,coal-tar liniment and calcipotriol ointment liniment and calcipotriol ointment

Treatment 二.oral medicine: the traditional chinese medicine: quyin mixture,xiaoyin mixture,complex indiginis naturals pill,tab.diyin the traditional chinese medicine: quyin mixture,xiaoyin mixture,complex indiginis naturals pill,tab.diyin vitamin: vitD2, vitE vitamin: vitD2, vitE antibiotic: cefradine and so on antibiotic: cefradine and so on antihistamine drug: cetirizine,mizoller, clarityne antihistamine drug: cetirizine,mizoller, clarityne hormone: prednisone hormone: prednisone immunosuppressive agent: MTX immunosuppressive agent: MTX

Treatment 三.vein blockage: another name procaine vein blockage vein blockage 四. Photochemotherapy: PUVA, means therapeutic alliance with 8-mop and therapeutic alliance with 8-mop and black light black light 五.light quantum therapy

Sepical type

Psoriatic arthritis

Psoriatic erythroderma

Pustular psoriasis