Plaques that are clearly defined, red, and scaly are the hallmark of the chronic inflammatory skin condition psoriasis.
It can begin at any age, including childhood, with peaks of onset at 15–25 years and 50–60 years. Psoriasis affects 2-4% of men and women and can affect people of any race. It is most common in Caucasians, though it can affect people of any race. About one-third of patients with psoriasis have family members who also have the condition.
Histology
Acral and intertriginous psoriasis lesions frequently show a background of spongiosis. Pustular psoriasis may never demonstrate acanthosis.
Here are the main adjustments:
·Parakeratosis:retaining nuclei in the horny layer during parakeratosis.
·Hypogranulosis:reduced until the granular layer was gone.
·Abscess:The spongiform pustule of Kogoj, which is more diagnostic than Munro abscess, is a collection resembling the epidermal polymorphonuclear leukocyte infiltrates and microabscesses that Munro first described.
·Irregular thickening:When scale is scratched off, bleeding may occur (Auspitz sign). The epidermis is abnormally thickened over the rete ridges but thinning over the dermal papillae.
· Dilated tortuous capillaries.
· T Lymphocytes.
CLINICAL TYPES
a.Plaque-type psoriasis vulgaris:90% of all cases of psoriasis are of the plaque variety, with the primary lesion being a scaly papule that ranges in color from red to salmon pink and enlarges to form a plaque. It is typically covered by a white or silvery scale, which, when removed, may reveal pinpoint bleeding (Auspitz sign).
The classic extensor disease plaque-type psoriasis frequently affects the knees, elbows, gluteal cleft, lumbosacral region, and umbilicus.
In contrast to dandruff, which affects the entire scalp, psoriasis may involve the scalp, where it typically extends beyond the hair margin. Psoriasis does not cause alopecia, and it does not affect the oral mucosa. Scalp psoriasis has a clear edge, usually with some areas unaffected.
b. Inverse psoriasis:This type must be made less moist (careful hair dryer drying, weight loss), and the lesions then typically respond well to vitamin D analogs in a gel base. It manifests as pink plaques with minimal scale in the axillae, inguinal and inframammary region area, and body folds of the trunk.
c. Guttate psoriasis.It is characterized by small ‘droplet like’ thin pink to salmon-colored papules and plaques topped by a fine white scale and occurs in less than 2% of cases, but it is a common subtype in children and is preceded by streptococcal sore throat.
d. Pustular psoriasis.Fever, systemic symptoms, and an elevated white blood cell count frequently coexist with generalized pustular psoriasis, an acute form of the disease that manifests as small, monomorphic, sterile pustules overlying painful, inflamed, erythematous papules.
Acral variants that affect the area around the nails and the palms and soles have both been reported (palmoplantar pustulosis and acrodermatitis continua).
During pregnancy, impetigo herpetiformis, a form of pustular psoriasis that affects the flexures, usually appears in the third trimester.
Hypocalcemia and abrupt steroid withdrawal are a couple of typical aggravating variables.
e. Erythrodermic psoriasis.Total body redness (more than 90%) and skin desquamation characterize this skin reaction pattern.
Loss of the lesions’ borders causes them to spread quickly and affect the entire body.
Infection, hypothermia, protein loss, hypoalbuminuria, dehydration, and electrolyte disturbances can all be brought on by the extensive skin loss that takes place during an erythrodermic psoriasis flare.
The following are the primary issues that may result:
A greater loss of fluid through the skin.
· Increased protein loss.
Mild heart failure, since up to 25% of the heart’s output could be directed toward the skin.
Despite the skin’s perception of heat, radiation causes a significant heat loss that leads to hypothermia.
NSAIDs, antimalarials, beta-blockers, lithium, phototoxic reaction, and infection are aggravating factors.
f. Psoriatic nails.It’s known that nail disease is more closely linked with psoriatic joint disease because up to 90% of patients with psoriatic arthritis have nail disease. Psoriatic nails can be seen in up to 50% of patients with psoriasis and may be the only sign of psoriasis.
Psoriasis is characterized by a plaque of psoriasis in the distal nail bed with accumulation of scale, which lifts the plate from the nail bed, leading to onycholysis (nail plate separation with red border), oil spots (yellow-orange subungual discoloration), and splinter hemorrhages; the most diagnostic feature is the “oil drop sign.” The most common nail defect is pitting and subungual hyperkerato
g. Psoriatic arthritisEvery psoriasis patient should undergo a specific examination to check for joint conditions and enthesitis (inflammation of the tendon insertions).
There are 5 main types:
Knee joints are the most frequent site for asymmetric oligoarthritis.
Participation of the Distal Interphalangeal Joint (DIP).
· Rheumatoid pattern (symmetric polyarthropathy).
The most severe form of psoriatic arthritis.
· Predominant spondylitis or sacroiliitis.
The CASPAR criteria are the standards used to categorize psoriatic arthritis.
Diagnosis
The clinical characteristics of psoriasis are used to make the diagnosis, which may then be confirmed by the results of a skin biopsy.
Differential diagnosis
Because the lesions involve the typical areas and have the distinctive silvery scale, diagnosis is simple.
There are a few variations where the diagnosis could be problematic, such as:
Intertrigo, tinea cruris, and intertrigo are all terms that can be used to describe intertriginous areas.
Scalp: Seborrheic dermatitis and psoriasis of the scalp are frequently mistaken for one another because the latter’s scaling is typically finer, yellower, and more diffuse with fuzzier borders.
On the trunk, guttate psoriasis can occasionally be mistaken for tinea corporis or pityriasis rosea.
Rarely, cutaneous T-cell lymphoma and chronic dermatitis can resemble psoriasis.
Clinically speaking, nail involvement and onychomycosis might be identical.
Management
General measures
·Take daily baths:Avoid using hot water and harsh soaps, which can exacerbate symptoms; instead, use lukewarm water and mild soaps that have added oils and fats to soothe inflamed skin. Bathing daily helps remove scales and calm inflamed skin.
·Use moisturizer:Oils may be preferable for dry skin because they have more staying power than creams or lotions do and are more effective at preventing water from evaporating from skin. In cold, dry weather, apply a moisturizer several times per day. Blot skin after bathing, then apply a heavy, ointment-based moisturizer right away while skin is still moist.
·Expose skin to small amounts of sunlight:Keep track of your time spent in the sun to help prevent overexposure, and protect healthy, unaffected skin with a broad-spectrum sunscreen with an SPF of at least 30. Apply sunscreen liberally, and reapply every two hours, or more frequently when swimming or perspiring.
·Avoid psoriasis triggers, if possible:Infections, skin injuries, stress, smoking, and prolonged exposure to the sun are all things that can aggravate psoriasis; learn what causes this condition and take steps to prevent or avoid it.
·Avoid drinking alcohol:Some psoriasis treatments may work less effectively when alcohol is consumed.
Homeopathy medicines
Antimonium crudum
Nail psoriasis, psoriasis with gastric abnormalities, brittleness and propensity to break, discolored, distorted, pitted, or ridged nails, and painful, sensitive skin beneath the nails are all symptoms.
Arsenic album
Lesions are raised, hard edges, surrounded by red and shining crown, with bottoms like lard, or blackish or blue color, with burning and shooting pains when affected parts become cold. Complaints are better from warmth. There is a lot of anxiety and restlessness.
Arsenic iodatum
Large scales of skin have clearly exfoliated, leaving a raw surface underneath. The skin is dry, scaly, and itchy.
Berberis aquifolium
Skin that is pimply, dry, rough, and scaly, with an outbreak on the scalp that spreads to the face and neck, is suffering from severe psoriasis.
Borax
Unhealthy skin, minor injuries that suppurate, itchy, stinging eruptions on the hands and fingers, and tangled hair ends are just a few of the symptoms that can cause these symptoms.
Calcarea carbonica
Fit for chubby, fair, flabby people who get tired easily from exertion. Physically sluggish. Chilly with clammy hands and feet. Sweat a lot, especially on the scalp at night. Sensitive to cold air. Catch colds easily. Wintertime skin complaints are worse. Cravings for eggs and indigestible things like dirt, chalk, pencils, coal, etc. Scurfy spots on the legs. Burning and itching.
Chrysarobinum
Psoriasis of the nails: Thighs, legs, and ears are affected. Thighs, legs, and ears are affected. Vesicular eruptions with fetid discharge and crust formation.
Dulcamara
Itching that is exacerbated by cold temperatures, humid eruptions on the face, genitalia, and hands, particularly the palmar surface, thick, brown, and yellow crusts, and bleeding when scratched.
Graphites
Rough, hard, persistent dryness of skin; rawness in groins, neck behind, and bend of knees; eruptions exuding thick exudate; burning, stinging pains made worse by heat and at night.
Hydrocotyle asiatica
Intense thickening and exfoliation of the skin, scaly-edged circular spots, and psoriasis of the trunk, extremities, palms, and soles.
Kalium arsenicosum
Fissures can be found in the bend of the arms and knees, and the itching is intolerable and worse when you take off your clothes.
Mercurius sol
The symptoms of scalp psoriasis include excessive sweating, raw skin underneath the scales, severe itching, especially at night, and swollen lymph nodes.
Mezereum
Scaly roughness and scaling on the back, chest, scalp, and thighs. Inflamed and swollen. Severe itching made worse by scratching or when undressed. Tendency to ulcerate and form thick swabs under which purulent matter exudes.
Petroleum
Dry skin, severe itching that is worse at night and when you get warm in bed, a cold feeling after scratching, palm and fingertip psoriasis, deep skin cracks that bleed when they open up, and worsening winter weather are all symptoms of this condition.
Phosphorus
Knee, elbow, and leg psoriasis; dry, scaly eruptions covering the skin; intense itching, burning, and stinging; made worse by heat.
Radium bromide
Circular patches all over the body, severe itching, redness, swelling, and an intense burning sensation that makes the skin feel like it is on fire are all alleviated by being outside and taking a hot bath.
Rhus Toxicodendron
Red and swollen lesions, severe itching, and stiffness of the joints are all symptoms of psoriasis with arthritis. These symptoms are also improved by warm activity and hot baths.
Sepia
Herpes circulate in isolated spots and the itching is not relieved by scratching; it is worse in the creases of the elbows and knees and is exacerbated by exposure to the open air.
Sulphur
Affected areas frequently appear bright red and irritated, with scaling skin that becomes inflamed from scratching. Itching, worse from warmth, evening. Skin complaints recur every winter and due to negative side effects of local medications. Dirty, filthy people are prone to skin affections. They dislike being washed. They have dry, scaly, unhealthy skin, which causes every little injury to suppurate. They have red lips and faces. They also experience severe itching and
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