PSORIASIS
Definition
– Psoriasis is a chronic inflammatory disease characterized by dry, rounded , red patches with silver scales in surface.
• Etiology
– Common between 15-30 years in cold , damp, climate
– Heriditary
– Upper respiratory tract infection
– Trauma
– Mental stress, anxiety
– Drugs like chloroquine
– Diabetes
– Arthropathy.
• Pathology
✓ Epidermis
– increased production of stratum germinatum
– Increased thickness of stratum spinosum
– stratum granulosum is absent
✓ In dermis
– Inflammatory changes .
– Dilation of capillaries with increased blood flow.
– Elongation of papillae.
✓ Healing process
– The centre of patch heals fast causing circular lesion.
– No scaring.
• Clinical features
– Well defined red and pink areas called as plaques
– Silver scales
– Nails becomes pitted , ridged, and separated from nail bed.
– Commonly seen over elbow , knee, scalp , fingers , axillae , groin, under breast , behind the ear.
– Face is rarely affected.
• Types
– Depending on size of plaques and distribution
(a) Guttate psoriasis
– It is commonest least severe and good prognosis
– They are small multiple plaques scattered over the trunks and limbs .
– Usually appears suddenly.
(b) Pustular psoriasis.
– It is more severe form of psoriasis
– Commonly affects scalp, palms and soles.
– The fluid contained in the pustules is sterile and should not be confused with the infected pustules of acne.
(c) Erythrodermic
– Plaques are formed with extensive erythema.
– It may cause cardiac failure and loss of temperature regulation.
– It usually does not respond to UVR.
• Management
(1) General treatment
– Avoid stress
– Relaxation techniques
– Positive re-inducement and re-assurance
– Dietetics
(2) Topical treatment
– Acqueous creams
– Coal tar application with salicyclic acid.
– Dithranol paste
– Corticosteroid creams
(3) Systemic treatment
– Retinoids
– Retinoic acid tablets
– Cytotoxic drugs
• Physiotherapy management
– UVR is used ( Theraktin and PUVA )
(1) Theraktin :
– It is a form of tunnel with four fluroscent tubes.
– Position :
Supine in 1st session
Prone in 2 nd session.
– Mode : UVB ( medium UVR )
– Spectrum : 290-320 nm
– Peak emission : 313 nm
– Dose : Sub-erythemal dose
– Duration : 3 times weekly for 8-12 weeks.
(2) PUVA ( psoralens + UVA )
– It is used for resistant psoriasis .
– Psoralens are photosensitizing agents ( 3-methoxypsoralen )
– Spectrum : 320 – 400 nm
– Peak emission : 360 nm
– Method :
√ 3-6 tablets of psoralen is taken with milk 2 hrs before exposure.
√ Tablet dosage depends upon body weight
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