PSORIASIS

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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BY PHYSIOFEEDS.

 

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