Kafr El-Sheikh University

Faculty of Medicine

Psoriasis
Dr. Maha Abo Gazia
Dr. Azza Helal
 Kafr El-Sheikh University

Group members:
1. Gana Hamed Khafagy
2. Marwa Mahmoud Zayed
3. Marwa Mahmoud Elgammal
4. Mahmoud Ismael Sharara
5. Mostafa Freg Kamal El-Zobairy
6. Mostafa Mohammed Abd El Hamid
7. Nermeen Sami Ghallap
8. Nourhan Ahmed Mahmoud Ouf
 Kafr El-Sheikh University
Introduction
Psoriasis is one of the prototypic
papulosquamous skin diseases characterised
by erythematous papules or plaques with
silvery scales .It is a chronic inflammatory
skin disease with increased epidermal
proliferation related to dysregulation of the
immune system.
Epidemiology
Psoriasis is estimated to affect 24% of the
population of the western world. The rate of
psoriasis varies according to age, region and
ethnicity; a combination of environmental
and genetic factors is thought to be
responsible for these differences. It can
occur at any age, although it most
commonly appears for the first time between
the ages of 15 and 25 years. Approximately
one third of people with psoriasis report
being diagnosed before age 20. Psoriasis affects
both sexes equally.
Etymology
The word psoriasis is from Greek ,
meaning
"Itching condition" or "being
itchy" from psora, "itch" and -iasis, "action,
condition"
Symptoms, signs, and types
Signs and symptoms are variable. Common
signs and symptoms include:
-Red patches of skin covered with
thick, silvery scales
-Small scaling spots (commonly seen
in children)
-Dry, cracked skin that may bleed
-Itching, burning or soreness
-Thickened, pitted or ridged nails
-Swollen and stiff joints
Psoriasis patches can range from a few spots
of dandruff-like scaling to major eruptions
that cover large areas.
Most types of psoriasis go through cycles,
flaring for a few weeks or months, then
subsiding for a time or even going into
complete remission.
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There are several types of
psoriasis. These include:
Plaque psoriasis: The most common
form, plaque psoriasis causes dry,
raised, red skin lesions (plaques)
covered with silvery scales. The
plaques might be itchy or painful and
there may be few or many. They can
occur anywhere on the body,
including genitals and the soft tissue
inside the mouth.
Nail psoriasis: Psoriasis can affect
fingernails and toenails, causing
pitting, abnormal nail growth and
discoloration. Psoriatic nails might
loosen and separate from the nail bed
(onycholysis). Severe cases may
cause the nail to crumble.
Scalp psoriasis: is a common skin
disorder that makes raised, reddish,
often scaly patches. It can pop up as a
single patch or several, and can even
affect the entire scalp. It can also
spread to the forehead, the back of
the neck, or behind the ears.
Symptoms of mild scalp psoriasis may
include only slight, fine scaling.
Symptoms of moderate to severe
scalp psoriasis include:
Scaly, red, bumpy patches, Silvery-
white scales, Dry scalp, Hair loss
Scalp psoriasis itself doesnt cause
hair loss, but scratching a lot or very
hard, picking at the scaly spots, harsh
treatments, and the stress that goes
along with the condition can lead to
temporary hair loss.
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Guttate psoriasis: This type primarily
affects young adults and children. It's
usually triggered by a bacterial infection
such as strep throat. It's marked by small,
water-drop-shaped, scaling lesions on your
trunk, arms, legs and scalp.
Inverse psoriasis: This mainly affects the
skin in the armpits, in the groin, under the
breasts and around the genitals. Inverse
psoriasis causes smooth patches of red,
inflamed skin that worsen with friction and
sweating. .
Pustular psoriasis: This uncommon form
of psoriasis can occur in widespread patches
(generalized pustular psoriasis) or in smaller
areas on your hands, feet or fingertips.
It generally develops quickly, with
pus-filled blisters appearing just hours
after the skin becomes red and
tender. The blisters may come and go
frequently. Generalized pustular
psoriasis can also cause fever, chills,
severe itching and diarrhea.
Erythrodermic psoriasis: The least
common type of psoriasis,
erythrodermic psoriasis can cover
your entire body with a red, peeling
rash that can itch or burn intensely.
Psoriatic arthritis: In addition to
inflamed, scaly skin, psoriatic arthritis
causes swollen, painful joints that are
typical of arthritis. Sometimes the
joint symptoms are the first or only
manifestation of psoriasis or at times
only nail changes are seen. Symptoms
range from mild to severe, and
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psoriatic arthritis can affect any joint.
Although the disease usually isn't as
crippling as other forms of arthritis, it
can cause stiffness and progressive
joint damage that in the most serious
cases may lead to permanent
deformity.
Causes
In general, the causes of psoriasis can be
limited to 8 main causes:-
1-With a family history of the disease
(Genetic disease)
Methods of genetic transmission:
There are two methods of genetic
transmission
1-type begins at the beginning of young
people with a family history of the disease
and is associated with (HLA) significantly
2- Type begins late in adulthood without a
family history and its link to the (HLA) less
clear.
If a parent has the disease, the son's chance
is 16 percent. If both parents are infected,
the chance of the son's injury is 50 percent.
Parents with psoriasis are more likely to
transmit the disease to their children than
their mothers.
If the parents have no psoriasis and have a
son who has psoriasis, the chances of
infection for the next two children are 10
percent, and the rate of infection in identical
twins is 70 percent, while in non-identical
twins 20 percent.
2-Cold weather
3-Overuse of alcohol
4-Some medications, including: lithium
medical disorder recipe bipolar disorder
(Manic depression or: bipolar disorder -
Bipolar Disorder), some medicines for the
treatment of hypertension, such as beta -
blockers, anti-malarial drugs and iodide
(Iodide).
Psoriasis can affect anyone, but people
belonging to one of the following groups are
more likely to have psoriasis:
1-Contamination, such as Streptococcus
(Streptococcus), or Candida (Oral
Candidiasis)
Injury to the skin, such as wound, soreness,
scratching, insect bite or severe sunburn
2-Living in a state of tension
3-Who suffer from excess obesity
4-Smokers (pustular psoriasis)
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Pathogenesis
*When a dendritic cell comes into contact
with an antigen it travels to the lymph node.
*within the lymph node the dendritic cell
interacts with the T cell this results in T cell
becoming an activated memory T cell
*these memory T cell migrate through the
circulation to the site if inflammation using
adhesion molecules.
*T cells extravagant into the skin, the
memory T cell secrete cytokines TNF alpha
and interferon gamma which causes
keratinocytes to hyperproliefrate
Histopathology
Three main histological findings are
commonly seen: (1) the epidermis shows
thickening (acanthosis) with regular
elongation of rete ridges (long arrow), (2)
superficial dermis shows a chronic
inflammatory infiltrate composed mainly of
small T-lymphocytes (arrowhead), (3)
hyperkeratosis with parakeratosis (top
arrow).
Healthy (a) and psoriatic(B)skin. Rete ridges
(indicated by arrows)with elongation of
dermal papillae and inflammatory
infiltrate(40X magnification)
Prognosis
Folate deficiency - patients with severe
psoriasis have a risk of developing folate
deficiency. Folate is a B vitamin that is vital
for proper nerve function; it also prevents
birth defects. Folate also prevents high
levels of homocysteine, which increase the
risk of heart disease.
Cancers - patients with severe psoriasis
who received systemic medications (those
that affect the whole body) have a higher
risk of developing skin cancers and
lymphomas.
Heart problems, obesity and diabetes - a
higher percentage of individuals with
psoriasis develop heart problems, diabetes
and/or obesity. Experts do not know
whether there is a genetic link between
these conditions and psoriasis. People with
moderate-severe psoriasis, ideally should be
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Tested for these conditions. Experts from
UC Davis explained in Archives of
Dermatology that fat cells in patients with
psoriasis secrete cytokines that raise insulin
resistance in the liver and muscle, which
initiates the destruction of the insulin-
producing beta cells in the pancreas.
Bad body temperature regulation - patients
with erythrodermic psoriasis may have
abnormalities in the bodys ability to
control temperature.
Zumbusch psoriasis - this is a combination
of erythrodermic and pustular psoriasis.
The condition may develop suddenly. The
patient may experience fever, chills, muscle
weakness and weight loss. Sometimes there
may be an over-accumulation of fluids,
protein loss, and electrolyte imbalances; in
such cases the patient may need to be
hospitalized until fluid, chemical balances
and body temperature are normalized.
Zumbusch psoriasis is especially dangerous
if the patient is elderly.
Risk of developing psoriatic arthritis - it is
estimated that between 10% and 20% of all
patients with psoriasis develop psoriatic
arthritis; in about 20% of these people the
arthritis symptoms occur before the
psoriasis ones.
Psychological and emotional consequences
- living with psoriasis often has emotional
and social consequences.
Patients may feel embarrassed by having
visible plaques and that can lead to
depression. In some cases the individual
may withdraw from society.
Symptoms may become so severe that
patients have to leave their jobs, further
increasing the risk of psychological and
emotional problems.
Treatments
Psoriasis has an unpredictable pathway, as
relapses occur for many patients. It cannot
be cured permanently however some
therapeutic methods can be followed to
alleviate symptoms.
The desired goals of treatment
1. Stop the process that leads to the
super production of skin cells which
leads to inflammation relief and
layering.
2. Preventing white blood cells from
attacking the body and slow the
immune system completely, which is
excessive activity in the case of
psoriasis.
3. Remove the peel and make skin finely
Considerations in choosing the type of
treatment
Doctors decide what type of treatment is
appropriate by
1. The type of the disease
2. Its severity
3. The areas of skin which are affected
Treatments for psoriasis can be divided
into 3 main types:
 Kafr El-Sheikh University
Topical treatments: creams and
ointments that you apply to your
skin can effectively treat mild to
moderate psoriasis. They include:
1. Topical ccorticostroids:the most
frequently prescribed for sensitive
areas like face or skin folds
2. Vitamin d analogues: such as
calcitriol
3. Anthralin
4. Topical retinoids(vitamin A
derivative)
This is known as systemic treatment:
5. Calcineurin inhibitors
6. Salicylic acid
7. Coal tar
8. Moisturizers: they reduce
itchings,scaling and dryness
Phototherapy (light therapy): this
treatment uses natural or artificial
ultraviolet light.
Excimer Laser
1. Sunlight: exposure to UV rays
in sunlight slow skin cell
turnover and reduces scaling
and inflammation
2. Broad band UVB
phtotherapy:that resists topical
treatments
3. Narrow band UVB
phototherapy
4. Excimer laser
Oral or injected medications: they
are used in severe psoriasis or
there is resistance to other types of
treatment.
1. Retinoids:related to vitamin A
e.g.acitretin
2. Methetrexate
3. Cyclosporine: suppresses the
immune system
4. Drugs that alter the immune
system(biologics)e.g. golimumab
and infliximab
Must be used with caution because
they have strong effects on
immune system and may permit
life
5.Other medications:e.g thiguanine
and hydroxyurea can be used when
other drugs cant be given.
Combine types of treatments:
The above mentioned treatments are
individual effective in treating
moderate cases but in more severe
cases, doctors depend on the
combination of chemotherapy, oral
medicine and ,phototherapy.
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Warning
Most of the treatments have severe side
effects:
Some of them increase the risk of
infection and other health problems
including cancer, kidney problems, high
blood pressure, upset stomach,sevre liver
damage, decrease production of red and
white blood cells and platelets and Alternative treatments
problems of immune system.
The cost of oral medications is very high There have been some alternative treatments
too. that some claim to be effective but most of
Women must avoid pregnancy for at them has not proven to be effective,
least three years after taking some of however some of them help to reduce some
these medicines, so the doctor must find symptoms.
the most suitable treatment for his
1. Aloe Vera
patient
2. Capsaicin: stinging substance responsible
for the heat of chili
Potential future treatment
3. Fish oil
There are a number of new medications
currently being researched. Most of these
treatments target different proteins that
work with immune system

Some of these treatments are:

1. Ixekizumab: a humanized monoclonal
antibody
Researchers confirm that this drug is
safe, except for some side effects, such as
high incidence of benign
hypoproteinemia or inflammatory bowl
disease

2. Alureed: it is 100%natural, has no side

effects. It consists of honey and cactus in
the form of ointment, in addition, this
medicine is an Egyptian discovery from
Ain Shams University.
 Kafr El-Sheikh University

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"Global epidemiology of psoriasis: a systematic review of incidence and prevalence". J
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562.
Gruber F, Kastelan M, Brajac I (2004). "Psoriasis treatmentyesterday, today, and
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Meenan FO (March 1955). "A note on the history of psoriasis". Ir J Med Sci (351):
1412.
Ritchlin, Christopher; Fitzgerald, Oliver (2007). Psoriatic and Reactive Arthritis: A
Companion to Rheumatology (1st ed.). Maryland Heights, MI: Mosby. p. 4.
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Pathol 1985; 12: 412-
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Ann Rheum Dis 2005
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