Transcript psoriasis.ppt

Psoriasis
Definition

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
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Natural population: 0.1%~0.3%
China(1984): 0.123%
Etiopathogenisis
1.Theory of heredity
Family positive of psoriasis is 4~91％,
11.9~32% in china
Concordance rate in twins:
monozygotic twins> binovular twins
High frequency in HLA-A1,B17,Cw6,DR7,
a multifactorial inheritance disease
Etiopathogenisis
2.Theory of infection
bacterial infection(esp.streptococcus)
fungal infection
bacteria
fungi
(streptococcus、superantigen) (yeast fungus)
lymphocytes
activated alternative
complement
pathway
clonal proliferation
functional disorder of immune system
Etiopathogenisis
3.Abnormal immune function :
cellular immunity function reduce partly
early skin lesions are infiltrated predominantly by
lymphocytes
autoantibody deposit in the horny layer
Th1/Th2 disequilibrium theory(Th1 dominant
skin disease)
Etiopathogenisis
4.Dysmetabolism:
cAMP
metabolic 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
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Psoriasis
Psoriasis
Psoriasis
Psoriasis
vulgaris
arthropathica
pustulosa
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
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of
psoriasis
Active stage:large amounts of new
lesions,red and pruritus
Resting stage:dark red lesions without
new eruption
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
clinical significance:suggest in active
stage
Course of psoriasis
exacerbate in winter ,improve in summer
chronic and persistent
clear spontaneously ,recur frequently
Diagnosis and differential
diagnosis
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Diagnosis:lesions,types and stages
Differential diagnosis:1.pityriasis rosea
2.secondary
syphilis
3.seborrheic
dermatitis
4.chronic eczema
Treatment
一.topical treatment:
1.general principle:
irritative medicine can not be used in
acute phase to avoid provoking
erythroderma.
stronger medicine can be applied in
stable phase
transdermic absorption must be noticed
during the general application
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
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
Treatment
二.oral medicine:
the traditional chinese medicine: quyin
mixture,xiaoyin mixture,complex
indiginis naturals pill,tab.diyin
vitamin: vitD2, vitE
antibiotic: cefradine and so on
antihistamine drug:
cetirizine,mizoller, clarityne
hormone: prednisone
immunosuppressive agent: MTX
Treatment
三.vein blockage: another name procaine
vein blockage
四. Photochemotherapy: PUVA, means
therapeutic alliance with 8-mop and
black light
五.light quantum therapy
Sepical type
Psoriatic arthritis
Psoriatic
erythroderma
Pustular psoriasis