Psoriasis Lecture Notes 2024-2025 PDF

Block 1.2 lectures 2024-2025 lecture Highlighter key Writer Doctor explanation Abbreviation Key information Book...

Block 1.2 lectures 2024-2025 lecture Highlighter key Writer Doctor explanation Abbreviation Key information Book Reviewer >> >> Abdulrahman Reem Alhussain Albousaif Student explaintion 221-222-223 notes References Deleted  PSORIASIS ‫الصدفية‬ Dr. Aminah Alhumam Assessment professor Dermatology department KFU  DEFINITION Chronic, disfiguring, inflammatory & proliferative condition of skin Red, scaly, sharply demarcated plaques Plaque = ‫الإرتفاع لما يكون في تغير في الجلد‬. Erythema = ‫إحمرار‬ Extensor surfaces and scalp and other area according to the type. Genetic and environmental influences Extensor surfaces = skin surfaces on the outer aspect of a joint Variable in duration, flares & extent. they are common regions for lesions or other skin changes in certain skin disorders.  EPIDEMIOLOGY Psoriasis occurs in 2% of the world’s population Highest in Caucasians Caucasian = ‫الأوروبيين والقوقاز‬ Males and females are equally affected  PATHOGENESIS T-cell mediated “‫ يوم‬٢٨ ‫”في الإنسان الطبيعي تجدد طبقات الجلد تاخذ‬ inflammatory disease Epidermal keratinocyte “‫ ايام‬٤ ‫”بس الي عنده الصدفيه يتجدد كل‬ hyperproliferation Impaired maturation of keratinocytes Inflammation Vascular changes Genetic factors: “‫ما لكم فيها تفاصيلها راح‬ ‫ناخذها سنة رابعة وخامسة‬ HLA-Cw6 ‫”ونفصل فيها‬ 8  CLINICAL FEATURES Round/oval, well-define “ Well defined ‫”يعني حدودها واضحة‬ Erythematous, plaques Plaque = ‫الإرتفاع لما يكون في تغير في الجلد‬. ‫إحمرار‬ Erythema = Usually symmetrical Symetrical = ‫متماثل‬ “‫ في الكوع اليمين والكوع اليسار‬،‫يعني نلقاها في الرجل اليمين والرجل اليسار‬ Covered by white, silvery Key word of psoriasis “white silvery scales” Silver = ‫ فضية‬Scales = ‫قشور‬ scales Extensor extremities DISTRIBUTION OF LESIONS Which skin areas is psoriasis located?  ASSOCIATED DISEASES arthritis Which diseases are associated with psoriasis? enteropathy Myopathy Enteropathy = intestinal disease Myopathy = muscle disease Heart disease Spondylosis is the degeneration of the Spondylitic disease vertebral column from any cause.  HISTOPATHOLOGY What is parakeratosis? Epidermis Where is it seen? Thickening Parakeratosis (retention of nuclei in keratinocytes - stratum corneum) cause of silvery scales) Microabcess = accumulation of pus under the skin Munro microabcesses (S.corneum) Spongiform pustules in the Malpighian layer pustule = filled with pus ‫حبة صغيرة اقل من نص سنتيميتر‬ Which is the subset of lymphocyte seen in psoriasis? Dermis Tortuous and dilated blood vessels Inflammatory infiltrate primarily of TH1 lymphocytes & neutrophils  CLINICAL TYPES Chronic stable plaque psoriasis The term “Vulgaris” = most common type (psoriasis vulgaris) Salmon pink scaly plaques Extensor extremities What is Koebner’s phenomenon? Elbows , knees, buttocks and scalp Koebner’s phenomenon (presence of isomorphic lesions at the site of trauma) Oil drop sign –nails A key word of psoriasis koebner’s Auspitz’s sign + phenomenon = the area of trauma, if scratched or burned will trigger new lesions of psoriasis  KOEBNER’S PHENOMENON Occurs 7–14 days after injury actively spreading, severe psoriasis. Local trauma induce a local inflammatory response that promotes lesion development  CLINICAL TYPES Presence of pinpoint What is Auspitz ‘s sign? bleeding spots after scraping the lesions Dilatation of dermal blood vessels & Supra -papillary thinning CHRONIC PLAQUE PSORIASIS  GUTTATE PSORIASIS Guttate = ‫حلقي‬ Characterized by numerous 0.5 to 1.5 cm papules and plaques Early age of onset Children Trigger- Streptococcal throat infection Spontaneous remissions ERYTHRODERMIC PSORIASIS Classic lesion is lost Entire skin surface becomes markedly erythematous with scaling. Erythema = ‫إحمرار‬ Febrile Febrile = having fever  ERYTHRODERMIC PSORIASIS We cannot give oral steroids for psoriasis because they can trigger the condition. However, topical steroids can Triggering Factors be option if other treatments fail. We use them for two severe forms of psoriasis: erythrodermic psoriasis and Systemic Infection generalized pustular psoriasis Withdrawal of high potency topical or oral steroids Withdrawal of Methotrexate methotrexate is an immune- system suppressant. Phototoxicity Irritant contact dermatitis Medication Photoxicity = ‫تحسس من تعرض‬ ‫للشمس‬ GENARILIZED PUSTULAR PSORIASIS Gradual or acute onset Waves of pustules on erythematous skin Weight loss Hypocalcemia = ‫نقص كالسيوم‬ Hypocalcemia Muscle Weakness Leukocytosis Elevated ESR Fever GENARILIZED PUSTULAR PSORIASIS Triggering Factors Infection Stress “This type of pustule in psoriasis is sterile = ‫”معقمة‬ Pregnancy Lithium Hypocalcemia = ‫نقص كالسيوم‬ Hypocalcemia Irritant contact dermatitis Withdrawal of corticosteroids, primarily systemic  LOCALIZED PUSTULAR PSORIASIS This type of psoriasis is sterile pustule ( no bacteria) PALMOPLANTAR PUSTULAR PSORIASIS More common in women Fifth or sixth decade Thenar eminence, instep, border of the foot - involved Presents as deep-seated lesions with multiple small pustules on palms and soles hand-foot eczema could be misdiagnosed when it is actually palmoplanter pustular Mimics dermatitis psoriasis not hand-foot eczema Possibly aggravated by trauma  Helpful information to differentiate between skin lesion by certain characteristics: A flat skin lesion characterized by a change in color, such as erythema, It might be hypopigmentation, or hyperpigmentation is macular patch. extra for your An elevated lesion larger than 1 cm is called a plaque. level but it Hard, elevated and less than 0.5 cm is nodule helps you If the nodule is small, it is called a papule. differentiat! Papule filled with clear fluid it will be vesicle. Filled with pus it becomes pustule. Very large and filled with high amounts of fluid is bulla PALMO PLANTAR INVOLVEMENT Typical scaly patches with silvery scales Absence of vesiculation Vesicle = small papule filled with clear fluid knuckles frequently show a dull red thickening  NAIL INVOLVEMENT 25-50% patients Sub-ungual = ‫تحت الظفر‬ Fingernails >Toenails Onycholysis ( separation Onych/o = ungu/o = Pertaining to the nails from nail bed) Pitting NAIL PITTING OIL DROP SIGN Subungual hyperkeratosis ‘Oil drop sign’ It could be associated with arthritis, so we have to ask the patient if there is joint pain, and we have to administer systemic therapy.  SCALP INVOLVEMENT Very thick plaques develop Auspitz ‘s sign is positive Dry silvery scales Over grows the hair line “‫”قد يتلخبط مع القشرة‬ Notice how it exceeds the hairline  Sometimes we hear corticosteroids, steroids, and cortisone. Don’t get TREATMENT confused; they are related and meant to refer to the We can’t use topical steroids for a Vitamin D analogues are typically same general class. long time because they have side applied to the skin. Also they have less effects, such as stretch marks. side effects than topical steroids. So we Mild : can complete the treatment by using topical corticosteroids,Vit d analogues them. Moderate : topical corticosteroids /vit d analogues Analogue = ‫نظير‬ + phototherapy Severe disease: topicals+ systemic agents ( methotrexate/retinoids/cyclosporine/ Biologic) Retinoids, such as Acretin and Roaccutan, are used for Biologic is safe and targeted acne, and this is also a type of retinoid, so it shares the therapy that directly acts on same side effects (it cannot be given to pregnant women). inflammatory pathways, suppressing specific mediators like IL-17 and IL-27.  team Wishes you the best