PsoriasisPsoriasis

DefinitionDefinition

Psoriasis is a recurrent,chronic,inflammatory diseaPsoriasis is a recurrent,chronic,inflammatory disease of the skin characterized by red papules or plaqse of the skin characterized by red papules or plaques covered by silvery white and multilayer scales.ues covered by silvery white and multilayer scales.

Morbidity rateMorbidity rate

Natural population: 0.1%~0.3%Natural population: 0.1%~0.3% China(1984): 0.123%China(1984): 0.123%

EtiopathogenisisEtiopathogenisis

1.Theory of heredity1.Theory of heredityFamily positive of psoriasis is 4~91Family positive of psoriasis is 4~91 ％％ ,, 11.9~32% in china11.9~32% in chinaConcordance rate in twins:Concordance rate in twins: monozygotic twins> binovular twinsmonozygotic twins> binovular twinsHigh frequency in HLA-A1,B17,Cw6,DR7,High frequency in HLA-A1,B17,Cw6,DR7, a multifactorial inheritance diseasea multifactorial inheritance disease

EtiopathogenisisEtiopathogenisis2.Theory of infection2.Theory of infectionbacterial infection(esp.streptococcus)bacterial infection(esp.streptococcus)fungal infectionfungal infection bacteria fungibacteria fungi (streptococcus(streptococcus 、、 superantigen) (yeast fungus)superantigen) (yeast fungus) lymphocytes activated alternative lymphocytes activated alternative

complement complement pathwaypathway clonal proliferationclonal proliferation functional disorder of immune system functional disorder of immune system

EtiopathogenisisEtiopathogenisis

3.Abnormal immune function :3.Abnormal immune function :

cellular immunity function reduce partlycellular immunity function reduce partly

early skin lesions are infiltrated predominantly byearly skin lesions are infiltrated predominantly by

lymphocyteslymphocytes

autoantibody deposit in the horny layerautoantibody deposit in the horny layer

Th1/Th2 disequilibrium theory(Th1 dominantTh1/Th2 disequilibrium theory(Th1 dominant

skin disease)skin disease)

EtiopathogenisisEtiopathogenisis

4.Dysmetabolism:4.Dysmetabolism: cAMP metabolic block of arachidonic acid 、 cGMP polyamines shortened epidermal cell transit time, hyperplasia5.others: psychosis,neuroendocrine,climate,medicine et al may induce or aggravate the disease.

Clinical featuresClinical features

Psoriasis vulgarisPsoriasis vulgaris Psoriasis arthropathicaPsoriasis arthropathica Psoriasis pustulosaPsoriasis pustulosa Psoriasis erythrodermicaPsoriasis erythrodermica

p. vulgaris:

red papule

silvery white

scales

Film phenome-

non

Auspitz’s sign

Predilection site

Lesion morphologyLesion morphology

Psoriasis guttata

Nummular psoriasis

Geographic psoriasis

distinctive features in different distinctive features in different regionsregions

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 of psoriasisStages of psoriasis

Active stage:large amounts of new lesions,Active stage:large amounts of new lesions,red and pruritus red and pruritus

Resting stage:dark red lesions withoutResting stage:dark red lesions without new eruptionnew eruption regression stage:erythema fade ,flatten and regression stage:erythema fade ,flatten and

disappeardisappear

Koebner phenomenonKoebner phenomenon

Mechanical injury,insect bite,cold injury,Mechanical injury,insect bite,cold injury,

sun shine et alsun shine et al

Normal skin of patients in active stageNormal skin of patients in active stage

express typical lesions express typical lesions

clinical significance:suggest in active clinical significance:suggest in active stagestage

Course of psoriasisCourse of psoriasis

exacerbate in winter ,improve in exacerbate in winter ,improve in summer summer

chronic and persistentchronic and persistent

clear spontaneously ,recur frequentlyclear spontaneously ,recur frequently

Diagnosis and differential Diagnosis and differential diagnosisdiagnosis

Diagnosis:lesions,types and stagesDiagnosis:lesions,types and stages Differential diagnosis:1.pityriasis roseaDifferential diagnosis:1.pityriasis rosea 2.secondary 2.secondary syphilissyphilis 3.seborrheic 3.seborrheic dermatitisdermatitis 4.chronic eczema 4.chronic eczema

TreatmentTreatment

一一 .topical treatment:.topical treatment:1.general principle:1.general principle: irritative medicine can not be used in acute phasirritative medicine can not be used in acute phas

e to avoid provoking erythroderma.e to avoid provoking erythroderma. stronger medicine can be applied in stable phasestronger medicine can be applied in stable phase transdermic absorption must be noticed during thtransdermic absorption must be noticed during th

e general applicatione general application reduce scales by using warm water and soap beforeduce scales by using warm water and soap befo

re treatment re treatment

TreatmentTreatment

2.medicine selection:2.medicine selection:Active stage:apply gentle medicine,for instanActive stage:apply gentle medicine,for instan

ce 15% carbamide lipoid,3%ce 15% carbamide lipoid,3% ～～ 5%5% boric acid ointment,simple cream boric acid ointment,simple cream Stable or regression stage:use medicine with Stable or regression stage:use medicine with

higher concentration,such as comples clobhigher concentration,such as comples clobetasol propionate creametasol propionate cream ，， sulfur salicylic asulfur salicylic acid ointment ,coal-tar cid ointment ,coal-tar

liniment and calcipotriol ointmentliniment and calcipotriol ointment

TreatmentTreatment

二二 .oral medicine:.oral medicine: the traditional chinese medicine: quyin mixturthe traditional chinese medicine: quyin mixtur

e,xiaoyin mixture,complex indiginis naturals e,xiaoyin mixture,complex indiginis naturals pill,tab.diyinpill,tab.diyin

vitamin: vitD2, vitEvitamin: vitD2, vitE antibiotic: cefradine and so onantibiotic: cefradine and so on antihistamine drug: cetirizine,mizoller, clarityantihistamine drug: cetirizine,mizoller, clarity

nene hormone: prednisonehormone: prednisone immunosuppressive agent: MTXimmunosuppressive agent: MTX

TreatmentTreatment

三三 .vein blockage: another name procaine .vein blockage: another name procaine vein blockagevein blockage四四 . Photochemotherapy: PUVA, means . Photochemotherapy: PUVA, means therapeutic alliance with 8-mop and therapeutic alliance with 8-mop and black lightblack light五五 .light quantum therapy.light quantum therapy

Sepical typeSepical type

Psoriatic arthritis

Psoriatic erythroderma

Pustular psoriasis