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Psoriasis

Psoriasis
(Last Updated On: 10 March 2020)

Introduction:

Pathogenesis:

Genetic factor: 30% of psoriatics are familial, when the condition begins in childhood, it is frequently linked to histocompatibility antigens (HLA Cw6)

Environmental factors:

Clinical:

Elemental injury: it is a scaly erythemato stain

Bleaching sign: the first strokes of curettes remove the crumbly surface layers and the surface becomes a bright white

Sign of the candle stain: the deep layers are more consistent, have a micacéd appearance

Sign of the sticky film: tearing a thin film sticking to the deep plane

Sign of the bloody dew (Auspitz sign): it is the appearance of thin hemorrhagic droplets, reflecting the stripping of dermal taste buds

Grouping and topography:

In a "punctata" point or in "guttata" drops a few millimetres in diameter, this is an eruptive psoriasis of the child, sometimes preceded by an infectious ENT episode

Nummular (nummulus – coin) a few centimetres in diameter

In plaque, more or less geometric or circumcised contours

Universalis: widespread, affecting almost all of the teguments

Functional signs (pruritus): Psoriasis is generally low or not pruriginous

Topographic forms:

On the acorn: very limited spots, purely erythematous

On the tongue: geographical language especially in pustular psoriasis, scrotal tongue

Child Psoriasis: May be early – psoriasis of napkin psoriasis, in children, often acute, in drops and may be a successor to a strep throat infection. The face is more often affected than in adults

Psoriasis caused:

Serious forms:

Localized palmoplanet psoriasis: in flare-ups, functional disability is often important

Generalized pustular psoriasis (von Zumbusch): sudden onset with altered general condition, fever and bright red cupboards that are covered with pustules that can confluence into large slicks

Arthrals, mono- or trace arthritis or arthritis similar to rheumatoid arthritis with however, a distal interphalangian disease and negative rheumatoid factor

Axial psoriatic rheumatism with spinal and sacroiliac damage adjacent to ankylosing spondylitis

Evolution / Complications:

Minors: overinfection, eczema, lichenification

Majors: erythrodermic, pustular and arthropathic psoriasis

Diagnosis:

Epidermal abnormalities:

Dermal abnormalities: papillomatosis (elongated dermal papillae) and inflammatory infiltrating (TCD4), a thick basal membrane with highly developed capillaries in the papillae

Treatment:

Local treatments:

Use 2 applications per day without exceeding 100 g/week to avoid the risk of hypercalcemia

Irritative phenomena occur in 20% of cases, especially when on the face

The combination of Calcipotriol and corticothérapie therapy is very effective (Daivobet®: Daivonex – Betamethasone)

Contraindications: pregnancy, kidney failure, patients on vitamin D or calcium

Keratolytics (salicylic acid at the concentration of 2-5% in a "Vaseline" fatty excipient, urea at 10-20%): are useful in very keratosic lesions

Baths and emollients: are useful for stripping lesions

Tar-based products: cade oil (wood tar), in the form of caditar lotion, to be put in bath water or shampoo

Topical retinoids (Tazarotene): have a significant irritative effect, reserved for very limited psoriasis (< 10% de la surface corporelle) 10%="" de="" la="" surface=""></ 10% de la surface corporelle)>

General treatments:

Side effects: are dose-dependent: dry skin and mucous membrane (compulsory cheilitis), hepatotoxicity (reversible at a standstill), high cholesterol, hypertriglyceridemia, teratogenic risk (contra-indicated its administration during pregnancy and involves in any woman during period of genital activity the carrying out of a pregnancy test before treatment and the use of reliable contraception started before treatment, continued during treatment and for 2 years after her stop)

Re-PUVA: combination of retinoids and PUVA

Form: 2.5 mg tablets and 10, 25 and 50 mg injectable bulb (IM or sub-cut)

Dose: 15-25 mg/week, the effect starts from the 8th week

Side effects: especially hematological and liver effects, require strict monitoring

Phototherapy:

Side effects: early rash, accelerated skin aging and induction of skin or cataract cancer)

Used at a rate of 3 sessions per week and not to exceed 100-150 j/cm2 for a cure of 30 sessions per year and 100 sessions in life

Biotherapy: These drugs are biological molecules (derived from biotechnology), used to block or inhibit specific stages of psoriasis pathogenesis, are anti-TNF or [Étanercept (Enbrel®), Infliximab (Remicade®), Adalimumab (Humira®)]lyphocytic T-targeted by binding inhibition LFA1-ICAM1 [Efalizumab (Raptiva®)]. Their indication is reserved for failures or contraindications of previous systemic treatments

Localized forms: local treatment is sufficient

Extensive forms: treatment includes: phototherapy and/or retinoids or Methotrexate or Ciclosporin

Special clinical forms:

Conclusion:

Psoriasis is a common, benign disease that can be serious, not only because of its complications but also because of its impact on the patient's quality of life. If the treatments used there are simply symptomatic, the hopes now come through immunomodulatory treatments targeted at the stages of psoriasis pathophysiology

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