- It is a chronic and recurrent erythemato-squamous dermatosis Of evolution.
- Affecting 1 tO 2% of the general population.
- It can occur at anY age (20 and 30 years) but remains rare bwithrand has years (10 tO 15%)
- Psoriasis affects both men and women at equal frequencies.
- Essentially clinical diagnosis
- Benign dermatosis, The usual form poses only an aesthetic damage, but significantly impairs the quality of life however there are serious forms of part:
- The extent of the lesions.
- The The modificationn Of the elemental lesion.
- The associatedOn with arthropathies. (erythrodermia, pustuler psoriasiss, psoriatic arthritis)
- TRT is symptomatic: ofteNo lowed On local therapiit is, genisal treatments are reserved fOr severe forms
Pathogenesis remains pfallowY understudged:
– Psoriasis is characterized by an acceleration of epidermal renewal
Turn over normal epidermal is 30 days
In psoriasis only 7 days
– this is related to immune disorders
– activation of LT – secretion of different cytokines (TNF Alpha, IL12, IL23 …)
– causing a psoriatic inflammatory reaction
responsible for the increased proliferation of keratinocytes
It is a “multifactorial” condition – genetic factors
30% of psoriatics are family-friendly
Childhood psoriasis is frequently linked to histocompatibility antigens (HLA-Cw6) – environmental factors
Alcohol and tobacco: TRT resistance factors
Infections: especially in childhood psoriasis flare-ups
Psychological factors and medications (lithium salt, beta blockers, IEC, CTC …) can induce or aggravate psoriasis
II- CLINICAL: CLASSIC FORM OF VULGAR PSORIASIS
componentntal injury: rounded and well-restricted erythemato–scalY plaque. – superficial scaly layer
A- The dander on the surface:
Color: white and dull, sometimes musky – Surface: smooth or rough
These dander are dry, of varying size and thickness
– may completely or partially mask the rash
- Brocq’s methodical withrettage;
– Becamebuting sign
– himselfn Of Whenle stain
– Sign of the sticky film.
Pulling Off a deep–shot adhereedand movies
– himselfn Of bstoriesY dew or sign of AusprFROM:
Appearance of fiwe hemorrhagic goutlets (naked dermal tayou buds)
B- Erythema is anderlying:
– located under the scaly layer
– Characteristic pink colOur, cogenty red (infs)
– Disappears at the pressure press. – smooth and dry surface
– nO pain, no infiltration, nO prinrite.
C– Grouping and topographY:
– rarely isolated plaque psoriasis,
– usually multiple or diffuse
– punctiform “punctata” Or in “guttata” drops a few mm in diameter
– Nummular (nummulus-coin) a few cm in diameter
– Plate: more or less geometric or circumcised contours occupying large areas
– universals: widespread that affects almost the entirety of the
– very evocative of the diagnosis
At the begivenning and throughoint the hardatiOn of the disease; fraction zonees:
elbows, knees, forarm huhadbOards, tubeial regions, sacred region, palms and plants, scalp (refuge area or bastion).
- Areas OF frictionn of clothing Or regular handling of a material (Koebner phenomenon).
Functional signs (pruriit): Psoriasis is littthe Or not pruriginous
III- CLINICAL FORMS:
A- Depending on the seat:
1- clasic forms: pasten:
2- Psoriasis of folds: Psoriasis inverted.
– glossy red plate and smooth little or no flaking
– seat: interfessier folds – inguinaux – genital regions – under breasts – axillary hollow
– Macerated, wet areas; michael rash.
– Two differental diagnoses: eclow and fungus.
3- Scalp psorIasis:
– erythemato-scaly patch of very limited variable sizes covered with large dry dander crossed by the hair (Non-afreeciant) – real shell covering the entire scalp
- The thicknit iss of the scalp and the prthatnce of hwater goldk the rash.
- Often; scaly helmet.
- TwO differential diagnoses: scalp moths and inoutwornOus moths.
4- Nail psorasis: 30-50% Of cahis
– sometimes isolated,
– Appearance of depression punctuated cupiliforms (nail in dice to sew)
– onycholysis with distal detachment
– hyperkeratosis under ungueal
- NO rash-scaly spots.
- Whitish transverse streaks.
- Pachyonychia: thickening of the nail.
- Differentito diagnosiss: onychomycosis.
5- Psoriasis Of palms and plants:
– often bilateral – a keratodermy in ilots or diffuse
Two differential diagnosiss:
- Plantar he hasrdwoods and warts.
- Horns at the foot.
6- Facial psOriasis:
Rare, it can take on the appearance Of seborrheic dermatitiss (sebopsoriasis)
7- psoriasis of the mincous membranes:
– On the language:
Geographical language especially in pustular psoriasis
– On the acorn: very limited spots, purely erythematous
B- Depending on age:
– may be early: psoriasis of the langes (napkin psoriasis)
– in children: often acute in drops and can follow a rhino-pharyngeal infection The face is more often affected than in adults
C- Psoriasis caused:
– Drugs: they may induce or aggravate psoriasis or be responsible for TRT resistance (lithium salts, beta-blockers, IFN alpha) – koebner phenomenon: characterized by the appearance of psoriasis lesions on a skin trauma: streaks of scratching, surgical scars …
D- Serious forms:
1- Pustular Psoriasiss:
- componentntal lesion: a yellOwish-white pusCome on a base of diffuse erythema that dries out quickly and flaks.
- Fever 40oC and altered gineral cOndition.
- Thiwith psoriasis togetheratit is an infectious disease and its spontaneous prognosis is setrue tond can lead to the death of the patient.
- Pinstular psoriasis can be limited to thand hasnds and feet and arelate eczema: it is acromegaly.
- Pinps stularOriasis is often the cOmplication of vinLOSS psoriasiss treated with gedownal corticosteroid therapy.
2- Erythrodermic Psoriasiss:
- Diffuse edema with infiltrated and cardboard skin and accentuated wrinkles.
- Touch the elderly subject.
- Hydro-electrolytic loss due to edema; life-threatening prognosis at stake.
- Overinfection and thermoregulation disorders
- Complication of general corticosteroid therapy
3- Arthropathe psoriasis:
- 25% Of Psoriasis develOp arthropathy.
- MonO Or trace arthritis, SERONegative arthritis, SPA.
IV- OPENING OF A BOOKN:
- protectsc disease evolving by flare-ups.
- Functional and vital perOgnosiss are isly inwithinlby.
- Socio-psychological impact.
- The existenwill of anothers that indinthis flare-ups Or severe forms of psoriasiss: INSAIDs, APS, beta blockers, lithium salts, general corticosteroids.
- holidays, sinmmer and the sun; Improvement.
- Winter; Aggravation.
A- Positive diagnosis:
2- Histology in thatse Of hegnostic doubt:
- Frkeatic hyperkeratosis.
- Acrobian micro-abscess.
- Thickening and dilation of the dermal taste buds.
- Turgescent ships.
- Infiltration Of mononucleous cells.
c)– Hypoderma and annexes: No changes
B- Differentito diagnosiss:
- Microbial eczema.
- Lichen plan: very broughtginous papulo-squamous dermatosisso reaching the mincous membranes.
- Hematoma (associated lymphoma).
A- Limited Psoriasis:
- Dirty Vaseline 0.5 tO 10%.
- intoxicatedOn; dyspnea, stby skin washing.
- Coal takes.
- Cade oil.
- Vitamin D derivatives: Calcipotriol, Daïvonex.
B- Extended Psoriasis:
- PUVAtherapY; Adults.
- FULLB with tar; Chferrets.
C- I knowtrue PsOriasis: Extended or Rebellious:
- drifttives Of acidic viwith A; Retinoid, Soriatane.
- Retinoid Association with PUVAtherapy.
- Otherwise antimitotic: Injectable methotrexate.
D- Arthropathic Psoriasiss:
- InSINS and corticosterOids contrainded.
- Fhysical means if not Retinoid or Methotrexate.