I- FROMFINISH/GENERAL :
- It is a Dermatose erythematous–squameuse devolution chronic and recurrent.
- touching 1 at 2% of the general population.
- It can occur at all the ages (20 and 30 years +++) but remains rare before dix years (10 at 15%)
- The psoriasis touch the man and the women at equal frequencies.
- Diagnostic essentially clinique
- Dermatose benign, The form usual poses one prejudice aesthetic, but significantly affects the quality of life, however there of the forms graves departure:
- The scope of the injury.
- The modification from lesion elementary.
- The association at of the arthropathies. (erythroderma, psoriasis pustular, rheumatism psoriasique)
- TRT East symptomatic : repose often sure of the therapeutic locales, the treatments general are reserved to the forms severe
Pathogénie rest times elucidated :
– Psoriasis is characterized by epidermal renewal acceleration
* Turn normal epidermal is over 30 days
* only in psoriasis 7 days
– This is associated with immune disorders
– activation des LT -> secretion of various cytokines (TNF Alpha, IL12, IL23 ... )
* causing psoriatic inflammatory reaction
* responsible for increased keratinocyte proliferation
This is a 'multifactorial' disease – genetic factors
* 30 % of psoriatic are family
* Psoriasis in children is often linked to the histocompatibility antigens (HLA-Cw6) – environmental factors
* alcohol and tobacco : resistance factors TRT
* infections : especially in outbreaks of psoriasis in children
* psychological factors and drugs (lithium salt, beta-blockers, IEC, CTC … ) may induce or aggravate psoriasis
II- CLinique : FFOOTSTEPS CLASSIQUE OF PSORIASISS VULGAR
Lesion elementary : plaque erythematous–squameuse rounded and flopn limited. – scaly surface layer
A- Dander surface :
* Color : whitish and dull, sometimes micaceous * Surface : smooth or rough
* these scales are dry, size and of varying thickness
* may mask completely or partially erythema
- curettage methodical from Brocq ;
– Sfire from whitening
– Sign from the task from candle
– Sign of the peelable film.
Arrachement d’a film adherente at plan deep
– Sign from the dew bloody or sign of Auspitz :
Apparaition from fines gouttlettes hemorrhagic (setting at not of the buds dermal)
B- erythema East under–underlying :
– underneath the squamous layer
– Color dew feature, rouge cogestif (earlier es infs)
– Disappears at the pressure-vitro. – Surface smooth and dry
– not from pain, not infiltration, not from pruritus.
C- Group and topography :
– rarely isolated psoriasis plaque,
– often multiple or diffuse
– point «Punctata» I in drops "Guttata" of a few mm
– Nummulaire (nummulus = coin) a few cm in diameter
– In plaque : more or less geometric contours or vine occupying large areas
– Universalis : generalized that almost touches the entire integument
– very evocative of diagnosis
At beginning and pendant all the duration from the sickness ; zones from friction :
elbows, knees, edges cubitaux of the forearm, tibial regions, sacral, palms and soles, scalp (refuge area or bastion).
- Zones from friction of the clothing or manipulation regular a equipment (Koebner phenomenon).
signs functional (pruritus) : the psoriasis East little or not prurigineux
III- FORMES CLINICAL :
A- According seat :
1- shapes Clasicos : bastion :
2- Psoriasis of the more : Psoriasis inverted.
– red plate glossy and smooth little or no scaly
– seat : interfessier ornaments - inguinaux – genital areas – in breast – axilla
– areas macerated, wet ; erythema micaceous.
– Of them diagnostic differential : eczema and mycosis.
3- Psoriasis of please haired :
– erythematous scaly plaque ciconscrites much limited varying sizes covered large dry scales through which the hair (non alopéciant) – real shell covering the entire scalp
- The thickness of please haired and the presence of the hair mask erythema.
- Often ; helmet squameux.
- Of them diagnostics differential : moth of please haired and false moth infectious.
4- Psoriasis of the nails : 30–50 % of the case
– sometimes isolated,
– Appearance of depression interspersed cupiliformes (nail thimble)
– onycholysis with distal abruption
– hyperkeratosis subungual
- Not from spots erythematous–squameuses.
- streaks transverse whitish.
- Pachyonychie : thickening from the nail.
- Diagnostic differential : onychomycoses.
5- Psoriasis of the palms and of the plants :
– often bilateral -> keratodermia in islands or diffuse
Of them diagnostics differential :
- Durillons and verrues plantar.
- hearts at pied.
6- psoriasis of face :
Rare, the can to take l’aspect d'a dermatitis seborrheic (sebopsoriasis)
7- psoriasis of the mucous :
– On the tongue :
* geographic tongue especially in pustular psoriasis
* langue scrotale
– On the glans : well limited spots, purely erythematous
B- By age :
– may be early : Psoriasis nappies (napkin psoriasis)
– in children : often sharp drops and can follow a nasopharyngeal infection The face is usually achieved in adults
C- Psoriasis caused :
– pharmaceuticals : they can induce or worsen psoriasis or be responsible for resistance to TRT ( lithium salts, beta-blockers, IFN alpha ) – Koebner phenomenon : characterized by the appearance of psoriatic lesions on a skin trauma : scraping ridges, surgical scars ...
D- severe :
1- Psoriasis pustular :
- Lesion elementary : pustule blanc–yellowish asked sure a base erythema diffuse which dries quickly and exfoliates.
- Fever 40°C and alteration from the state general.
- This psoriasis simulate a sickness infectious and son prognosis spontaneous East grave which can lead to death of the patient.
- The psoriasis pustular can to be limit to the mains and to the feet and simulate a eczema : is acromegaly.
- The psoriasis pustular East often the complication a psoriasis vulgar treaty through corticosteroids.
2- Psoriasis erythrodermic :
- Erythema diffuse edematous infiltrated with skin and cardboard and accented wrinkles.
- the elderly Button.
- Fluid and electrolyte loss due to edema ; life-threatening game.
- Superinfection and thermoregulation disorders
- Complication corticosteroids
3- Psoriasis arthropathique :
- 25% of the psoriasis develop a arthropathie.
- Mono or trace arthritis, arthritis seronegative, SPA.
IV- ISEVOLUTION :
- Sickness chronic evolving through outbreaks.
- Prognosis functional and vital born are what in Game.
- repercussion socio–psychological.
- Existence from pharmaceuticals inducers from outbreaks or from forms graves of psoriasis : AINS, APS, beta-blockers, lithium salts, corticosteroids.
- Environment :
- the vacation, been and the soleil ; improvement.
- Winter ; aggravation.
V- DIAGNOSTIC :
A- Diagnostic positive :
1- Clinique : +++
2- histology in case from doubt diagnostic :
a)- ISepidermis :
- hyperkeratosis parakératosique.
- Micro–abscess amicrobiens.
b)- Dermis :
- thickening and dilatation of the buds dermal.
- vessels turgescents.
- Infiltration from cell mononuclées.
c)- Hypoderme and annexes : Absence from modifications
B- Diagnostic differential :
- Eczema microbial.
- Lichen plan : Dermatose papulo–squameuse very CASTROTHEODORICIENNE up also the mucous.
- Hématodermie (lymphoma associate).
WE- TREATMENT :
A- Psoriasis limit :
1- keratolytic :
- Vaseline salicylate 0,5 at 10%.
- Intoxication ; dyspnea, stop lavage from the skin.
2- Gearboxes :
- Tar from coal.
- Oil from cade.
- derivatives vitamin D : Calcipotriol, Daïvonex.
B- Psoriasis expanded :
- PUVA ; adults.
- PUVB with tar ; children.
C- Psoriasis grave : extended or refractory :
- derivatives from the vitamins A acid ; retinoid, Soriatane.
- Association retinoid with PUVA.
- If not antimitotic : methotrexate in injectable.
D- Psoriasis arthropathique :
- The AINS and corticosteroids against-indicated.
- Means physique if not retinoid or methotrexate.