JNUH

Psoriasis Vulgaris

  • Psoriasis is a complex, chronic, multifactorial, inflammatory disease that involves hyperproliferation of the keratinocytes in the epidermis, with an increase in the epidermal cell turnover rate
  • Environmental, genetic, and immunologic factors appear to play a role
  • Characterised by red, scaly, sharply demarcated indurated papules and plaques of various sizes
Psoriasis Vulgaris
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  • Prominent itchy, red areas with increased skin scaling and peeling
  • New lesions appearing at sites of injury/trauma to the skin (Koebner phenomenon)
  • Actual clearance of lesions following trauma to the skin (Reverse Koebner phenomenon)
  • Exacerbation in winter, improvement in summer
  • Significant joint pain, stiffness, deformity in 10-20%
  • Family history of similar skin condition
  • Trauma : Mechanical, chemical, radiation
  • Infections : Streptococcus, staphylococcus, HIV
  • Stress
  • Alcohol and smoking
  • Metabolic factors : hypocalcemia
  • Sunlight : usually beneficial but in some may cause exacerbatio

How is it diagnosed?

  • Lesions: Erythematous, scaly papules and plaques. Characteristic lesions include well-demarcated, erythematous plaques with adherent silvery white scales.
  • Cardinal features: ERYTHEMA, INDURATION & SCALING.
The commonest type is Psoriasis vulgaris.
  • Sites: Mostly extensors sites are involved. Elbows, knees, scalp, lumbosacral areas, intergluteal clefts.
Palms / soles involved commonly.
  • On scraping a lesion of psoriasis with a blunt glass slide, silvery scales are observed followed by a glistening transparent membrane. On removal of this membrane [Bulkeley’s membrane] multiple small bleeding points are observed.
  • This sign is absent in pustular psoriasis and inverse psoriasis

While eliciting the Auspitz sign,the characteristic coherence of scales seen as if one scratches a wax candle (candle grease sign)

Psoriasis Vulgaris

How is it treated?

  • Avoidance of trauma or irritating agents
  • Weight reduction in obese patients
  • Reduce intake of alcoholic beverages
  • Reduce emotional stress
  • Sunlight and sea bathing improve psoriasis except in photosensitive

Emollients

  • Minimize the symptoms of itching and tenderness
  • Help prevent irritation and thus the potential for
  • Subsequent Koebnerization

Tar

Antiproliferative effect

2% or 3% crude coal tar

  • Alternative is 4 to 10% LCD
  • (liquor carbonis detergens, a tar distillate)

Anthralin

May restore normal epidermal

  • proliferation and keratinization
  • Stains clothes, irritant

Salicylic acid

  • Keratolytic agent
  • Adjuvant to other topicals

Topical corticosteroids

  • Mainstay of topical treatment especially for plaque psoriasis
  • Antiinflammatory, antiproliferative, and immunosuppressive actions
  • Can be used as monotherapy 1-2 times daily or combined with other topical agents

Topical vitamin D analogues

  • Inhibition of keratinocyte proliferation and enhancement of keratinocyte differentiation
  • Calcipotriene, Calcitriol, Tacalcitol, Maxacalcitol, Becocalcidiol
  • Topical retinoids
  • Tazarotene (0.05% / 0.1%)
  • Act by normalizing abnormal keratinocyte differentiation, diminishing hyperproliferation, and by decreasing expression of inflammatory markers
  • Calcineurin inhibitors
  • Tacrolimus/ Pimecrolimus
  • Act by blocking the synthesis of numerous inflammatory cytokines
  • Facial & intertriginous psoriasis

Indication

  • Generalized psoriasis unresponsive to topicals.
  • Narrow band UVB is not only more effective than broad band UVB but also leads to rapid clearance of lesions.

Dosage :

  • Initial dosing according to skin type (130-400 mJ/cm2) or MED (50% of MED)[ MED = Minimal erythema dose]
  • Subsequent dosage increase by 15-65 mJ/cm2 or ≤10% of initial MED
  • Treatment 3-5 times/week

Methotrexate

Indication: Severe, recalcitrant, disabling psoriasis that is not adequately responsive to other forms of therapy.

Dosing: Weekly single oral dose Total dose should not ordinarily exceed 30 mg/wk

A test dose of 2.5-5 mg is recommended

Folate supplementation: Cyclosporine, Acitretin

Consult with experienced Doctors

JNU is home to some of the most eminent doctors in the world, most of whom are pioneers in their respective arenas and are renowned for developing innovative and revolutionary procedures
Gajanand Ojha

Dr. Gajanand Ojha

Professor

Qualification

MBBS, MD

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Priyanka Sharma

Dr. Priyanka Sharma

Associate Professor

Qualification

MBBS, MD

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Neha Agarwal

Dr. Neha Agarwal

Assistant Professor

Qualification

MBBS, MD

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Vikarn Garg

Dr. Vikarn Garg

Assistant Professor

Qualification

MBBS, MD

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Amit Kumar Malhotra

Dr. Amit Kumar Malhotra

Assistant Professor

Qualification

MBBS, MD

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