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PSORIASIS COMPLEX & PERPLEXING

UNTAR MEDICAL FACULTY April 14th 08 – May 17th 08

DESNI PARAMITAIVONNE KURNIAWANVINA LIAWATIRADOT SIHOMBINGYONGKY SUTANTOWILLIAM KESTER

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HISTORY

The condition was finally given the name PSORIASIS.

Be identified two categories =1. Leprosa Graecorum – had scales2. Psora Leprosa – became eruptive

The fourth variant of impetigo, a condition caused by staphylococcus pyogenes.

Psoriasis was first to be talked with.

Ferdinand von Hebra - 1841

Robert Willan - 1812

Cornelius Celsus – 1st C

Hippocrates – 377 BC

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SIGN of PSORIASIS

Auspitz Sign = pint point bleeding ,

papilomatous

Koebner respon = skin trauma by scratching

Tetesan Lilin phenomena = milky white blister , radiance index

changing

Silver

White Scales

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ERUPTION

CHRONIC CHRONIC RESIDIFRESIDIF

SOLITAIRSOLITAIR

MULTIPLEMULTIPLE

SYMETRISSYMETRIS

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HISTOPATHOLOGY

PSORIASISPSORIASISPapilomatosis

AcantosisAgranulosis

Hiperkeratosis

Parakeratosis

Subepidermal Vasodilatation

Munro Abcess

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RISK FACTOR

STRESS OBESITY SMOKINGOTHER

MEDICAL CONDITION

Strong impact to :immune system

Skin folds friction Inverse psoriasis

•Immunodeficient•Child :Strept inf•Adult :HIV ( + )

• Physic & Psycho Stress • Polution

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TYPE

PSORIASISPSORIASIS

1

2

3

4

5

PLAQUE - raised, inflamed, red lesions covered by a silvery white scale. Occurs in scalp & extensor

INVERSE – eritema only, occurs in skin fold obesity, armpits and groin.

ERYTHRODERMIC – generalized eritema, over treatment Koebner respon

PUSTULAR – acute milky white blisters surrounded by red skin, caused by Steroid withdrawal

GUTTATE – generalized small lessionred spots on the trunk.

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PLAQUE type

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INVERSE type

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ERYTHRODERMIC type

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GUTTATAE type

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PUSTULAR type

T

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DIFFERENTIAL DIAGNOSIS

Psoriasi

s

Chronic Type

Gutata Type

Eritroderm Type

Flexural Type

Corporis TineaNumularis DermatitisMorbus Hansen

Pitriasis RoseaDrug EruptionLues std 2

Atopic DermatitisContact DermatitisDrug Eruption

Cruris TineaAtopic DermatitisCandidosisTHE GREAT IMITATOR

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DIFFERENTIAL DIAGNOSIS

Psoriasi

s

Nail

Facial

Unguium Tinea

Capitis TineaSeborrhoic Dermatitis

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DIFFERENTIAL DIAGNOSIS

Squama = ( - )Nodul = ( + )Infiltrate = ( + )< 5 Cardinal Sign >

PSORIASIS

CORPORISTINEA

NUMULARISDERMATITIS

MORBUSHANSENCHRONIC type CHRONIC type

Perifer > ActiveKOH = ( + ) long hypha

Squama = ( - )Size = numularMadidans.Erosive crust.

Perifer = Central = ActiveKOH = ( - ) hyphaEpitel = ( + ) nucleatedSquama = ( ++ ) Size = lentikular,numular, plaqued.

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DIFFERENTIAL DIAGNOSIS

CHRONIC type CHRONIC type PSORIASIS CORPORIS TINEA NUMULARIS D’s MORBUS HANSEN

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DIFFERENTIAL DIAGNOSIS

Adults.Bacterial induced.Dark red / brownish lesions with softand infiltrated scales.

PSORIASIS

PITRIASISROSEA

DRUG ERUPTION

LUESstd 2

GUTTATE type GUTTATE type

Tends to disappear in 4 – 8 weeks.Children & young adults.Virally induced.Pink rash with fine scale.

Drug induced.Scales = ( - )Burning sensation.Acute

Adults.Genetic.Red rash with rough scales.

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DIFFERENTIAL DIAGNOSIS

GUTTATE type GUTTATE type

PSORIASIS PITRIASIS ROSEA DRUG ERUPTION LUES std 2

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DIFFERENTIAL DIAGNOSIS

Squama = ( - )

Burning sensation.

PSORIASIS

ATOPIC

DERMATITIS

CONTACT

DERMATITIS

DRUG

ERUPTION

ERYTHRODERMIC type ERYTHRODERMIC type

Ig E = increase

Atophy stigma

Squama = ( - )

Patch tes = ( + )

Squama = ( + )

Eritema = ( + )

Patch tes = ( - )

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DIFFERENTIAL DIAGNOSIS

ERYTHRODERMIC type ERYTHRODERMIC type

PSORIASIS ATOPIC D’s CONTACT D’s DRUG ERUPTION

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DIFFERENTIAL DIAGNOSIS

KOH = ( + ) pseudohypha

Scales = ( + ) wet

Corimbiformis +Satelite lessions.

PSORIASIS

CRURISTINEA

ATOPICDERMATITIS

CANDIDOSISFLEXURAL type FLEXURAL type

KOH = ( + ) long hyphaScales = ( + ) softPolycyclic,

Ig E and eosinophiliaincrease.Lichenification,fossa cubiti& popliteaStigma atopy.

KOH = ( - )Scales = (++ ) rough

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DIFFERENTIAL DIAGNOSIS

FLEXURAL type FLEXURAL type

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DIFFERENTIAL DIAGNOSIS

Black dot Black dot ringwormringworm

Mousy odorMousy odorROUGH ROUGH whitewhitescalesscales

OillyOillyyellowishyellowishlessionlession

PSORIASIS

SCALP

SEBORRHOIC

DERMATITIS

CAPITIS

TINEA

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DIFFERENTIAL DIAGNOSIS

SCALP typePSORIASIS SEBORRHOIC D’s CAPITIS TINEA

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DIFFERENTIAL DIAGNOSIS

PSORIASIS

Pitting nail.

Onycholysis.

Nail dystrophy.

NAIL type

UNGUIUMTINEA

Broken nail from distal.

Hyperpigmentation.

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DIFFERENTIAL DIAGNOSIS

NAIL type UNGUIUM TINEA

PSORIASIS

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TREATMENT OVERVIEW

Psoriasis have no cure, but many different therapies can reduce, or nearly stop their symptoms. No single treatment works for everyone, but something is likely to work in most cases.

Topical treatments are usually the first line of defense in treating psoriasis. Researchers believe psoriasis occurs when faulty signals in the immune system cause skin cells to grow too rapidly. Topicals slow down or normalize that excessive cell reproduction and reduce inflammation (redness) associated with psoriasis.

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TREATMENT

TOPICALTOPICALTOPICALTOPICAL

EMOLIENEMOLIEN ANTHRALIN ANTHRALIN

TER LCDTER LCD

CALCICALCIPOTRIOLPOTRIOL

PUVAPUVAPUVBPUVB

ACUTE CHRONIC

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TREATMENT

TRANQUILIZER

CORTICOSTEROID

CYCLOSPORIN

METHOTREXATE

ETRETINATE

SYSTEMICSYSTEMIC

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Cover with an airtight plastic wrap, waterproof dressing.2hours only.Increase the effect of steroid.

Directly to the lession. Once / twice daily. Not to uninvolved skin.

On the schedule / tappering off.

METHODS OF USING TOPICAL STEROIDS

Apply to the

lessionOcclusion Pulse

Dosing

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POTENTIAL SIDE EFFECTS OF TOPICAL STEROIDS

Skin Damage

Rebound Phenomena

Facial Psoriasis

Internal Absorption

Cushing's Disease

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AVOIDING STEROIDS SIDE EFFECTS

HEALTHY LIFE

AFTERMEAL

LOW DOSESHORT TERM

BASED ONPRESCRIPTION

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SPECIAL CONDITIONS CONCERNING STEROIDS

Pregnancy

Allergies

Breast Feeding

Diabetes

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generalisatageneralisataZumbusch typeZumbusch type

PALMOPLANTARPALMOPLANTAR ( BARBER type )( BARBER type )

ACROPUSTULOSIS

PUSTULAR PUSTULAR PSORIASISPSORIASIS

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BOTTOM LINE OF STEROIDS

Corticosteroids are powerful drugs which can improve symptoms and provoke incredible results. There are potential consequences to their use though. The power of corticosteroids should not be feared, but must be respected.

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WAYS TO MAKEA POSITIVE

CHANGE

Acknowledge your feelings Don't hesitate to talk to a professional

Don't give up on finding a treatment that work

Educate yourself about your disease

Share your feelingswith others

Ask for help

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Obesity

Stress

Drugs

ImunologyInfection

Weather

Hormonal

GeneticTrauma

Iritation

What are some other trigger ?

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MEDICINE TRIGGERING PSORIASIS

Quinidin

LithiumAnti Malaria

Inderal

Indometasin

Medications associated with ?

WHAT ARE

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REFERENCES

Catherine H Smith, consultan dermatologist; J N W N Barker, professor of

clinical dermatology. Risk Of Myocardial Infraction with Psoriasis. Last

updated : August 19, 2006

Joel M. Gelfand, MD, MSCE; Andrea L. Neimann, MD; Daniel B. Shin, BA.

Psoriasis and It’s Management. Last updated : 2006

Randy Parks, MD, Chair, Associate Professor, Departement of Emergency

Medicine, Denton Regional Medical Center. Psoriasis. Last updated : May 1,

2007

Tim Editor Fakultas Kedokteran Universitas Indonesia, 2003. Metode

Diagnostik dan Penatalaksanaan Psoriasis dan Dermatitis Seroboik. Balai

Penerbit FKUI. Jakarta.

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DERMATOLOGY HUSADA HOSPITAL – UNTAR MedFac

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..:: Radot – Ivonne – William – Desni – Vina – Yongky ::..