Psoriasis


A chronic disorder with polygenic predisposition and environmental triggers, such as bacterial infections, trauma or drugs. Psoriasis affects between 1.5 and 2% of the population in Western countries. It is presented all over the world.

Serious clinical expressions. The typical lesions are chronic and recurrent desquamative papules and plaques. Pustular rashes and erythroderma also occur.

The clinical presentation varies between one individual and another, from those who only have some circumscribed plaques to those with generalized skin involvement.

  • Psoriatic erythroderma in psoriasis that affects the entire skin.
  • Psoriatic arthritis occurs in 10 to 25% of cases.

Classification

  • Psoriasis vulgaris                                   
  • Psoriatic erythroderma                                  
  • Pustular psoriasis
  • Palmoplantar  psoriasis                                 
  • Acrodermatitis continuous
Vulgar psoriasis
Vulgar psoriasis The primary lesions are well-defined, reddish or pink-colored papules, in the form of drops, with a silver-white lamellar scale attached.
Psoriasis vulgaris: elbow.
Psoriasis vulgaris: elbow. Chronic psoriasis of stable plates in the elbow. In this location, the scales can accumulate to form a hyperkeratosis similar to an oyster shell, or detach in large sheets and reveal a fleshy red base.
Psoriasis vulgaris: chronic stable type
Psoriasis vulgaris: chronic stable type. Multiple large scaly plaques on the trunk, buttocks and legs. The lesions are round or polycyclic and confluent; they form geographical distributions.
Areas of preferential involvement

 

Factors that influence the selection of the treatment of Psoriasis

  1. Age: childhood, adolescence, young adult age, middle age,> 60 years.
  2. Type of psoriasis: in drops, plaques, palmar and pustular palmar, generalized pustular psoriasis and erythrodermic psoriasis.
  3. Place and extent of affectation: circumscribed to the palms of the hands and the soles of the feet, the scalp, the genital ano region, scattered plaques but affected <5%; generalized and affected> 30%.
  4. Previous treatment: ionizing radiation, systemic glucocorticoids, photo chemotherapy (PUVA), cyclosporine (CS) and methotrexate (MTX).
  5. Concomitant medical conditions (eg, HIV infection).

 Circumscribed psoriasis

  • Topical fluorinated glucocorticoid covered with plastic dressing. The tape impregnated with glucocorticoid is also useful. The side effects of corticosteroids must be borne in mind.
  • A hydrocolloid dressing, which stays for 24 to 48 h, is effective and avoids scratching.
  • For small plates (≤4 cm), triamcinolone acetonide in aqueous suspension 3 mg/ ml diluted in isotonic solution that is injected intradermally in the lesions. We must bear in mind the hypopigmentation in dark skin.
  • Topical anthralin is also effective, but may cause irritation.
  • Vitamin D analogues (calcipotriene, ointment and cream) are good non steroidal antipsoriatic topical compounds, but less effective than corticosteroids; they are not accompanied by cutaneous atrophy; They can be combined with cortico steroids.

 

 

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