Psoriasis

Psoriasis:  This chronic disorder is marked by epidermal proliferation and recurring remissions and exacerbation's.  It's lesions, which appear as red ( erythematous papules ), and plaques covered with silvery scales, vary widely in severity and distribution.  The tendency to develop psoriasis is genetically determined.  Studies shows significantly higher than normal incidence of human leukocyte antigen (HLA) in patients with psoriasis, suggesting a possible autoimmune deficiency.

Symptoms: 

Small erythematous papules
Red, elevated plaques with silver scales appearing on the scalp, face, chest, elbows, knees, back, buttocks, genitals.
Itching (pruritus)
Possible nail pitting and joint stiffness

Treatment :

No permanent cure exists
Intervention varies:  * lukewarm baths and the application of occlusive ointment bases (petrolatum or preparation containing urea)
 * Salicylic acid preparations - it may soften and remove psoriatic scales
 * Steroid creams such as Hydrocortisone cream/oint.
 * Ultraviolet light - wavelength B (UVB) or natural sunlight (methods to retard rapid cell proliferation to the point of minimal erythema)
 * Anthralin, combined with a pasted mixture may be prescribed for well defined plaques but mustn't be applied to unaffected areas, because it may cause inflammation.  Anthralin irritates and stains the skin.  It also stains clothing and household items, such as the sink or bathtub.
In patient with severe chronic psoriasis treatment includes:
 * Goeckerman treatment - which combines tar application and UVB - It may achieve remission and clear the skin.
 * Ingram technique - a variation of this treatment, uses anthralin instead of tar.
 * A program called PUVA (Photo - therapy) - combines administration of methoxsalen (a psoralen derivative) with exposure to ultraviolet light, wavelength A.
 * Methotrexate - may help severe, refractory psoriasis
 * For last resort, the doctor may prescribe etretinate therapy.

To relieve pruritus - low dose of antihistamines, oatmeal baths, emollients (perhaps with phenol and methol), and open dressings.

To alleviate the pain of psoriatic arthritis - aspirin and local heat application

For severe cases - may require nonsteroidal anti - inflammatory drugs

Treatment for psoriasis of the scalp usually consists of a tar shampoo, followed by an application of a steroid lotion while the hair is still wet.

No effective treatment exists for psoriasis of the nails, the nails usually improve as skin lesions improve

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