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1、1PSORIASIS1.Common,chronic,recurrent,inflammatory disease of skin2.Round,circumscribed,erythematous,dry,scaling patches,papules or plaques3.Covered by grayish white or silvery white,imbricate and lamellar scales4.Various sizes,shapes,portions21.The incidence:0.123%,prevalence 0.1-3.0%,(numerator/den
2、ominator in a fraction)2.Patients about 3 millions3.First onset:15-45 years old4.No sex differenceEpidemiology in China in 19843Incidence in the world has a great difference,which is related to species,geography,and environment.41.Unknown2.Heredity(multifactorial and multigene inheritance disease)3.
3、Environment(infection,stress,emergency event)4.Immune-mediated mechanismEtiology51.Family history about 20%2.30%in one of father and mother3.60%in both mother and father4.70%in twin,not 100%5.Autosomal dominent in heritance6.Higher frequency in HLA-Cw6,HLA-B17,HLA-B37Etiology:Heredity61.Infection:in
4、 psoriasis guttala,tonsillitis,streptococcus infection,anti-streptolysin“O”test,virus infection?2.Stress:nervous,depressive 3.Emergency events:injury,operation,pregnancy,drugEtiology:Environment71.Lymphocyte,monocyte infiltration2.Cytokins:IL-1,IL-6,IL-8,interferon-3.Keratinocyte proliferation,promo
5、tion and persistence of the lesions Etiology:Immune81.The keratinocytes entering proliferation pool are much more than normal condition.2.Mitosis circle shortens from normal 311 hours to 37.5 hours.3.Epidermal turn-over time from 28-56 days to 3-4 days.4.As Ks quickly pass through epidermis,parakera
6、tosis in histopathology is formed with the lose of granular layer,presenting silvery white imbricated,and lamellar scales.Psoriatic pathophysiology9Psoriasis vulgaris:most common1.Primary lesions:papules or maculopapules,plaque with silvery white lamellar scales2.Three diagnostic features -wax-drop
7、phenomenon -film phenomenon -bleeding point phenomenon (Auspitz sign)Clinical Manifestation(4 types)10-whole body involved,scalp,extensive side of four extremities,lumbosacral area,nails,even balabusOther features of psoriasis vulgaris11-symmetry,multiform:psoriasis guttata,nummular,petal-like,nail
8、involved,bunch-like hair on scalp lesions-itching in various severityOther features of psoriasis vulgaris12图例13Ps.knee14Ps.scalp15Flexural Ps.16Rupioid Ps.17Pityriasis amiantacea18Psoriatic pitting:onycholysis and salmon patch19Subungual hyperkeratosis20-progressive phase:lesions increasing,enlargin
9、g,bright red,thin scales,red halo,isomorphism reaction is usually encountered-steady phase:no new eruption,thick scales-regressive phase:lesions regressing,color lighting,number reducing,white halo or pigmentationChronic course with 3 phases:inconstant211.Koebner reaction(isomorphism):psoriatic lesi
10、ons appear on the normal skin of patients with psoriasis after injured or scratched.Three Special Phenomena222.Auspitz sign(bleeding point phenomenon):There is pinpoint bleeding when a psoriatic scale is forcibly removed.This occurs only in psoriasis.It occurs because of the severe thinning of the e
11、pidermis over the tips of the dermal papillae.Three Special Phenomena233.Woronoff ring is concentric blanching of the erythematous skin at or near the periphery of a healing psoriatic plaque.Three Special Phenomena241.Youth2.Streptococcus infection,tonsillitis,anti-streptolysin“O”test 3.Acute onset,
12、developing fast,drop-like papules or maculopapules of 0.3-0.5 cm in size,4.Easily regress after properly treatedAcute guttate psoriasis25Guttate psoriasis.26Generalized Psoriasis Pustulosa(Von Zumbusch):most severe type,rare1.Causes unknown,topical irritant,infection,suddenly stop steroids or immuno
13、suppressive2.Acute,high fever,whole body fatigue,arthredema,superficial aseptic small pustules based on erythema which are merged to form“pus lake”,generalized distribution3.Last for several weeks and then resolve spontaneously.If repeated,prognosis is not good.Clinical Manifestation27Generalized Ps
14、oriasis Pustulosa28Localized Psoriasis Pustulosa(Palmoplantar pustulosis):1.Millet-like,grouped light yellow pustules based on erythema,symmetric distribution,limited to palm and sole.2.Last for 1-2 weeks,repeated,with nail changesClinical Manifestation29Localized Psoriasis Pustulosa30Psoriasis Arth
15、ropathica:1.Common with psoriasis pustulosa,psoriasis vulgaris,erythrodermic psoriasis or developed from psoriasis vulgaris2.Incidence being 6.8%,common in male3.Not symmetrical,small joint or large joint,chronic course with the limitation of function caused by destroying of joints,fever,anemia,lymp
16、h node enlarging4.Rheumatoid factor always negative31Psoriatic arthritis32图例33Erythrodermic Psoriasis:1.Usually caused by improper treatment such as suddenly stopping steroids or strong topical agents or later phase of generalized psoriasis pustulosa2.General scaling erythema with normal“skin island”,nail changes and general symptom3.Protein loss caused by scaling4.Chronic course34Erythrodermic psoriasis35Diagnostic/regular epidermal hyperplasia with long,test-tube-shaped rete ridges/atrophy ove
