Question

Describe to me the etiology, pathogenesis, clinical manifestations, and treatment options for Psoriasis. What education will you provide to patients about interventions to keep their joints healthy as long as possible?

Answer 1

Psoriasis :

A genetically determined, chronic,non infectious,epidermal proliferative disease.

It is a inflammatory disease of the skin in which epidermal cells are produced at a rate that is 6 to 9 times faster than normal.

Etiology :

​​​​​​The cause is unknown (Idiopathic).

Precipitating factors or the factors which trigger psoriasis are :

• Changes in climate
• Autoimmune reaction.
• Stressors
• Trauma/skin injury
• Any infection
• Smoking
• Obesity
• Certain medication :Propranalol,Lithium, Indomethacin

Pathogenesis :

  Due to etiological factors/Precipitating factors

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Epidermal cells are produces in a faster rate than normal skin.

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Lack of Keratin production(which gives hardness to skin surface) due rapid skin cell production.

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Flaky and Patchy Skin

(Psoriasis)

Clinical manifestation :

Lesions are usually seen over the entire body but are more commonly seen on the scalp,chins,extensor surface of elbows and knees,trunk,intragluteal cleft and the genitalia.

• Intial/first signs includes elevated,red spots which is sharply circumscribed.
• Dry patches
• Patches covered with silvery white flakes/scale.
• Thick,rough,cracked skin.
• Itchy and burning skin.
• Yellow ,discoloured and pitting nail.
• Restricted joint mobility and pain
• Drandruff on scalp.
• Pustular lesions (when psoriasis over palms and soles)

Treatment :

• There is no cure.
• Avoid precipitating Factors/Aggravating factors such as smoking,stress,trauma,certain medication.

Treatment modalities includes :

• Topical theraphy :

​​​​​Topical keratolytic agents such as salicylic acid and ammoniated mercury can be used.It will soften the dry,thick scales.

Topical steroids with occlusive dressing to decrease inflammation.Topical steroids should not be used for a prolonged time due to its side effects.

Use plastic wrap or gloves on the clients hands,plastic bags on the feet and skull cap over the scalp to keep the skin moist and to avoid drying of skin.

• Interlesional Theraphy :

Injection are given at the site of psoriotic patches.

Care must be taken to avoid injecting into normal skin.

Triamcinolone acetonide is injected.

• Systemic Therapy :

​​​​​In a cases where psoriasis fails to respond to other treatment measures,systemic theraphy can be considered.

Methotrexate :

It inhibits DNA syntesis in epidermal cells,and reduces epidermopoesis.

While patient is on methotrexate strict monitoring of hematopoietic, hepatic and renal systems are essential.

Oral Retinoids ,Hydroxyurea,Cyclosporin A  are also used.

Phototherphy:

It is the first line of treatment for psoriosis,where affected skin is exposed to natural or artificail light.

Sunlight :Daily exposure to sunlight is recommended.

Ultraviolet broadband(UVB)is also used to treat psoriasis.

Psoralen and Ultraviolet A (PUVA) Theraphy:This treatment involves taking a photosensitizing drug before exposure to UVB light.

Educating patients to keep their joints healthy as long as possible :

The most important part of the patient teaching is making the pateint aware about the nature of disease which is non curable and recurrence of symptoms.

Teach the patient about the need of :

• Taking treatment as prescribed,stopping the treatment in between will lead to quick worsening of the disease condition.
• Avoid taking certain medication which triggers the patient condition.
• Regular,brief exposure to sunlight.
• Regular exercises such as walking,swimming.
• Avoid drinking alcohol and smoking
• Eat healthy diet.
• Weight control
• Teach the patient regarding signs and symptoms of joint involvement in psoriosis such as swollen and tender joint,swelling over fingers and toes,reduced range of movements,morning stiffness,nail dystrophy,painful joints.
• Yearly /more frequent consultation to identify the early signs and symptoms of psoriotic arthritis.