By, ANAREEN RODRIGUES 2nd year B.P.

Definition Psoriasis is a noncontagious, chronic inflammatory disease of the skin characterized by clearly defined dry, rounded red patches with silvery white scales on the surface.

Aetiology

Age: Common age of first occurrence is 15-30 years. It can occur as young as 2 years. Also it can start as late as 80 years. Sex: Both sexes are equally affected. Climate: The condition is worse in damp, cold climates..

 Predisposing / precipitating factors A number of factors appear to predispose or precipitate an exacerbation of the psoriasis. These are: Heredity: There is an inherited defect in the skin which results in psoriasis developing in certain circumstances; 30 percent of patients have blood relative with the condition. Infection: Psoriasis has been known to develop after, for example, an upper respiratory tract infection. Trauma: Lesions tend to develop at sites of potential or actual trauma, e.g. mechanical friction, cuts, stings etc. Anxiety: Psoriasis often appears in relation to mental stress, e.g. bereavement, examinations etc. Drugs: Some drugs, e.g. chloroquine, may precipitate the condition. Diabetes: Some patients with diabetes develop the condition.

Causes The exact cause of psoriasis remains unknown. There may be a combination of risk factors, including genetic predisposition and environmental factors. The following may trigger an attack of psoriasis or make the condition more difficult to treat: Bacteria or viral infections, including strep throat and upper respiratory infections Dry air or dry skin Injury to the skin, including cuts, burns, and insect bites Some medicines, including antimalaria drugs, betablockers Stress Too little sunlight Too much sunlight (sunburn) Too much alcohol

SYMPTOMS

Symptoms include: Irritated, red, flaky patches of skin Most often seen on the elbows, knees, and middle of the body Red patches may appear anywhere on the body, including the scalp The skin may be: Itchy Dry and covered with silver, flaky skin (scales) Pink-red in color (like the color of salmon) Raised and thick

Distribution:
Elbows, knees, scalp and sacrum are covered in

thickly scaled patches. Plaques of varying sizes appear any where on the body. Nail become pitted, ridged or separated from the nail bed. This can be the only evidence of the disorder in some people. Skin contact areas can be badly affectedbetween fingers, axillae, groin, between toes, under breast and behind ears. The face is rarely affected.

FIGURE X.1. Common areas of distribution of psoriasis. The lesions are usually symmetrically distributed and are characteristically located on the ears, elbows, knees, umbilicus, gluteal cleft and genitalia. The joints (psoriatic arthritis), nails and scalp may also be affected.

TYPES
They

are of Five main types:

Plaque

Psoriasis Guttate Psoriasis Inverse Psoriasis Erythrodermic Psoriasis Pustular Psoriasis

Plaque psoriasis is characterized by raised inflamed lesions covered with a silvery white scale .This is most common on the extensor surfaces of the knees, elbows, scalp, and trunk. Most common type.

Guttate psoriasis presents as small red dots of psoriasis that usually appear on the trunk, arms, and legs; the lesions may have some scale. It frequently appears suddenly after an upper respiratory infection (URI).

Inverse psoriasis occurs on armpit, groin, under the breast, and in the skin folds and is characterized by smooth, inflamed lesions without scaling

Erythrodermic psoriasis presents as generalized erythema, pain, itching, and fine scaling. It covers a larger area.

Pustular psoriasis

White blisters are surrounded by red, irritated skin. Appears on hands or feet.

Scalp psoriasis affects approximately 50% of patients, presenting as erythematous raised plaques with silvery white scales on the scalp.

Nail psoriasis may cause pits on the nails, which may develop yellowish color and become thickened. Nails may separate from the nail bed.

Psoriatic arthritis

Psoriatic arthritis is a specific condition in which a person has both psoriasis and arthritis It is an auto-immune disease. Symptoms include :Joint swelling Skin patches (psoriasis) and pitting in the nails Tenderness Stiffness (morning stiffness). Reduced joint ROM

The inflamed joints become painful, swollen, hot, and red. Sometimes, joint inflammation in the fingers or toes can cause swelling of the entire digit, giving them the appearance of a "sausage."

TREATMENT

Physiotherapy for Psoriatic Arthritis

Ice packs helps to reduce heat & swelling in inflamed joint. Massage helps to improve circulation. Heat is also useful in relieving pain & stiffness. Hydrotherapy reduce stiffness & strengthen weak muscles. Strengthening exercise for joints.

Topical Applications
Corticosteroids cream produces good results at first but when treatment stops the diseases can return worse than before. It is useful in an acute eruption and on the face and hands because there is greater absorption in moist areas.

Physiotherapy Management of Psoriasis

Psoriasis can be treated very successfully with UVR. Two sources are used: the Theraktin and PUVA. The psoralen combines with the cells in the skin to slow down their rate of division The treatment causes a reddening of the skin and increased production of the natural pigment melanin.

Treatment time depends mainly on your skin type (up to 20 mins). Treatment is usually given twice a week. Psoriasis usually clears after 6-8 weeks of treatment. The most common short-term side effects of PUVA are nausea, itching and redness of the skin Long term use of PUVA may age the skin

PUVA Treatment Unit

Figure X.3: Psoriasis of back, buttocks and upper limbs

Figure X.4: Plaque psoriasis on the elbow.

Figure X.5: Plaque psoriasis on the back.

THANK YOU !