银屑病英文版课件

1、1PSORIASISCommon, 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, portions2The incidence: 0.123%, prevalence 0.1-3.0%, (

2、numerator / denominator in a fraction)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

3、inheritance disease)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,

4、HLA-B37Etiology: Heredity61. Infection: in psoriasis guttala, tonsillitis, streptococcus infection, anti-streptolysin “O” test , virus infection? 2. Stress: nervous, depressive 3. Emergency events: injury, operation, pregnancy, drugEtiology: Environment7Lymphocyte, monocyte infiltration2. Cytokins:

5、IL-1, IL-6, IL-8, interferon-3. Keratinocyte proliferation, promotion 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 2

6、8-56 days to 3-4 days. 4. As Ks quickly pass through epidermis, parakeratosis 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, p

7、laque with silvery white lamellar scales2. Three diagnostic features - wax-drop 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 featur

8、es of psoriasis vulgaris11- symmetry, multiform: psoriasis guttata, nummular, petal-like, nail 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: on

9、ycholysis and salmon patch19Subungual hyperkeratosis20- progressive phase: lesions increasing, enlarging, 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

10、, white halo or pigmentationChronic course with 3 phases: inconstant21Koebner reaction (isomorphism): psoriatic lesions 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 whe

11、n a psoriatic scale is forcibly removed. This occurs only in psoriasis. It occurs because of the severe thinning of the epidermis 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 psor

12、iatic plaque.Three Special Phenomena24Youth2. Streptococcus infection, tonsillitis, anti-streptolysin “O” test 3. Acute onset, 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 P

13、soriasis Pustulosa (Von Zumbusch): most severe type, rareCauses unknown, topical irritant, infection, suddenly stop steroids or immunosuppressive2. Acute, high fever, whole body fatigue, arthredema, superficial aseptic small pustules based on erythema which are merged to form “pus lake”, generalized

14、 distribution3. Last for several weeks and then resolve spontaneously. If repeated, prognosis is not good.Clinical Manifestation27Generalized Psoriasis Pustulosa28Localized Psoriasis Pustulosa (Palmoplantar pustulosis):1. Millet-like, grouped light yellow pustules based on erythema, symmetric distri

15、bution, limited to palm and sole.2. Last for 1-2 weeks, repeated, with nail changesClinical Manifestation29Localized Psoriasis Pustulosa30Psoriasis Arthropathica:Common with psoriasis pustulosa, psoriasis vulgaris, erythrodermic psoriasis or developed from psoriasis vulgaris2. Incidence being 6.8%,

16、common in male3. Not symmetrical, small joint or large joint, chronic course with the limitation of function caused by destroying of joints, fever, anemia, lymph node enlarging4. Rheumatoid factor always negative31Psoriatic arthritis32图例33Erythrodermic Psoriasis:Usually caused by improper treatment

17、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 epider

18、mal hyperplasia with long, test-tube-shaped rete ridges / atrophy over the dermal papillae / thin granular layer / overlying parakeratosis / Munro Microabscess (small collection of neutrophils present in the stratum corneum) / dermal papillae being prominent and containing ectatic vessels / perivasc

19、ular mononuclear cell infiltrateHistopathology of Ps. V36- The features of lesions- Involved area- Chronic course- Easy to recover- Histopathologic featuresDiagnosis37- Seborrheic dermatitis- The psoriasiform syphilid- Lichen simplex chronicus- Rheumatoid arthritis- Pityriasis rosea- Lichen planus-

20、Acrodermatitis continua- Impetigo herpetiformis- ErythrodermaDifferentiation Diagnosis38Seborrhoeic eczema of infancy3940Imetigo 41Staphylococcal scalded skin syndrome42- Basic knowledge and information introduced- Ps. V not too serious to the health, not using systemic steroids, immunosuppressive t

21、o avoid the deterioration and changing to other types- Mild topical medicine to avoid strong irritant- Individual treatment for different causes, types and phases- Limited lesions, treated with topical treatment; Generalized lesions, with comprehensive treatment Key points in the treatment43Steroids: medium, strong, super-strong; (Side effects: atrophy, telangiactasis, folliculitis, pigmentation, changing to other types)2. Retinoic acids3. Calcipotriol (CPT): less than 4