Psoriasis Disease

Psoriasis Disease

PSORIASIS Disease Name PSORIASIS Cross Ref Skin, psoriasis; Etiology Unknown; inherited predisposition. Symptoms Slight

pruritus. Physical Signs Most common in young to middle-aged adults, possibly 1-2% of all persons with white skin; rare in infants under 2 years; distinctive silvery gray papules or plaques, margins becoming sharply defined, possibly heaped up over scalp, elbows, knees, lumbosacral region; peripheral extension possibly forming ring, geometrical pattern with central clearing. Lab Data Removal of crust by stripping with Scotch tape revealing numerous points of bleeding or Auspitz sign. Disease Course Prognosis: variable; recurrent; possibly disappearing in summer, reappearing in winter; frequently disfiguring; general health usually good; psoriatic arthritis; psoriatic erythroderma; unfavorable reaction to physical, chemical trauma called Koebner phenomenon. Pathology In corium: moderate infiltrate, neutrophilic cells possibly clumping, forming Munro microabscesses beneath stratum corneum. In epidermis: parakeratotic scaling, thinning; elongation, narrowing of epidermal pegs; enlargement, edema of papillae; capillary dilatation; inflammation. Author sutton 923 ff., 1370, 291; moschella 410; roxburgh 372-74; allen ac 61; harrison 8:263; Reference Shuster S: Br Med J 3:236-239, 1971.; Molin L: Acta Derm Venereol (Suppl)(Stockh) 53:1-125, 1973.; Baden HP, et al: DM:3-47, Sep 1973.; McDonald CJ: Minn Med 57:813-820, 1974.; Disease Name ARTHRITIS, PSORIATIC See Also Psoriasis; Cross Ref Joint, arthritis; Other Terms Psoriasis, arthropathic; Etiology Unknown; manifestation of psoriasis; possibly hereditary. Symptoms Psoriatic skin lesion commonly precedes arthritis; less pain, disability than rheumatoid arthritis. Physical Signs Affects about 7% of patients with psoriasis; more common in those with severe skin involvement; primarily arthritis of distal interphalangeal joints; pitted, discolored, thickened nails with longitudinal ridging, splintering, erosion; exacerbations, remissions of articular, dermatological processes. Distinguished from rheumatoid arthritis by: absence of subcutaneous nodules; less symmetry; high incidence of sacroiliac involvement; dactylitis; spondylitis. Lab Data Blood: anemia; elevated ESR; rheumatoid factor negative; increased alpha-2 globulins; high incidence of positive HLA-B27. Radiology Gross destructive changes of isolated small joints; peripheral arthritis mutilans with osteolysis and ankylosis; “whittling” of terminal phalanges, “pencil-in-cup” appearance resulting from bony erosion; “fluffy” periostitis; atypical spondylitis with nonmarginal as well as marginal syndesmophytes; osteosclerosis; sacroiliitis. Disease Course Prognosis: more favorable than rheumatoid arthritis. Pathology Dense acellular fibrous tissue replacing articular spaces; synovitis similar to rheumatoid arthritis. Author hollander 655; cecil 1486; harrison 8: 2063; sutton 929; price 873; JAMA Supplement 224:732, April 30, 1973; McCarty DJ: Arthritis and Allied Conditions, 642-652, 1979.; Kelley WN, et al: Textbook of Rheumatology, 539, 1047-1060,; 1981.; Reference Moll JM, et al: Semin Arthritis Rheum 3:55-78, 1973.; Baker H, et al: Ann Int Med 58:909-925, 1963.; Wright V: Arth Rheum 21:619-623, 1978.; Disease Name PSORIASIS, PUSTULAR Cross Ref Skin, psoriasis; Other Terms Pseudopsoriasis, pustular; Etiology Unknown; possibly infection, primary or secondary; contact with irritating substance; malnutrition; metabolic imbalance. Symptoms Mild pruritus. Physical Signs Antecedent history of psoriasis; deep vesicles or vesicopustules in crops on skin of palms, soles; bilateral, symmetrical; later drying, crusting, exfoliating; fever. Lab Data Pustules sterile on

culture. Disease Course Prognosis: uncertain; protracted; recurrence; often

totally resistant to therapy. Pathology Flat, coalescent microabscesses forming pustules under epidermal layers of keratin; absence of characteristic psoriatic changes under pustular eruption. Author sutton 291; roxburgh 221; ormsby 276; tobias 113, 577; becker 196; moschella 419;