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THE HISTORY OF PSORIASIS


Prof. Dr. Alfredo Buzzi Emeritus Professor and Dean at the School of Medicine, University of Buenos Aires

Psoriasis is a dermatological condition that affects about 1 to 2% of the population. It is considered a chronic proliferative skin disease which is genetically determined and of unpredictable course. Lesions are manifested as papules and as erythematous plaques covered by thick scales which are easily removed. The lesions are usually symmetrically distributed on the joints such as elbows and knees. The following clinical forms can be observed 1) gutarda psoriasis in which many small papular injuries suddenly develop one to three weeks after a streptococcal pharyngitis; 2) inverse psoriasis in which plates are developed in intertriginous areas; 3) pustular psoriasis, manifested by surface pustules; 4) erythrodermia in which the condition affects all over the skin; 5) psoriastic arthritis where arthritis might be present in 10 to 15 % of psoriasis cases. The first historical notion of psoriasis is included in the Holy Bible, In the Old Testament, the Deuteronomious, makes reference to the leprous diseases which might have probably included this condition. Dermatology has been to greater extent a set of symptomatic conditions much more than a group of specific diseases at least up to The Modern Age in medicine. In fact it was almost impossible in most cases until dissemination of clinical microscopy and histochemistry to draw a clear distinction between symptomatic skin disorders in which skin lesions are only a secondary manifestation disease or certain organic pathology and specific dermatological conditions which originate in the skin and are confined to it. The word psoriasis derives from a greek term psora= itching. Hippocrates of Cos ( 468-377 BC) refers to psoriasis al though its nature had not yet been separated from other skin conditions including even leprosy. This misunderstanding spread throughtout several centuries and as a result of thus patients were abandoned and isolated from the community. The greek physician Galen of Pergamon ( 130-200 BC) uses the term Psoriasis vulgaris to refer to all dermo and epidermopathies accompanied by pruritus. It was just in 18 th (eighteen century ) when the English dermatologist Robert William ( 17571812) included psoriasis in the erythematous squamous conditions. In 1841 thanks to the work of Ferdinand to Von Hebra (1816-1880) and Moritz Kaposi ( 1837- 1902) from the school of Vienna was psoriasis definitely set apart from leprosy and their clinical and anatomopathological characteristics were separately described. In the XIX century the interrelation of psoriasis and arthritis was described for the first time by Jean Louis Alibert (1768-1837) in the 1818 Pierre Bazin ( 1807- 1878) described psoriasis arthritique in 1860. In 1937 Seghers and Robinson considered psoriatic arthritis as a clinical entity. Nevertheless the etiology and mechanisim of arthritis remained unknown during the last centuries.

Revista Latinoamericana de Psoriasis y Artritis Psorisica 2011, 4: 1-3 http://www.fmvuba.org.ar/

The History of Psoriasis

The fast growth of skin cells was known. Some authors theorized on emipirical grounds about the genetical component of the disease. As far as it is known the evolution of the treatment for psoriasis reveals that it began with topical applications of the kind of salicylic acid. Since 1950 local applications and systemic use of corticosteroids was implemented. UVA light and antimetabolite methotrexate were introduced between 1970 and 1980. Vitamin D3 in topical applications, retinoids and cyclosporin became popular in the 1990s. The latest advances have been the use of biological therapies and laser treatment. The pathogenesis of the disease had a turning point in the mid 1980s where it was focalized in the study of an alteration in the inmune system. Altered cells atack healthy skin cells misidentifying them as strange-the affected skin the skin aims at repairing itself generating new cells, but it does seven times more quickly than healthy skin. In free of psoriasis individuals skin cells mature and are deleted every 28 days or so. In the psoriatic skin cells are rapidly move to the skin surface in a period of 3 to 6 days. The body cannot eliminate epidermical cells fast enough and this process results in the formation of surface skin lesions. The elimination cycle of 28 to 30 days of normal skin speeds up to 3 days and necrotic skin plaques start to show.

HISTORY OF SOME CLINICAL AND HISTORICAL SIGNS OF PSORIASIS


Koebner Phenomenom Herry Koebner ( 1834- 1904) was a German dermatologist and a disciple to Ferdinand Von Hebrad ( 1816- 1880). He introduced the concept that the skin of psoriatic patients was prone to develop lesions after several years of local traumas, including animal bites or tattoos. Brocq methodic scaling Louis Brock ( 1856- 1929) was a leading French dermatologist who worked at Sain Louis Hospital in Paris. He introduced the plate methodic scaling with the curettage technique discovering in that way the sign of haemorragic partner . Munro microabscesses William Jon Munro ( 1829- 1908) an Australian physician who studied in London Vienna and Paris described microabscesses in psoriatic epidermis associated to this name.

Revista Latinoamericana de Psoriasis y Artritis Psorisica 2011, 4: 1-3 http://www.fmv-uba.org.ar/

The History of Psoriasis

REFERENCES
1.- Willam, R: On cutaneous diseases. Volumen I. Londres, 1808. 2.- Hebra, F.: Atlas der Hautkrankheiten. Vienna, 1856-1876. 3.- Kaposi, M.: Pathologie und Therapie del Hautkrankheiten. Vienna, 1880. 4.- Cecil, R.: Tratado de Medicina Interna. Por J.C. Bennett y F. Plum. Mc Graw-Hill. Vol II, 1997. 5.- Mettler, C.C.: History of Medicine. Pgs. 662-683. Blokiston Co, 1947. 6.- Sierra X editor: Historia de la Dermatologa. Barcelona, 1994. Pgs. 251-257. 7.- Buzzi, A.; Doisenbant, A.R.: Evolucin Histrica de la Medicina. Panamericana, Buenos Aires, 2008.

Revista Latinoamericana de Psoriasis y Artritis Psorisica 2011, 4: 1-3 http://www.fmv-uba.org.ar/