• INTRODUCTION

• EPIDEMIOLOGY

• PATHOPHYSIOLOGY

• CLINICAL FEATURES

• TYPES OF PSORIASIS

• DIAGNOSIS
• One of the commonest inflammatory dermatoses

• Chronic inflammatory skin disorder, red elevated plaques

with silvery scales on the outer layer of epidermis

• Exact cause is still unknown, strong genetic component

• Triggers: trauma, infection, stress

• Not curable, but manageable

• Affect 1-3% of population

• 2-6% of new dermatology cases in Malaysia

• 48.5% Malay, 24.3 Chinese, 17.8% Indian

• Male:female in Malaysia 1.7:1

• Mean age onset in Malaysia is 33 years-old

• Immune cell activation (T-lymphocytes) move from dermis to
epidermis and secrete cytokine
• Inflammatory cascade stimulates hyperproliferation of
keratinocytes  overproduction of skin cells
A. Abnormal thickening
(acanthosis)
B. Dilated & tortuous blood
vessels
C. Thickening of stratum
corneum (hyperkeratosis)
D. and stratum granulosum
(hypergranulosis)
• Clinically diagnosed

• Skin biopsy reveal

• Neutrophil collection in stratum corneum
• Lymphocytic infiltration in epidermis
• Excessive keratinocytes
CLASSIC PLAQUE PSORIASIS
• Most common
• Plaque may develop at any part
of the body, predilection at
extensor part.
• Knees, elbows, base of spine,
scalp, nail
• Arthropathy may occur
• Tends to be chronic and stable
NAIL PSORIASIS
• Nail abnormalities are frequent
• Almost always present in arthropatic psoriasis
• Pitting and onycholysis (nail plate separation from the nail bed)
GUTTATE PSORIASIS
• Develops suddenly, usually follow
infection
• Widepsread of small oval spots,
scaling red papules
• Streptococcal sore throat
• Common site : trunk and limbs
• Resolve rapidly
ERYTHRODERMIC PSORIASIS
• Psoriatic plaques merge to involve most of the skin
• Serious life threatening condition
PUSTULAR PSORIASIS
• May develop in patient with or without pre-existing psoriasis.
• Sudden development of widespread erythema, pustules
superimposed (sterile)
• Fever, toxic and unwell
• Affecting up to 10%
• Arthritis usually symmetrical
• 4 basic pattern:
• Distal interphalangeal
involvement (80%)
• Seronegative rheumatoid –like
joint changes
• Large joint mono- or
polyarthropathy
• spondylitis
 Stimulate fibroblast
proliferation and
activity in joints

Cytokine activation

Stimulates
Erosions and
osteoclast
osteolysis
proliferation
Assessment tools:
• Psoriasis physician global
assessment (PGA)
Measures severity based on
induration, erythema and
scaling
• Body surface area (BSA)
• Measures percentage of body affected by taking patient’s one
palm-size as 1%
• Psoriasis area and severity index (PASI)
• Measures severity (erythema, scaling, induration) and
involvement based on 4 regions (head and neck, upper limbs,
trunk and lower limbs)
• Score ranging from 0-72
• Dermatology life quality index (DLQI)
• Questionnaire to assess impact of psoriasis on quality of life.
• Score ranging from 0-30