皮肤性病学英文ppt课件：08Psoriasis.ppt

Psoriasis（银屑病）,Definition,Clinically, it is a chronic non-infectious dermatitis characterized by red scaly plaques that attack repeatedly.,Definition,Pathogenically, psoriasis is a chronic disorder with polygenic predisposition combined with triggering environmental factors such as trauma, infection or medication.,Definition,Historically, psoriasis is a benign and over proliferation of keratinocytes due to imbalanced T cell function.,Epidemiology,Prevalence in China: 0.123% (1984) 0.47% (2008,6 cities)More common in youth & middle aged peopleMaleFemaleCitycountrysideNorthSouthWhite raceyellow raceblack race,Aetiology and Pathogenesis,Genetic factors: polygenic disease related HLA-A1,B13,B17,Cw6,etcEnvironmental factors: infection, trauma (both mentally and physically), drugImmune factors: abnormal activation of T cells with cytokines releasing (IL-1,IL-6,IL-8,TNF-a),Histopathology,Epidermis: hyperkeratosis, parakeratosis with Munros microabscesses, disappearance of stratum granulosum, acanthosis. Dermis: elongation and twist of dermis papillae, dilatation of capillaries, inflammatory infiltration,Normal skin,psoriasis,Munros microabscess,Clinical Manifestations,Classification: psoriasis vulgaris psoriasis arthropathica psoriasis erythrodermic psoriasis pustulosalocalized & generalized,psoriasis vulgaris,Primary lesions: red papules or maculopapulesTypical lesions: red scaling plaques Features: wax-like scales Transparent film Auspitz signCommon involved places: scalp,elbow,knee,sacrococcgeal skinSpecial involved places: nail, glansLesion patterns:psoriasis guttata psoriasis nummularis psoriasis annulata psoriasis rupiodesStages: progressive-static-recedingCourse: chronically repeated with alleviation in summerSubjective sensation: absent or itchy,Auspitz sign,Psoriasis guttata,Psoriasis nummularis,Psoriasis annulata,Psoriasis rupioides,Psoriasis hypertrophica,Psoriasis zosteriformis,Psoriasis geographica,Kobners phenomena,Psoriasis arthropathica psoriasis+seronegative arthritis arthrocele, arthralgia ankylosis joint malformation common involved joints: finger & toe joints vertebral joints elbow & knee joints,X-ray of psoriasis arthropathica,OsteoporosisStenosis of joint cavityErosion of the joint,Psoriasis pustulosa localized generalized,Localized psoriasis pustulosa,Generalized psoriasis pustulosa,Psoriasis erythrodermic generalized edematous rash with heavy scale, usually accompanied by fever, LN enlargement and hypo-proteinemia,normal skin islands in psoriasis erythrodermic,Diagnosis,Clinical manifestations,lesion features,involved positions and pathology examination,Treatment,Topical treatment,keratoplastics and keratolytics: coal tar, anthralin et alcytotoxic drugs: nitrogen mustard, 5-Fu et alCorticosteriods: flucinolone, triamcinolone, chlorbetasole et al Derivatives of Vit D3: calcipotriol Retinoid acid: Tazarotene,Systemic treatment,1.Retinoids: etretinate(Tigason), acitretin(new Tigason) - the first-line drugsMain pharmacological mechanisms: inhibit abnormal proliferation and differentiation of keratinocytes; keratolysisMain indications: psoriasis pustulosa; psoriasis erythrodermic; chronic obstinate psoriasis vulgarisMain side-effects: monstrosity; dryness of skin and mucosa; abnormality of hepatic function and hyperlipemia,2.Cytotoxic drugs or immunosuppresive drugs: methotrexate(MTX), cyclosporin-a3.Corticosteroids: only used in psoriasis erythrodermic, generalized psoriasis pustulosa and acute psoriasis arthropathica4. Biologic preparations anti-TNF-a: Etanercept, Infliximab, Adalimumab anti-IL-12,23: Ustekinumab5.Others: antibiotics, vitamins, traditional Chinese medicines,Photo therapy,NB-UVB:311nm UVA:320-400nmMain mechanisms: inhibition of proliferation of keratinocytes; vasodilationMain side-effects: short term: phototoxic reaction long term: skin aging; skin cancer,Pityriasis Rosea,An acute, self-limited skin eruptionTypically manifests as oval scaly light-red plaques located along the lines of skin cleavage on trunk maybe related with infection of HHV-7 or 6,Clinical manifestations of pityriasis rosea,Oval scaly light-red plaquesBegins as a single plaque on trunk (herald patch), which is followed by numerous smaller lesions, locating along the lines of skin cleavageCommonly involved places: trunk, neck and proximal ends of extremities (centrality) Subjective sensation: slight itchyCourse: self-limited, usually lasts 6-8 weeks,Pityriasis rosea: oval scaly light-red plaques,pityriasis rosea: herald patch & special arrangement,Key points,Clinical manifestations of psoriasis vulgarisThe histopathology of psoriasis vulgarisThe clinical characters of pityriasis rosea,