PSORIASIS

Psoriasis adalah suatu penyakit inflamasi kulit kronis yang umum dan kompleks yang dapat mengenai semua usia. Penyakit ini ditandai dengan plak berbatas tegas yang disertai dengan skuama tebal berwarna keputihan. Lesi psoriasis terdistribusi secara simetris dengan predileksi utama di daerah ekstensor ekstremitas terutama siku dan lutut, kulit kepala, lumbosakral, bokong dan genitalia

It commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis, called psoriatic plaques, are areas of inflammation and excessive skin production. Skin rapidly accumulates at these sites and takes a silvery-white appearance.Plaques frequently occur on the skin of the elbows and knees, but can affect any area including the scalp and genitals.

Psoriasis adalah penyakit kulit inflamasi di mana sel-sel kulit berreplikasi pada tingkat yang sangat cepat Sel-sel kulit baru diproduksi sekitar delapan kali lebih cepat dari normal tetapi lapisan jaringan yang lama tidak berubah. This causes cells to build up on the skin's surface, forming thick patches, or plaques, of red sores (lesions) covered with flaky, silvery-white dead skin cells (scales).

Gangguan kronis yang menyerang tubuh yang timbul hanya dari plak kecil hingga menyebar ke seluruh tubuhKuku kuku sebagai gambaran (psoriatic nail dystrophy) psoriasis yang terisolasiPsoriasis yang menyerang sendi, disebut juga psoriatic arthritis.

Penyebabnya belum diketahui, tapi mungkin aja dari autoimun atau genetik.Faktor pencetusnya bisa stres, mengkonsumsi alkohol berlebihan, dan merokok.Penderita biasanya mengalami depresi dan rasa percaya dirinya hilang. As such, quality of life is an important factor in evaluating the severity of the disease. Kemungkinan lithium salt sama beta blockers, memperburuk gambaran penyakit

Pertumbuhan berlebihan dari epidermis dan keratinositnya.Dimulai dengan makula dan papula eritematosa dengan ukuran mencapai lentikular-numular, yang menyebar secara sentrivugal.Ada juga hipotesis yang nyebutin gangguan sistem imun. T cells (which normally help protect the body against infection) become active, migrate to the dermis and trigger the release of cytokines (tumor necrosis factor-alpha TNF, in particular) which cause inflammation and the rapid production of skin cells. It is not known what initiates the activation of the T cells.The immune-mediated model of psoriasis has been supported by the observation that immunosuppressant medications can clear psoriasis plaques.

Plaque psoriasis (psoriasis vulgaris) is the most common form of psoriasis. It affects 80 to 90% of people with psoriasis. Plaque psoriasis typically appears as raised areas of inflamed skin covered with silvery white scaly skin. These areas are called plaques.Types of Psoriasis

Flexural psoriasis (inverse psoriasis) appears as smooth inflamed patches of skin. It occurs in skin folds, particularly around the genitals (between the thigh and groin), the armpits, under an overweight stomach (pannus), and under the breasts (inframammary fold). It is aggravated by friction and sweat, and is vulnerable to fungal infections.

Guttate psoriasis is characterized by numerous small oval (teardrop-shaped) spots.

Pustular psoriasis appears as raised bumps that are filled with non-infectious pus (pustules). The skin under and surrounding pustules is red and tender. Pustular psoriasis can be localised, commonly to the hands and feet , or generalised with widespread patches occurring randomly on any part of the body.

Nail psoriasis produces a variety of changes in the appearance of finger and toe nails. These changes include discolouring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail, and the loosening (onycholysis) and crumbling of the nail.

Psoriatic arthritis involves joint and connective tissue inflammation. Psoriatic arthritis can affect any joint but is most common in the joints of the fingers and toes. This can result in a sausage-shaped swelling of the fingers and toes known as dactylitis. Psoriatic arthritis can also affect the hips, knees and spine (spondylitis). About 10-15% of people who have psoriasis also have psoriatic arthritis.

Erythrodermic psoriasis involves the widespread inflammation and exfoliation of the skin over most of the body surface. It may be accompanied by severe itching, swelling and pain. It is often the result of an exacerbation of unstable plaque psoriasis, particularly following the abrupt withdrawal of systemic treatment. This form of psoriasis can be fatal, as the extreme inflammation and exfoliation disrupt the body's ability to regulate temperature and for the skin to perform barrier functions.

Diagnosis ditegakkan dari gambaran kulitnya.Another sign of psoriasis is that when the plaques are scraped,(seperti lapisan lilin yang digaruk) one can see pinpoint bleeding from the skin below (Auspitz's sign).

Talak

Some Types of Psoriasis and Their TherapiesTypeCharacteristicsAreas of InvolvementTherapies

PlaqueDeeply erythematous Sharply demarcated Oval Moderate: Heavy, silvery-white surface Scalp Extensor surface Fold areas (abdomen, gluteal)Mild: Topical therapies Corticosteroids Tazarotene Calcipotriene Anthralin Coal tar Keratolytic agents EmollientsModerate-to-severe: Phototherapy, MTX, cyclosporine, oral retinoids, SC etanercept, IM/IV alefacept, biological agents

GuttateAcute eruption Teardrop-like Erythematous ScalyTrunk (mainly) Face Scalp Hands FeetPhototherapy +/ tar Photochemotherapy Topical agents Systemic agents prn

TypeCharacteristicsAreas of InvolvementTherapiesFlexural (Inverse)Smooth, inflamed patchesSkin folds (axillae, breasts, groin)Topical steroids Emollients MTX

PustularPus-filled Blister-like patchesHands Feet Palms/soles (palmar-plantar pustulosis)Oral retinoids MTX Cyclosporine Phototherapy Immunobiologicals Hospitalization

ErythrodermicSkin surface red & scalyNearly all of bodyHospitalization Cyclosporine MTX Oral retinoids +/ photo(chemo)therapyMTX: methotrexate; SC: subcutaneous; IM: intramuscular.

Topical treatmentSalicylic acidKeratolytic agents, weak antifungals, antibacterial agentsRemove accumulated scale, allow topical agents to pass throughAE: irritation, salicylism (N&V, tinnitus)

Coal TarPrefered for limited or scalp psoriasisCan be effective in widespread psoriasisAntimitotic, anti-pruriticNo quick onset but longer remissionOften combined with SA, UV light therapy2 types: Crude coal tar and Liquor picis carbonis

DithranolMay restore normal epidermal proliferation and keratinizationUseful in thick plaque psoriasisCommonly used with SA2 treatment approach: long contact and short contactStains clothes, irritating to normal skin

Topical CSAnti-inflammatory, immunosuppressiveQuick onset than coal tar and dithranolTachyphylaxis can occurHigh potent agents used in severe cases, thick plaquesAE local and systemicShould not be stopped abruptly rebound psoriasis

PhototherapyUVA, UVB, PUVAUVB preferedAdministered by lamp, sunlight exposure alone or in combo with another topical agentPsoralen plus UVA phototherapy (PUVA (methoxsalen)) given PO 2 hours before UVA or lotion applied 30mins before exposureAE: itch, edema

Systemic TherapyImmunomodulatorsCyclosporin, methotrexate commonly used

Antibiotics in case of secondary bacterial infections

Bentuk titik (psoriasis pungtata)Tetes-tetes (P. gutata)Numular (P. Numular)Psoriasis folikularis atau universalis (Seluruh tubuh)*LimbsTrunkScalpSkin foldsButtocksGroin* A diagnosis of psoriasis is usually based on the appearance of the skin There are no special blood tests or diagnostic procedures for psoriasis. Sometimes a skin biopsy, or scraping, may be needed to rule out other disorders and to confirm the diagnosis. Skin from a biopsy will show clubbed pegs if positive for psoriasis.

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