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        Variable; recurrent; possibly disappearing 
Course         in summer, reappearing in winter; frequently 
Prognosis      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; 
               inflamation. 
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.;

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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        More favorable than rheumatoid arthritis. 
Course
Prognosis

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.;

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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        Uncertain; protracted; recurrence; 
Course         often totally resistant to therapy. 
Prognosis

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;