Psoriasis

Psoriasis is a chronic autoimmune skin disease that causes rapid accumulation of skin cells, scaling, redness, and inflammation. Psoriasis is not contagious and often has a genetic component. Psoriasis can occur on any part of the body and varies in severity. 

 Types of Psoriasis:

1. Psoriasis Vulgaris: - 

• Most common form. 
• It is characterized by raised red patches covered with silvery-white scales.
• Typically seen on the scalp, elbows, knees, and lower back

2. Guttate Psoriasis: - 

• appears as small, drop-like sores on the trunk, arms, legs, or scalp. 
• Often provoked by bacterial infections such as streptococci.

3. Psoriasis Inversa: - 

• occurs in folds of skin (e.g., under the breasts, around the groin area). 
• Smooth, shiny red patches without scaling;

 4. Pustular psoriasis: -

• characterized by white pustules (pus-filled blisters) surrounded by red skin. 
• It may be localized to the hands and feet or spread over the entire body.

5. Erythrodermic Psoriasis: - 

• Rare and severe form, causing extensive redness, scaling, and desquamation. 
• It can be life-threatening and requires immediate treatment.

6. Nail Psoriasis: -

• Fingernails and toenails are affected, causing depression, discoloration, thickening or peeling of the nail bed.

7. Psoriatic Arthritis: -

•  Joint pain, stiffness and swelling, often with skin symptoms. 

General Skin Symptoms: - 

• Red inflamed patches on the skin.
• Silvery-white scales or plaques.
• Dry, cracked skin may bleed. 
• Itching, burning, and pain in affected areas. 

 Nail changes: -

• Pitted, raised or thickened nails. 
• Nail detachment from nail bed. 

 Joint Symptoms(in psoriatic arthritis): - 

• Joint pain, swelling, stiffness. 
• Decreased range of joint motion. 
• Morning stiffness lasting several hours. 

Causes and Triggers :

 Causes: Psoriasis is an autoimmune disease, which causes rapid cell turnover (3-7 days instead of the usual 28 days) as the immune system mistakenly attacks healthy skin cells. The result is an accumulation of skin cells and characteristic scaling.

 

Triggers :

• Stress: Stress exacerbates symptoms. 
• Infections: e.g., streptococcal or respiratory infections. 
• Weather: Cold, dry weather can aggravate symptoms. 
• Injuries: wounds, cuts, sunburn (Kevner's phenomenon). 
• Medications: beta-blockers, lithium, antimalarials. 
• Lifestyle: smoking, alcohol consumption, obesity. 

 Diagnosis : 

Physical Examination: - 

• Based on the appearance of the skin, scalp, or nails.

Skin biopsy: - 

• Rarely, a small sample of skin may be examined under a microscope to confirm the diagnosis and rule out other conditions. 

Treatment:

 There is no cure for psoriasis, but there are a variety of treatments aimed at reducing symptoms, reducing flare-ups, and improving quality of life. 

Topical Treatments: 

1.Corticosteroids: -

•  Reduce inflammation and itching.
• Examples: hydrocortisone, betamethasone; 

2. Vitamin D analogues: -

•  slow skin cell growth. 
•  Examples: calcipotriol, calcitriol.

3. Cole tar: -

• reduces scaling, itching and inflammation.

4. Salicylic acid: -

•  removes scaling and promotes the effects of other treatments.

5. Hydrating agents and emollients: - 

• moisturizes skin and reduces scaling.

  Phototherapy:

1. Ultraviolet Phototherapy: - 

• irradiate skin with controlled amounts of ultraviolet B.

 2. PVA Therapy: - 

• use UVA light in combination with a photosensitizer (psoralen).

 Systemic Therapy (moderate to severe): 

1. Medications: - 

• Methotrexate: methotrexate: reduces inflammation and suppresses the immune system.
• Cyclosporine: suppresses the immune system. 
• Acitretin: retinoid that normalizes skin cell growth.

 2. Biologic Therapy: - 

• Targets specific immune pathways involved in psoriasis.
• Examples: adalimumab, infliximab, etanercept, secukinumab, ustekinumab. 

Complications - 

Psoriatic arthritis: - 

•  may cause permanent joint damage if untreated.

Increased risk of other diseases: -

•  Cardiovascular disease, type 2 diabetes, metabolic syndrome.
•  Anxiety, depression, low self-esteem. 

 Infections: - 

• Open or cracked skin can become infected.

 

Prevention and Management - 

Avoid Triggers: - 

• Identify and minimize stress, injuries, and irritants that aggravate symptoms. 

 Maintain a healthy lifestyle: - 

• Eat a balanced diet, exercise, avoid smoking and alcohol. 

 Skin Care - 

• Use gentle cleansers, moisturize frequently, and avoid harsh chemicals.

 - Regular checkups: - 

• Monitor symptoms and consult a health care professional to adjust treatment as needed. 

Prognosis :

Psoriasis is a lifelong disease with periods of remission and flare-ups. With effective management, most individuals can control symptoms and maintain a good quality of life. Newer therapies, especially biologic agents, have significantly improved the prognosis of patients with moderate to severe psoriasis.

Eczema

 Eczema, also known as atopic dermatitis, is a chronic inflammatory skin disease characterized by itching, redness, dryness, and cracking. Eczema can occur in people of all ages, but is most common in children. Eczema often occurs in cycles, with flare-ups and remissions. 

Types of Eczema :

1. Atopic Dermatitis: 

• most common eczema, associated with allergies, asthma or hay fever.

2. Contact Dermatitis: -

• Irritant Contact Dermatitis: caused by direct skin contact with an irritant (soap, chemical, etc.).
• Allergic contact dermatitis: caused by allergic reactions to substances such as nickel, perfumes, poison ivy, etc.

3. Dyshidrotic eczema: small itchy blisters on the hands and feet.

4.Coinoid eczema: mostly on legs, arms, or torso, 

5. Seborrheic dermatitis: scaly, greasy patches on the scalp, face, or chest;

 6. Stasis dermatitis: stasis dermatitis: occurs on the lower extremities due to poor circulation and fluid buildup; 

causes :

 The exact cause of eczema is unknown, but a combination of genetic, environmental, and immune factors are involved. Common triggers include:

• Irritants Irritants: soaps, detergents, fragrances, or certain fabrics.
• Allergens Allergens: pollen, dust mites, pet dander, or certain foods. 
• Environmental factors: cold, heat, humidity. 
• Stress: Can aggravate symptoms.
• Heredity: Family history of eczema, asthma, or hay fever increases risk.
• Immune system dysfunction: overreaction to external stimuli. 

Symptoms - 

Itching: often intense, especially at night. 

Red or brownish-gray spots: often on hands, feet, ankles, wrists, neck, upper chest, eyelids, elbows, or inner knees.

Dry, cracked skin: may bleed or fester.

Thickened skin: from prolonged scratching or friction.

Liquid-filled blisters: may ooze and crust over. 

Diagnosis:

• Eczema is usually diagnosed by: Based on the appearance of the skin. 
• Medical history: includes allergies, asthma, family history of eczema. 
• Patch test: identifies specific allergens if contact dermatitis is suspected. 
• Skin biopsy: In rare cases, to rule out other conditions. 

 Treatment:

There is no cure for eczema, but treatment is aimed at managing symptoms and preventing flare-ups:

 1. Topical treatment: 

• Moisturizers (emollients): keep skin moist and protect barrier function. 
•  Corticosteroid creams or ointments: reduce inflammation and itching. 
• Calcineurin inhibitors(e.g., tacrolimus, pimecrolimus): for sensitive areas such as the face.

2. Oral medications: - 

• Antihistamines: for nighttime itching;
• Systemic corticosteroids:Used for severe flare-ups. 
• Immunosuppressants(e.g., cyclosporine, methotrexate): for severe, refractory eczema.

3 Biological therapies: -

 

• Dupilumab (Dupixent): monoclonal antibody for moderate to severe atopic dermatitis.

4 Lifestyle and home therapy: -

 

• Warm bath: after warm bath, Apply moisturizer immediately after warm bath. 
• Wet wrap therapy: After applying the medication, wrap the skin with a wet bandage. -
•  Avoid triggers: Identify and eliminate allergens and irritants. 

5. Phototherapy: - 

•  Controlled exposure to ultraviolet light. 

 Complications :

•  Infections: - Scratching and skin breakage can lead to bacterial, viral,   and fungal infections. 
• Chronic itching and scratching: can lead to lichenification (thickened, leathery skin). 
• Sleep disturbances: Severe itching may affect sleep. 
• Psychological effects: stress, anxiety, depression. 

Prevention :

• 1. Regular moisturizing: use a thick cream or ointment after bathing;
• 2. Avoid harsh soaps and detergents: use fragrance-free, non-irritating products; 
• 3. Wear soft, breathable fabrics: cotton, etc.; 
• 4. Stress management: practice relaxation techniques such as yoga and meditation;
• 5. Allergy management: avoid allergens and keep living conditions free of dust mites and pet dander; 

prognosis:

• Many children will outgrow eczema by puberty, but others will experience periodic recurrences throughout their lives.  
• With proper treatment and prevention strategies, most can effectively manage their symptoms and lead comfortable lives.

The human papillomavirus (HPV)

The human papillomavirus (HPV) is a group of more than 200 related viruses, most of which are sexually transmitted; some types of HPV cause warts (papillomas) on different parts of the body, while others cause cancer, especially in the cervix, anus, oropharynx and genitals HPV is one of the most common sexually transmitted infections (STIs) worldwide. 

Types of HPV :

 1. Low-risk HPV: - 

• Causes warts (e.g. genital warts and warts vulgaris). 
•  It does not cause cancer.  
• Examples: HPV types 6 and 11 (cause of most genital warts);

 2. High-risk HPV: - 

• Associated with the development of cancer.
• Persistent infection with these types can lead to precancerous changes and cancer. 
• Examples: e.g. HPV types 16 and 18 (cause of cervical cancer and most other HPV-related cancers).

 Symptoms of HPV 

1. Warts: - 

• Genital warts: soft, fleshy growths on the genitals, anus or around the mouth.
• Common warts: hard, raised bumps, usually on the hands or fingers. 
• Plantar warts: hard, granular growths on the soles of the feet. 
• Flat warts: slightly raised, smooth growths, usually on the face or feet; 

2. Pre-cancerous changes: -

•  detected by screening (e.g. Pap smear or HPV test). 
•  Found on the cervix, anus, pharynx, etc.

3. Symptoms of cancer (advanced stages): - 

• abnormal bleeding or discharge (e.g. vaginal bleeding). 
• Pain during sexual intercourse or urination. 
• Persistent sore throat or hoarseness (cancer of the middle pharynx). 
• Lumps or swelling in the affected area. 

Transmission

• Infection HPV is spread through direct skin-to-skin contact, such as  Vaginal, anal or oral sex. 
•  Close contact with infected skin or mucous membranes. 
•  Rarely, HPV can be transmitted from mother to baby during birth, even if the infected person has no visible signs or symptoms.

 Diagnosis :

1.For warts: - 

• Visual examination by a health professional.

2. For Cervical HPV infection: - 

• Pap smear: detects abnormal cervical cells.
• HPV test: confirms the presence of high-risk HPV. 
• Colposcopy: examines abnormal areas using a special microscope.

3. For other HPV-related disease: - 

• Biopsy of suspicious lesions or warts. 
•  Imaging studies of HPV-related cancers. 

 Treatment :

There is no treatment for HPV itself, but its symptoms and complications can be addressed: -

•  Topical treatment: salicylic acid, podophyllin or imiquimod. 
• Cryotherapy: freezing the warts with liquid nitrogen.
•  Surgical excision or laser treatment for stubborn warts;

 2. Precancerous changes: -

•  procedures such as cryotherapy, loop electrosurgical excision (LEEP) and conical excision to remove abnormal cells.

3.Cancer: -

•  Treatment depends on the type and stage of cancer and may include surgery, radiotherapy, chemotherapy and immunotherapy. 

 Prevention :

1. Vaccination: -

HPV vaccine (Gardasil 9): - 

• Protects against the most common cancer-causing HPV types (types 16 and 18) and the types that cause genital warts (types 6 and 11). 
•  Recommended for :
•        boys and girls aged 11-12 years (vaccination can be given from              age              9). 
•         Catch-up vaccination up to 26 years of age.
•         Some adults aged 27-45 years, after consultation with a health             professional.

2. Safe sexual practices: - 

• Use condoms or dental dams during sexual activity. 
•  Limit the number of sexual partners.

3. Regular check-ups: - 

•  Pap smear: Start at age 21 and continue as recommended in guidelines. 
•  HPV testing: For women over 30, usually combined with Pap smear.

4. Lifestyle measure: - 

• Avoid tobacco use as it increases the risk of HPV-related cancer. 
• Maintain a healthy immune system through a balanced diet and regular exercise. 

 Complications of HPV

 1. Genital warts: - 

• can recur even after treatment;

 Cancer: - 

• cervical cancer is the most common cancer associated with HPV.
•   Other affected sites include the anus, vulva, vagina, penis and oropharynx (throat and mouth).

3. Psychological outcomes: -

• Stigmatization and anxiety associated with the diagnosis. 
• Most HPV infections are cleared by the immune system within 1-2 years and do not cause problems.
• Persistent infection with high-risk HPV types can lead to precancerous changes and cancer if left untreated.
• Regular vaccination and screening can significantly reduce the burden of HPV-related disease.