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PSORIASIS
DR DIVYA R PRAKASH
ASSISTANT PROFESSOR
DEPT OF KC
KRAMC
February 4, 2025
psorasis February 4, 2025
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ETYMOLOGY
• The word ‘psoriasis’, is derived
from the Greek word “psora”,
which means “itch” or “scurf” or
“rash”.
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INTRODUCTION
• Psoriasis is a chronic (long-lasting) skin
disease that result in patches of thick red
skin covered with the silvery scales.
• These patches are reffered as plaque which
usually occur on the elbow, knees,legs,scalp,
lower back, palm and sole of the feet, nails.
Psorasis – Dr Divya Prakash February 4, 2025
4 DEFINITION
• Psoriasis is an autoimmune noninfectious,
chronic, inflammatory skin disorder where
altered keratinization of epidermal cell takes
place with well-defined erythematous lesion
and silvery plaques with a predilection for
the extensor surface and scalp and have a
chronic fluctuating course.
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PREVALENCE
• Sex- Equal in males and females.
• Age of onset- It has bimodal peak,
first peak- 16-22yrs.
Second peak 57-60yrs.
It is uncommon under the age of 5 years.
• Psoriatic arthritis is seen in 10-30% of Psoriatic
patients.
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6 ETIOLOGY
Skin Trauma- Koebner isomorphic phenomenon
Infection- viral infections, streptococcal, HIV
Physiological factors- Anxiety, Stress
Drugs- Anti-malarial,beta blockers, Lithium,
Chloroquin, NSAID
Metabolic- Hypercalcemia, Pregnancy
Other factors- Diet, alcohol, smoking, cold and dry
weather, sunlight
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7 Pathophysiology
Epidermis
Due to Hyperactivity of T- infiltration
causativ cells(responsible for and
e factor cell mediated keratinocyte
immune response) proliferation
Superficial Large
Disregulated
blood vessels production of
immune
dilated and various
response
vascular cytokine
engorgement
Fails to release
adequate lipid Silvery scale
Epidermal which lead to of the skin.
hyperplasia & flaking, scaling
improper cell presentation of
maturation psoriasis lesion
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9 CLINICAL FEATURES
The first sign is ‘red spot’ on body.
Rashes or patches of red, inflamed skin, often covered with loose, silver colored
scales.
Redness mainly on elbows, knees, trunk and scalp,symptoms can occur anywhere on
the body.
Itchy and painful skin
Cracked and bleeding point, if scales are scraped away.
Scaly plaques on the scalp.
Yellow discoloration, pitting and thickening of the nails are noted if they are affected.
In severe cases plaques will grow and merge into one another, covering large area.
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11 TYPES OF PSORIASIS
1. Chronic Plaque psoriasis
2. Guttate psoriasis
3. Inverse psoriasis
4. Pustular
5. Erythrodermic psoriasis
6. Local forms – palmoplantar
7. - scalp
- nail (psoriatic onychodystrophy)
8. Psoriatic arthritis
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12 Chronic Plaque Psoriasis/Psoriasis Vulgaris
• It affects 80 to 90% of people
• Well defined, red, dry, scaly, plaques.
• Scales- abundant, loose, silvery white
• Woronoffs ring- hypopigmented halo.
• Auspitz sign- multiple, minute, bleeding points
• Plaques may involve large areas of skin
• Site: The extensor surfaces of elbows, knees, buttocks and scalp. The
genitalia and nails may also be affected
• Koebner phenomenon
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Plaque psoriasis
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15 GUTTATE PSORIASIS
• It starts during childhood or young adulthood.
• It is characterized by numerous small red spots (tear
drop-shaped).
• spots are usually not as thick as plaque psoriasis (less
than 1cm diameter).
• Site:trunk and proximal limbs.
• Often preceeded by an upper respiratory tract
streptococcal infection.
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Guttate psoriasis
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17 FLEXURAL /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.
FLEXURAL /INVERSE
PSORIASIS
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19 PUSTULAR PSORIASIS
Two forms: Localised and Generalised
• Localised: more common
1.Palmoplantar pustulosis 2.Acrodermatitis continua
• Appears as raised bumps that are filled with non-
infectious pus (pustules).
• The skin under and surrounding pustules is red and
tender. commonly to the palms and soles.
• Generalised: Uncommon
• Associated with fever Widespread patches occurring
randomly on any part of the body
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20 Conti…
1. Palmoplantar pustulosis 2. Acrodermatitis continua
Chronic condition Chronic , sterile , pustular
Red,scaly plaques eruption
Studded with sterile pustules Tips of fingers & toes
Palms & soles Common in children
Red scaly plaque studded
with pustules
Nail dystrophy
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23 ERYTHRODERMIC PSORIASIS
• Uncommon
• The widespread inflammation and exfoliation of the
skin over most of the body surface.
• It may be accompanied by severe itching, swelling
and pain.
• Patients may become febrile, hypo/hyperthermic
and dehydrated
• Complications include cardiac failure, infections,
malabsorption and anaemia
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Erythrodermic Psoriasis
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25 Local forms: PALMOPLANTAR PSORIASIS
• Occur at any age
• Affects the palms and soles
• The symptoms include:
-Redness and scaling
-Itching and burning sensation
-Pain, cracking and bleeding
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SCALP PSORIASIS
• Varies from minor scaling with erythema to thick hyperkeratotic
plaques
• May extend beyond hairline
• Patient scratching may produce asymmetric plaques
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29 NAIL PSORIASIS
• May be present in patients with any type of psoriasis
• Can take several forms:
Pitting: discrete, well-circumscribed depressions on nail
surface
Subungual hyperkeratosis: silvery white crusting under
free edge of nail with some thickening of nail plate
Onycholysis: nail separates from nail bed at free edge
‘Oil-drop sign’: pink/red colour change on nail surface
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Nail psoriasis
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PSORIATIC ARTHRITIS
• About 10-15% of people who have psoriasis also have psoriatic arthritis.
• 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).
• Five major patterns of psoriatic arthritis:
1. Distal interphalangeal involvement
2. Symmetrical polyarthritis
3. PSoriatic spondylarthropathy
4. Arthritis mutilans
5. Oligoarticular,asymmetrical arthritis
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33 DIAGNOSIS
• 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.
• Another sign of psoriasis is that when the plaques are
scraped, one can see pinpoint bleeding from the skin below
(Auspitz's sign)
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34 DIFFERENTIAL DIAGNOSIS
• Eczema
• Seborrheic dermatitis
• Drug erruption
• syphilis
• Tinea
• Candidiasis
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35 MEDICAL MANAGEMENT
• Treatment is based on:
• The severity of the disease
• The extent and location of the areas involved
• Responsiveness to the treatment
• Treatment is divided into 3 types
1. Topical treatment
2. Light therapy
3. Systemic medications
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36 TOPICAL TREATMENT
• Emollients
• Corticosteroid creams and ointments (most common treatment)
• Synthetic forms of vitamin D and retinoids
• Coal tar preparations
• Bath solutions and moisturizers
• Tacrolimus and pimecrolimus (especially for inverse psoriasis)
LIGHT THERAPY
UVA
UVB
PSORALEN (PUVA) therapies
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37 Systemic medications
• Hydroxyurea
• Cyclosporine
• Methotrexate
• Systemic retinoids
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38 Side effects
• Skin atrophy
• Telangiectasia
• Hypertrichosis
• Hypopigmentation
• Glaucoma
• Pituitary adrenal suppression
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39 According to Ayurveda
• “Kushnati iti Kustha” (Amarakosha)
Means that which makes ones skin look disgraceful or ugly or which destroys
twak and other dhatus is called Kustha.
• Journal of Ayurvedic and Herbal Medicine 2016;
2(5): 186-191
Psoriasis is mostly comparable with Eka kustha,
Kitibha kustha and Sidhma kustha which are
categorized under kshudrakusthas and mahakustha
respectively
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40 NIDANA
1. Aharaja - consumption of navashali,viruddhahara,
dadhi, matsya, masha,kulattha, Excessive intake of
Amla, Lavana ,Kashaya Rasa, Guru, Snigdha and
Drava .. Improper food habits play an important role in
kushta manifestation.
2. Viharaja- divaswapna, maithuna, dhoopa, vegadharana,
shoka, ativyayama ,Atapasevana.
3. Sansargaja nidana
4. Kulaja – adibalapravrtta vyadhi
5. Manasika – chinta shoka,papa, Tiraskara of guru ,
Brahmana.
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41 POORVA ROOPA
1. Sparsajnatva
2. Atisweda or Na Va
3. Loma harsha
4. Kandu,Toda,Shrama and Klama,kotha in the skin
5. Shoolam
6. Vranaadhikam
7. Daha,Suptangata
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42 SAMPRAPTI
• Nidana Parigrihya
Pitta –
Sevana Anila
Kapha
(Sanchaya) (Avaranatvena
Prakopa
OR Prakopa)
Lodged in
• Khavaigunya
Bahya
Roga Spreads in whole Pravriddha Vata
Marga body by Tiryaka carries Prakupita
(Sthana Sira (Prasara) Kapha and Pitta
Samshraya
)
Kustha If untreated
Produce Pradurbha Enters the deeper
Mandala va Dhatus
(Vyakti)
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Doshas: Vata –Udana,Vyana, Samana,
SAMPRAPTI
Kapha (Ch. & Vagh.)
Pitta (Sushruta)
PittaGHATAKA
- Pachaka. Bhrajaka,
Kapha -Avalambaka, Kledaka
Dushyas Twaka, Rakta, Mamsa, Lasika
Agni Jatharagni and Dhatvagni mandya
Srotas Rasavaha,Raktavaha,Mamsavaha,Swedavaha
Srotodushti Sanga and Vimargagamana
Marga Bahyaroga Marga
Udabhavasthana Amashaya
Sancharastahana Triyaka-gami sira
Adhisthana Twacha
Swabhava Chirakari
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44 LAKSHANAS
1. Sidhma Kustha
• Svetam, Tamram – White and coppery in color.
• Tanu, Ghrustam vimunchati – Thin, and when rubbed, it emits
small particles of the skin in the form of dust
• Alabu pushpavarnam – It resembles the flower of alabu
(Lagenariasiceraia)
• Prayena Cha Urasi – It is generally located in the chest.
• It is caused due to Vata and Kapha Dosha increase.
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Conti…
2. Kitibha
• Shyavam- It is blackish brown in color
• Kina kharasparsham – It is rough in touch like a scar tissue
• Parusham – It is hard to touch
• It occurs due to increase of Vata and Kapha Dosha
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48 Comparison of symptoms of Kitibha Kushta and
Psoriasis
Kitibha PSORIASIS
Shyavoam/Krishna Erythematous lesion turns to
black in chronic cases
Kharatwam Candle grease sign- positive
Parushatwam Abnormal hardening seen in
chronic cases
Rukshatwam Scales rough to touch
Ugra kandu Severe itching observed
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49 Conti…
3. Eka Kushta
• Asvedana – Absence of sweating Extensive
localization
• Yatmatsyakalopamam – Resembles the scales of fish.
• It occurs due to increase of Vata and Kapha Dosha
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51 Comparison of symptoms of Eka Kushta and
Psoriasis
Eka-Kushta Psoriasis
Aswedana Dry and rough leisons
Mahavastu Cover the entire body
Matsya shakalvata Well demarked raised patches with large silvery
loose scaling
Krishna-aruna varnata Erythmatous, black in colour
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52 CHIKITSA
• Vatottareshu sarpivamanam sleshmottareshu kushtheshu |
pittottareshu moksho raktasya virechanam cha agre || ( Cha.chi 7/39)
• Pakshat pakshat chardananyabhyupeyan masanmasat sramsanam //
sravyam raktham vatsare hi dwiralpam nasyam dadhyat cha triratran triratran||
(Su.chi 9/43)
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53 Treatment protocol
1.samshodhana
• Deepana and pachana with – chitrakadi vati, vaishwanara
churna , agnitundi vati.
• Abhyantara snehana with – Tiktaka grita, mahatiktaka
ghrita, mahakhadiraghrita, panchatikta ghrita, tikta
shatphala ghrita, triphala ghritam.
• Vamana with – kutaja, madanaphala, madhuka.
• Virechana with – Avipathi churnam, Manibhadra gulam,
Trivrith lehyam.
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54 • Nasya karma with – dantimoola, maricha, tulasi beeja, pippali, karanja, vidanga
• Dhoomapana – virechanika dhoomapana
2. Samshamana chikitsa;
a)Antahparimarjana – tikta kashaya rasa pradhana aushadha prayoga.
b) bahirparimarjana - lepa, pralepa,pradeha,taila snana prayoga.Takra dhara
a) Antah prayogartha ;
dose -125-250mg
Anupana – Madhu, goghrita, amalaki swarasa, gomutra
• Rasaushadhis - Gandhaka rasayana ,rasamanikya, talakeshwara rasa, kushtakuthara rasa
• Vati – Arogyavardhini vati, rasagandhimezhuku vati, Vilwadi gulika, panchatiktaghrita
Guggulu.
• Churna – manjishtadi churna, narasimha churna , triphaladi churna
• Kwatha -matra – 20-40 ml . Anupana – Madhu ,gomutra, ghrita.
Mahamanjishtadi kwatha, patoladi kwatha, Tikthaka kwata, Mahatiktaka kwata
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55 • Asava/arisht- Matra – 20-40ml. Anupana – samabhaga jala
Khadirarishta, kanakabindu asava, madhwasava,Aragwadarishta
• Ghritam – matra – 10-20ml . Anupana – ksheera, jala.
Mahatiktaka,Tiktaka gritam, mahakhadira, panchatiktaka.
• Taila – matra – yathavashyaka
Bakuchi, marichadya,somaraji taila, suryapaki,
• Lehya - amruthabhallathaka lehya, dhatryavaleha,Madhusnuhi
rasayanam, Gandaka rasayanam
b) Bahya prayoga;
• Taila- karanjanimba,Chakra mardha taila, Dinesha keram, Sanjeevani
Tailam, Neelidhalati keram
• Pralepa –manahshiladi , karaviradi, karanjadi pralepa.
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56 Pathya & Apathya
Pathya Ahara Pathya Vihara
Laghu anna ,Tikta Shaaka, Abhyanga - Karanja taila, Parisheka,
Purana Dhaanya, Avagaha-Khadira Kashaya,
Mudga,Patola, Purana Brahmacharya, sleep only during the
Shaali, Shashtika Shaali, night, Vegaavarodha varjana, Uccha
Yava, Godhuma, Khadira vachan varjana, Shoka, krodha
Jala Pana, Aushadha varjana, Hima Aatap varjana,
Samskruta Takra Vyaayama varjana, Diva swapa
varjana, Raatri jagrana varjana,
Sidhartaka snana
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57 Apathya
Apathya Ahara- Apathya Vihara-
Guru and Amla ahara, Ksheera, divaswapna, maithuna, dhoopa,
dhati, guda, tila, consumption vegadharana, shoka,
of navashali,guru, ahara, ativyayama ,Atapasevana
viruddhahara, dadhi, matsya,
masha,kulattha, intake of Amla,
Lavana ,Kashaya Rasa, Guru,
Snigdha and Drava .. etc
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58 Conti…
Avoid the following items in single or in combination with
each other
• Pickles, Jam, and Sauce
• Milk and its derivatives like Curd, Buttermilk, cheese, paneer etc
• Guava, Pear, Banana, Pineapple, Mango, Cherry, Pomegranate,
Orange, Sweet Lime etc.
• Chicken, Mutton, Pigeon, Peacock etc
• Honey, Jaggery, Phanita
• Sesame and Castor oil etc
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67 Dactylitis
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