PSORIASIS Disease Name PSORIASIS Cross Ref Skin, psoriasis; Etiology Unknown; inherited pr

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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.; =========================================================== 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.; =========================================================== 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;

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