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Psoriasis

Psoriasis. Definition. Psoriasis Chronic, inflammatory disease of the skin characterized by altered epidermal growth and differentiation with multiple vascular and immunologic abnormalities Still of unknown etiology. Pathophysiology. Initial Lesions. Developing Lesion.

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Psoriasis

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  1. Psoriasis

  2. Definition • Psoriasis • Chronic, inflammatory disease of the skin characterized by altered epidermal growth and differentiation with multiple vascular and immunologic abnormalities • Still of unknown etiology

  3. Pathophysiology Initial Lesions Developing Lesion Increased edema and mononuclear cells in the upper dermis ~50% increase in epidermal thickness Increase in metabolic activity in the epidermis Mast cells, macrophages, T-cells and dendritic cells Slightly dilated venules in upper dermis w/ mononuclear inflitrate Parakeratosis, capillary elongation, rete ridges, lymphocyte, macrophage infiltration “marginal zone” Thickening of epidermis into a band-like pattern

  4. Pathophysiology Mature Lesion Involves various immune cells; e.g.: T-cells – specifically, CD4 and CD8+ cells which are rich in TNF-gamma. This indicates Th1 polarization Dendritic cells – plays a central but still unidentified role Macrophages – thought to fenestrate the epidermal basement membrane and also produces TNF-a Involves various cytokines and chemokines which show a polarization towards Th1 reponse; e.g. TNF-a, IFN-gamma – promotes keratinocyte proliferation Elongated rete ridges w/ thinned out epidermis on top. 100% basal layer mitotic activity Increased infiltration by lymphocytes, macrophages, dendritic cells, mast cells

  5. Co-morbidity • Associated with an increased risk for obesity, metabolic syndrome and insulin resistance • Increased risk for lymphoma but only for Hodgkin’s and cutaneous T-cell types • No significant increase in risk for non-Hodgkin’s lymphomas

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