3. WHAT IS PSORIASIS?
Inflammatory and
hyperplastic disease of
skin
Characterised by
erythema and elevated
scaly plaques
Chronic, relapsing
condition
Course of disease often
unpredictable
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5. EPIDEMIOLOGY
Common skin disorder
Prevalence variable: ~ 0.3–2.5%
Prevalence equal in males and females
Estimated incidence: ~ 60 per 100,000 per year
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6. AGE OF ONSET
Mean age: ~ 23–37 years
Current theory:
2 distinct peaks with possible genetic
associations
Early onset (16–22 years)
More severe and extensive
More likely to have affected first-degree family member
Late onset (57–60 years)
Milder form
Affected first-degree family members nearly absent
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7. PSORIASIS IS A T-CELL MEDIATED, AUTOIMMUNE
DISEASE1
Current hypothesis:
Unknown skin antigens stimulate immune response
Antigen-specific memory T-cells are primary
mediators
Leads to impaired differentiation and
hyperproliferation of keratinocytes
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13. TYPES OF PSORIASIS
Chronic plaque
Guttate
Flexural
Erythrodermic
Pustular
Localised and generalised
Local forms
Palmoplantar
Scalp
Nail (psoriatic
onychodystrophy)
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14. CHRONIC PLAQUE PSORIASIS
Most common type –
affects approximately
85%
Features pink, well-
defined plaques with
silvery scale
Lesions may be single or
numerous
Plaques may involve
large areas of skin
Classically affects elbows,
knees, buttocks and scalp
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19. GUTTATE PSORIASIS
Numerous and small
lesions – ~ 1 cm diameter
Pink with less scale than
plaque psoriasis
Commonly found on trunk
and proximal limbs
Typically seen in
individuals < 30 years
Often preceded by an
upper respiratory tract
streptococcal infection
1. 19
20. FLEXURAL PSORIASIS
Lesions in skin folds
articularly groin,
gluteal cleft, axillae
and submammary
regions
Often minimal or
absent scaling
May cause diagnostic
difficulty when genital
or perianal region is
affected in isolation
1 20
21. ERYTHRODERMIC PSORIASIS
Generalised erythema
covering entire skin surface
May evolve slowly from
chronic plaque psoriasis or
appear as eruptive
phenomenon
Patients may become
febrile, hypo/hyperthermic
and dehydrated
Complications include
cardiac failure, infections,
malabsorption and
anaemia
Relatively uncommon
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22. PUSTULAR PSORIASIS
Two forms:
Localised form
More common
Presents as deep-seated
lesions with multiple small
pustules on palms and
soles
Generalised form
Uncommo Associated with
fever and widespread
pustules across the body
inflamed body surface
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23. PALMOPLANTAR PSORIASIS
Can be
hyperkeratotic or
pustular
May mimic dermatitis
– look for psoriatic
manifestations
elsewhere to aid
diagnosis
Possibly aggravated
by trauma
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24. 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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25. 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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27. PSORIATIC ARTHRITIS
Approximately 5–20%
have associated arthritis
Five major patterns of
psoriatic arthritis:
Distal interphalangeal
involvement
Symmetrical polyarthritis
Psoriatic
spondylarthropathy
Arthritis mutilans
Oligoarticular,
asymmetrical arthritis
Clinical expressions
often overlap
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28. DIAGNOSING PSORIASIS
Other dermatological disorders
can resemble psoriasis
Diagnosed clinically according to
appearance, distribution, history of lesions
and family history
Important to consider non-cutaneous
complications
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31. MANAGING PSORIASIS
Goals of management
Tailor management to individual and address both
medical and psychological aspects
Improve quality of life
Achieve long-term remission and disease control
Minimise drug toxicity
Evaluate and monitor efficacy and suitability of individual
treatments
Remain flexible and respond to changing needs
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32. MANAGING PSORIASIS
Before starting treatment
Establish relationship of trust with patient
Provide patient with information
Emphasise benign nature of disease
Explain that psoriasis tends to be chronic and
recurrent
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34. FACTORS FOR SELECTION OF TREATMENT
Age: childhood, adolescence, young adult hood,
middle age,>60 yrs
Type of psoriasis: Plague, palmar, generalised
pustular, etc
Site and extent of involvement: localised to scalp,
palms, scattered plaques but <5% involvement:
generalised and >30% involement.
Previous treatment: Systemic glucocorticoids,
methotrexate
Associated medical disorders(eg. HIV, CVD)
Duration of Disease: <1month, <1 yr, >1yr
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36. CHIKITSA
Sadya Virechana with Avipatti choornam-20gms for
1day
if saama lakshanas are seen - Shaddharana(5gm) /
panchakola choorna)
Mahatiktakam kashaya - 15ml bd for 1st week
Kaisoraguggulu - 1 tab bd for first week
Manasamitra vataka - 1 tab bd for 2 weeks
Gandhaka rasayan - 100mg with honey bd
(throughout)
Vitpala kera taila - external application followed by
sun exposure
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37. PROTOCOL 2
MODERATE SYMPTOMS
HISTORY OF 2-6 MONTHS
AFFLICTED TO A LARGER AREA
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38. CHIKITSA
Mahatiktakam ghrutha -15 gm(inc acc to agni bala X 7 days for
snehan (along with Abhyangam and sarvanga swedanam)
SadyoVirechana with Avipatti choorna - 20gm for 1st week.
Tiktakam kashaya - 15ml bd X 2 weeks
( if saama lakshanas are seen - 5-6gm shaddharana choorna
/gutika)
Kaishore Guggulu - 1 tab tds X 2 weeks
Arogya vardhini gutika - 1 tab tds X 2weeks
Gandhaka Rasayan- 100mg with honey (throughout)
Haridrakhandam -12gm bd X 2weeks
Manasmitra vatakam – 2 tabs bd X 2weeks
Vitpala kera taila - external application followed by sun exposure
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40. PROTOCOL 3
SEVERE SYMPTOMS
HISTORY OF 6 MONTHS AND MORE
SPREAD EXTENSIVE AREAS
WITH SEVERE MENTAL STRESS
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41. CHIKITSA
Starting with the previous protocol according to the bala,
avastha of Roga and Rogi, moving on to the additional
treatments.
Rookshana – Takra dhaara(musta,triphala,aragwadhadi)
Deepana-pachana -Panchakola churna with takra/usna
jala
Snehapana -dose acc. to agni bala. (Mahatiktakam
ghrutha/guggulutiktakam ghruta)
Abhyangam - vitpala
Swedana - usna jala snana, atapa sevan
Nasya - shadbindu taila
Vamana - madana,vacha,yashti,pippali+madhu
Virechana - avipatti choorna/ trivrut leha
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42. FOLLOW UP
Need of Rasa-Rakta prasadana - Manobala
vardhaka -Rasayana chikitsa. Rasa-Rakta
parasadana
Mahamanjishtadi kashaya. 15ml bd X 1
month
Krumimudgar ras 1 hs X 1week
Manasamitra vataka 1bd X 1 month
Kalayana ghrutha 12gm hs X 1month
Gandhaka Rasayana 1tab bd X 1month
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43. PATHYA
For a minimum of 3 months to control symptoms
and relapse
Ahara :Avoid Virudha, vidaahi , guru , abhishyandi,
navaanna, matsya, anupa mamsa, kanda varga. :
reduce the use of lavana : include more haridra,
rasona, pepper in the diet. : avoid pickles, dadhi at
night ,fermented food items. : avoid bakery items
(maida), oily and spicy foods. : strictly avoid egg,beef
and pork. : Avoid ready to cook items, tinned foods
etc. : avoid re-cooking refrigerated foods.
Vihaara : maintain hygiene in all aspects. : practice
Achara rasayana.
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44. MANAGEMENT OF PSORIASIS: SUMMARY
Chronic, inflammatory disease of skin
Classic presentation characterised by
red, scaly plaques
Management should address both
medical and psychological aspects
Treatments include externaltherapy,
panchkarma, Rasa-Rakta prasadana -
Manobala vardhaka -Rasayana chikitsa.
Rasa-Rakta parasadana
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