Psoriasis vulgaris

Psoriasis vulgaris, a disease showing some tendency to autosomal dominant transmission, is characterized by well demarcated salmon red plaques surmounted by a micaceous (mica-like) scale.
These plaques characteristically involve the elbows, knees, scalp, lumbosacral area, as well as the palms and soles, but the eruption can be generalized.
Removal of the micaceous scale can result in punctate bleeding, the Auspitz sign.
Psoriasis can occur in traumatized skin in someone who has a tendency towards psoriasis, Koebner’s phenomenon.
Psoriasis can either be a mild disease with only a few lesions or a severe generalized eruption, associated with active arthritis.

Treatment:

• Trauma worsens psoriasis and must be avoided.
• Topical tazarotene
• UVB and narrow band UVB
• Systemic to include cyclosporine, sulfasalazine, mycophenolate mofetil, Infliximab, and etanercept

Topical treatment:

• The treatment of mild, very localized psoriasis is usually begun with the application of a mid-strength steroid such as betamethasone 0.1 % ointment bid - qid. This, or intra-lesional triamcinolone diacetate, results in significant improvement in most small lesions.
• Tar containing ointments and lotions have been historically useful but have, by and large, been supplanted by the application of anthralin 1-2 % cream applied as short contact therapy for ten minutes and then removed.
• Topical calcipotriol, a vitamin D derivative, can be effective for mild to moderate psoriasis.

Ultraviolet light treatment:

• Ultraviolet B has been shown to be quite effective for most patients. Ultraviolet light treatments are generally given three times a week and resolution is over months of treatment.
• Failure to respond to UVB, leads to use of PUVA which is a combination of oral or topical psoralen and UVA. Treatments two times a week for many months are required for resolution of severe systemic psoriasis with PUVA.

Systemic treatment:

• Systemic therapy beyond PUVA for severe recalcitrant psoriasis includes cyclosporine 1-5 mg/kg/day, methotrexate 2.5-5 kg/12 hours x 3 once a week, or hydroxyurea 500 mg-1 g/day.

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