Question

• Describe the pathophysiology, clinical manifestations, evaluation, and treatment(s) for psoriasis, lichen planus, pemphigus, seborrheic keratosis, and actinic keratosis.

Answer 1

The answer is given below

1. Psoriasis.

Psoriasis ;is an immune mediated disease that caused raised ,red, scaly patches to appear on the skin ..

PATHOPHYSIOLOGY ; is multifactorial and involves epidermal hyperproliferation,abnormal differentiation of epidermal keratinocytes,and inflammation with immunologic alterations in the skin.

CLINICAL FEATURES ;

a) Redpatches of the skin covered with thick,silvery scales.

b) Small scaling spots.

c) Dry cracked skin that may be bleed.

d) Itching,burning or soreness.

e) Pitted or rigged nails.

f) Swollen or stiff joints.

EVALUATION AND TREATMENTS;

   There are different algorithms regarding the evaluation of psoriasis patient related to treatment pre treatment,during treatment,post treatment.

Pre treatment ; including medical history, physical examination with the objective assessment of the disease with specific scales (PASI,PGA, DLQI etc) ,Performing laboratory controls,checking skin cancer,hypersensitivity, gastrointestinal and renal disease,ned of vaccines etc.

During treatment; Medical history and physical examination(focusing on malignancies,depression,contraception,anxiety)performing laboratory control when indicated on medical history and physical examination).

Post treatment evaluation indications ;discussing contraception be pursued at least 20 weeks after discontinuation of biological treatment,continue followup focusing on malignancies,infection etc.

TREATMENTS ;

   Moisturising and imolients ; Peoples with psoriasis often have dry skin which become itchy and irritated.by scarching these areas ,new psoriasis plaques can develop.To applying emoliants to dryskin ,this helps prevent from this happening.

Emoliants should be applied in the direction of the hair growth, if it is applied against ,these can cause infection of thehair follicles.

Topical steroids ; use as prescribed but normaly twice a day .once in the morning and once in the evening,The topical steroids comes as creams or oinment.

Light therapy ;Natural or artificial ultra violet rays can be used to slow down the growth of skin cells.Light therapy is also combined with medications.

Biologics are used to moderate to severe psoriasis. biologic target specific part of the immune system instead of affecting the entire immune system  as systemic treatment do.

LICHEN PLANUS  

Pathophysiology it is an T cell mediated autoimmune diseases in which the cytotoxic CD8+T cells trigger apoptosis of the basel cells of the oral epithelium.

clinical features may appear white patches, red swollen tissues these lesions may cause burning sensations or other discomfort.

evaluation and management

treatments ; high potency topical corticosteroids ,(administer twice a day,),oral corticosteroids,(pednisone)

phototherapy (30 to 40 minutes treatments two or three times weekly)

3 PEMPHIGUS

Pathophysiology it is an autoimmune disease caused by antibodies directed against both desmoglein 1 and desmoglein 3 present in desmosomes .

clinical features; This type usually begins with blisters in your mouth,and then on your skin and genital mucus membranes.The blisters tend to be more itchy than painful.

Evaluation and management ;Systemic corticosteroids remain the golden standard treatment of pemiphigus vulgaris. Azathioprine and mycophenolate mofetil are the first line of steroid sparing treatment .

4 seboric keratosis and actinic keartosis

	seboric keratosis	actinic keatosis
pathophisiology	seboric keratosis are thought to from a colonal expansion of a mutated epidermal keratinicyte.seboric keratosis exbit the histologic evidence of proliferation.	AKs are clinicaly as erythematous scaly plaques that occur or sun damaged skin and are aresult of exposure to ultraviolet radiation.
clinical features	Usually look like waxy or wart like growth.it is typically appears on face ,neck and chest .You may develop single growth though multiple growth are more common.	Dry or scaly patches of skin usually less than 1 inch.flat to slightly raised patces or bump on the top layeer of skin.
evaluation and treatment	they include cryotherapy with carbon dioxide or liquid nitrogen,shave biopsy or excision using a scalpel.	destructive therapies eg ; surgery,cryotherapy,photo dynamic terapy etc.Topical medications igenol mebutate,diclofinac etc,