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Sufferers have monomorphic typically reddish, usually roundish island shaped, sharply defined and slightly raised herd. These lesions are found preferentially at the scalp, elbows, knees and disks around the navel and the anus, over the coccyx and the knuckles and under the earlobe. General skin especially are affected, often stretched (like the mentioned joints, but also, for example, the calves), or otherwise mechanically stressed (eg under your belt). It takes the scalp psoriasis has a special status. The scalp is both juvenile and adult forms, the most commonly affected area of the skin of psoriasis. According to the German Society of Dermatology in the guideline for psoriasis of the scalp [4] vary statistical data on the incidence of infestation in scalp psoriasis from 50 to 80 percent. The scalp is one among others due to their sensitivity and the thick hair on the so-called "difficult-to-treat areas."
The skin (epidermis) of a healthy person is renewed within 26 to 27 days. During this time, new skin cells are formed and the aged (keratinized) skin cells (keratinocytes) by the body almost invisible. In healthy skin, the keratinocytes are the mechanical, microbial and chemical protection of the skin. The transcription factor STAT3 is normally activated only after skin defect and then triggers a proliferation of keratinocytes and an activation of cutaneous T cells from the repair process.
In psoriasis, however is the keratinization to the affected areas accelerates both - the skin layer renews itself prematurely within only 3 to 7 days - and propagated (hyperkeratotic) and loss of the stratum granulosum disturbed by construction and function (parakeratotic). The reasons are the increased DNA synthesis and increased mitotic activity of the basal cells of the epidermis. It also comes without skin defect for activation of STAT3 and maladaptive remodeling in the epidermis. Thus continuously [5]
The aged skin cells form in psoriasis due to the accelerated renewal silvery coarse-lamellar scales, which have a talgartige, silvery texture, reminiscent of candle wax (candle wax phenomenon). The underlying tissue, the lowest cell layer of the epidermis, the border with corium (dermis) is due to the accelerated growth by bleeding heavily and is therefore among the easily removable scales as strong reddening. It easily dislodged even deeper cell layers (phenomenon of the last cuticle). Can this thin film to be replaced, this is almost always a sure sign of psoriasis. After removal, there is a point-like blood flow (phenomenon of bloody Taus Auspitz phenomenon).
Also typical is the infiltration of neutrophils, resulting in microabscesses ("Munro's abscess") under the horny layer.
The severity of the disease is determined primarily for the evaluation of therapeutic results with the PASI score.
The emotional stress psoriasis patients are greatly underestimated; according to recent studies, however, they are in the order of heart attack patients. Many sufferers find their condition as severe impairment of personal quality of life. They feel socially isolated, suffer from low self-esteem and often depression. [6] The fact that the rate of alcohol abuse in psoriasis significantly above that of the general population is, can be both a consequence and an aggravating nonspecific irritant of the skin disease.
Psoriasis Vulgaris
Type I (60-70% of cases) manifests itself before the age of forty, has a familial incidence and is in its course to be classified as more serious than Type II At 95%, this form with the histocompatibility antigen HLA-Cw 6 and HLA- dr 7 and coupled with HLA-B17 and HLA-B 57th All genes are located on the short arm of chromosome 6
Typical onset of psoriasis, guttate psoriasis, which often occurs after contact with trigger factors such as medications (β-blockers, lithium, antimalarials, etc.) or a streptococcal infection. However, it may subside again or merge into a vulgaris. Localization sites of psoriasis are the scalp (psoriasis capilitii), intertriginous areas, the Bend area (psoriasis inversa), the palms and soles (psoriasis palmarum et plantarum), the genital and anal localization (where an rhagade in Analkerbe than typical sign applies).
Type II (30-40% of cases) Late onset often after the age of forty. It is usually associated with nail psoriasis or joint pain (Psoriasisartrithis). The HLA-coupling is small, and there is no family history. There are usually lighter curves.
Type Zumbusch. (0.5-2.5% of cases) 50 skin infection with pustules and increased linkage with HLA-B27, especially after the Observed age, rarely before.
The causes of this usually generalized psoriasis occurring form are still poorly understood. It is believed that flow unusually large amounts of neutrophil chemotactic interleukin-8, which could be the mass emigration of neutrophils in the stratum corneum explain. The influx leads to sterile pustules. An essential importance in addition to the IL-8 to the tumor necrosis factor-α (TNF) that leads to cutaneous inflammatory responses and systemic symptoms.
The clinical course is characterized by an acute fever. Within hours, first develops at the contact of the skin (eg under the breast) and later generalized erythema with pustules that may coalesce in severe cases.
Within 24 hours, the number of white blood cells, the calcium content decreases, as the level of albumin in the blood plasma. In the further course it always comes back to new episodes of fever and generalized pustules.
Pustular generalisata
This particular form of psoriasis therapy can without including inward applications (see below) be fatal and is caused by cosmetic products (see below).
Pustular Psoriasis Palmoplantaris
Type Barber is In good general condition, the pustules only on hands and feet.
Acrodermatitis Continua Suppurativa
Hallopeau type, see also Crohn Hallopeau. The pustule is acral (ie: fingers, toes, hands, feet, nose, chin, eyebrows and zygomatic arches), especially on the fingers. Nail and hair loss are possible.
