Psoriasis. Psoriasis may be divided into psoriasis vulgaris, generalized pustular psoriasis, and localized pustular ps

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬ Psoriasis Psoriasis may be divided into psoriasis vulgaris, generaliz...
Author: Jeffery Perry
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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Psoriasis

Psoriasis may be divided into psoriasis vulgaris, generalized pustular psoriasis, and localized pustular ps

Psoriasis Vulgaris

Clinical Features

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Psoriasis vulgaris is a common chronic inflammatory skin disorder that affects approximately 1.5% to 2%

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

associated with acute group A ~-hemolytic streptococcal infections . Involvement of the nails is common

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Psoriatic arthritis characteristically involves the terminal interphalangeal joints, but frequently the large jo

Generalized Pustular Psoriasis

Clinical Features

Generalized pustular psoriasis includes (a) acute generalized pustular psoriasis (von Zumbusch type an

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

This cutaneous eruption is characterized by the presence of variable numbers of sterile pustules appear

The four variants of generalized pustular psoriasis show considerable resemblance and overlapping in th

mainly in the mode of onset and the distribution of the lesions. Frequently, all four diseases show oral pu

Acute generalized pustular of psoriasis

von Zumbusch

is generally diagnosed when exanthe the

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Generalized pustular psoriasis of

In some instances of

pregnancy

is a rare pustular eruption impetigo that a

subacute annular pustular thepsoriasis annular or gyrate lesions show a clinical resemblanc

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Very rarely, children develop infantile generalized and juvenile pustular pustular In psoriasis, these psoriasis. patients also known the disease as has a benign course with f

Localized Pustular Psoriasis

Clinical Features

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

There are three types of localized pustular psoriasis: (a) "psoriasis with pustules" , in which only one or a

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Acrodermatitis continua of

Hallopeau

is the term used when the pustu

Pustulosis palmaris et plantaris is a chronic, relapsing disorder . occurring on the Crops palms,of soles, small, ordeep-seated both pus

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Psoriasis and AcquiredClinical Immunodeficiency Features Syndrome

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

The association between. psoriasis and human immunodeficiency Extensive erythrodermic virus (HIV) psoriasis infection mayisoccur commonly (109).seen Palm

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Psoriasis Vulgaris

Histopathology

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

The histologic picture of psoriasis vulgaris varies considerably with the stage of the lesion and usually is

The earliest pinhead-sized macules or smooth-surfaced papules show subtle histologic changes with a p

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

exocytosis of neutrophils, they may aggregate in the uppermost portion of the spinous layer to form sma

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

In the fully developed lesions of psoriasis, as best seen at the margin of enlarging plaques, the histologic

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Of the listed features, only the spongiform pustules of Kogoj and Munro microabscesses are truly diagno

The rete ridges show considerable elongation and extend downward to a uniform level, resulting in regul

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

show thickening ("clubbing") in their lower portion. Not infrequently, adjacent rete ridges seem to coalesc

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

The suprapapillary epidermis appears relatively thin in comparison with the markedly elongated rete ridg

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

In some instances the cornified layer consists entirely of confluent parakeratosis forming a platelike scale

Munro microabscesses are located within the parakeratotic areas of the cornified layer . They consist of

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

The dermal papillae, in accordance with the elongation and basal thickening of the rete ridges, are elong

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

An entirely typical histologic picture as described earlier is not always found, even if the biopsy specimen

indicates a fluctuation in the activity of the psoriasis.

The bleeding points that may be produced by gentle scraping of the skin (Au spitz sign) correspond to th

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Guttate or eruptive psoriasis shows the histologic features of an early or active lesion of psoriasis, where ther

The histologic picture of erythrodermic psoriasis in some instances shows enough of the characteristics o

Generalized Pustular Psoriasis

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Histopathology

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Whereas in ordinary psoriasis the spongiform pustule of Kogoj is a very small micropustule and is seen o

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

In addition to the large spongiform pustules, the epidermal changes in generalized pustular psoriasis are

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

In the healing stage, the lesions of all types of generalized pustular psoriasis may present the same histo

Localized Pustular Psoriasis

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Histopathology

In the variants of localized pustular psoriasis "psoriasis with pustules"  and localized annular pustular pso

In localized acrodermatitis continua of Hallopeau, the nail bed is mainly affected, showing marked epithe

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

In pustulosis palmaris et plantaris there is a fully developed large intraepidermal unilocular pustule. It is e

the ustule, most commonly at the junction of the lateral walls and the overlying epidermis . These spongi

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Very early lesions may show spongiosis and exocytosis of lymphocytes in the lower epidermis overlying

Psoriasis and Acquired Immunodeficiency Syndrome

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Histopathology

The histologic picture in most cases is similar to that of psoriasis. In others, the histologic sections may s

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Pathogenesis

of

Psoriasis Vulgaris

Although the cause of psoriasis is unknown, there is increasing evidence of a complex interaction among

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Electron Microscopy

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

The earliest recognizable morphologic events in psoriasis have been investigated in lesions that cleared

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

35 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Ultrastructural studies of the spongiform pustule of Kogoj, one of the most characteristic histologic struct

The ultrastructure of the capillary loops in the dermal papillae shows them to be different from normal ca

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Epidermal Cell Cycle Kinetics

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

The rate of epidermal cell replication is markedly accelerated in active lesions of psoriasis, as shown by

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Early calculations made it appear likely that in psoriatic lesions there was a great acceleration of the tran

2 Further investigations  have found that (a) the germinative of epidermal cellsurface cycle isarea, shortened and (c)from 311 to 36 hours, i

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

100% of the germinative cells of the epidermis enter the growth fraction instead of only 60% for normal s

The source of the cycling cells in the suprabasal layers of the epidermis is not well defined. They could b

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Recent studies suggested that psoriatic epidermis shows aberrant expression of apoptosis-related molec

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Keratinocyte Differentiation

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Keratinocytes undergo the process of differentiation as they migrate upward through the epidermis from

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

44 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Immunopathology

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Immunologic factors playa very important role in the pathogenesis of psoriasis. Psoriasis is now regarde

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

CD4+ T cells produce a variety of cytokines, including interleukin-2 (IL-2), tumor necrosis factor-a (TN Fa

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Keratinocytes stimulated by TNFa may produce IL-B, which is a potent T-Iymphocyte and neutrophil che

48 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

49 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

50 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

ylFN is believed to play an important role in the initiation of psoriatic lesions as demonstrated by the indu

51 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

ylFN induces the expression of the ICAM-1 in keratinocytes and endothelial cells. This molecule mediate

52 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

not to be responsive to the growth inhibition effects of yIFN, leading to their hyperproliferative state in the

53 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Increased expression of p53 and downregulation of Bcl-2, consistent with the dynamics of psoriasis, hav

54 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Pathogenesis

of

Localized Pustular Psoriasis

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

A relationship of pustulosis palmaris et plantaris with psoriasis is not generally accepted, although two fa

56 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Pathogenesis

of

Psoriasis and AIDS

57 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

There is evidence of the role of both CD8+ and CD4+ T lymphocytes and ylFN in the pathogenesis of ps

58 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

 . Paradoxically, as T-helper cell counts decline, it appears that psoriatic lesions exacerbate until a prete

59 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

The immunodysregulation resulting from HIV infection may trigger psoriasis in those genetically predispo

60 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Differential Diagnosis

61 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Two histologic features are atopic of great dermatitis, value nummular in the or diagnosis dermatitis, of psoriasis vulgaris: allergic (a) contact mounds dermatitis, of parakerato which th

62 / 68

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

including Reiter's disease, pustular histologically dermatophytosis, typical spongiform and bacterialpustules impetigo,may pustular candidiasis, occurdrug alsoeruptions, in

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particula

Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

Because of the clinical and, particularly, the histologic resemblance of the tongue lesions in pustular pso

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

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Spongiform pustules of Kagoj in Psoriasis = ‫اﻠﺼدﻒ ﻓﻲ اﻠﺸﻜﻞ اﻠاﺴﻔﻨﺠﻴﺔ اﻠﺒﺜراﺖ‬

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