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Psoriasis

QuestionAnswer
Se caracteriza por placas eritroescamosas bien definidas Psoriasis
Localización Codos, rodillas, región sacra, piel cabelluda. Puede afectar superficie cutánea, articulaciones, uñas, genitales
Epidemiología Mayor frecuencia en raza blanca. Ambos sexos. A cualquier edad; predominio entre 2º y 4º década. 77% tiene formas graves. Forma artropática en 1 - 15%.
Genética 33% tiene antecedente familiar. Autosómica dominante o multifactorial. Relación con antígeno HLA-Cw6
Regulación de queratinocitos Actividad mitótica acelerada. Aumenta proliferación y diferenciación. Mayor expresión de queratina K16 (maduración de queratinocito alterada)
Alteración inmunológica Células dendríticas son iniciadoras ante estímulos no definidos. Acumulación y activación de linfocitos T y otras células inflamatorias y citocinas. Predominio de respuesta Th1
Clasificaciones Tipos, morfología, localización
Tipos I (juvenil), II (adulto)
Tipo I(juvenil) <40 años. Antecedente familiar. Relación con HLA-Cw6. Tiende a ser generalizado, resistente a tx y grave
Tipo II (adulto) >40 años. Antecedente familiar; no relacionado a HLA. Evolución benigna
Localización Piel cabelluda, zona del pañal, uñas, facial, palmo-plantar, invertida, del glande y prepucio, bucolingual, universal
Morfología Gotas. Placas. Anular. Gyrata. Numular. Ostrácea. Lineal. Folicular. Eritrodermia. Pustulosa (generalizada, palmo-plantar, acrodermatitis continua)
Complicaciones Dermatitis por contacto (eccematización). Impétigo secundario. Candidiosis. Eritrodermia. Artropatía
Relación con enfermedades autoinmunitarias AR, Esclerosis múltiple, LES, vitiligo, Tiroiditis autoinmunitaria, glomerulonefritis crónica, enfermedad de Crohn
Relación con neoplasias Linfoma de Hodgkin, linfoma cutáneo de células T
Diagnósticos diferenciales Pitiriasis liquenoide, Pitiriasis rosada, Pitiriasis rubra pilar, Liquen plano, Micosis fungoide, Erupciones por fármacos, Tiña de la cabeza, Dermatitis seborreica, Dermatitis de la zona del pañal,sx de Reiter, AR, Espondiloartritis anquilosante
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