化「癬」為夷 新一代生物製劑助患者走出「癬」境.pdf

新光醫院莊志誠醫師：乾癬性關節炎 2016-09-08

PSORIASIS

• Common; affects 1-2% of population; chronic relapsing
• Typically ~27 yr old; elbows, knees, scalp
• Plaque (sharply demarcated, scaly surface; removing scales with fingernail results in small droplets of blood: Auspitz's sign—diagnostic)
• Guttate (eruptive: small lesions on trunk, proximal extremities)
• Pustular (sterile 2-3 mm pustules over trunk and limbs following fever, with surrounding generalized erythema)
• Parakeratosis, hyperkeratosis: cells undergoing rapid turnover with thinning or absence of granular cell layer
• Flaky scale with inflammatory cells in groups in scale
• Acanthosis with long rete ridges and thinning of epidermis over dermal papillae
• Extravasated RBCs in dermis
• Pustular variant: intraepidermal (between granular and cornified layers) vesicle with essentially all neutrophils (Munro's microabscesses)