Guttate Psoriasis vulgaris
Jun 05, Author: Manifestations, Management Options, and Mimicsa Critical Images slideshow, to help recognize the major psoriasis subtypes and distinguish them from other skin lesions.
This variant of Würmer und Psoriasis primarily occurs on the trunk guttate Psoriasis vulgaris the proximal extremities, but it may have a generalized distribution. Lesions usually spread centripetally and are monomorphic.
New guttate psoriasis lesions continue to develop during the first month of disease; they remain stable during the second month, and the remission begins during the third month. Guttate psoriasis is more common in individuals younger than 30 years. An upper respiratory tract infection from group A beta-hemolytic streptococci eg, Streptococcus pyogenes often precedes the eruption by weeks.
Although episodes may recur, especially those due to pharyngeal carriage of streptococci, isolated bouts have guttate Psoriasis vulgaris been described. Generally, the disease is self-limiting, but a certain percentage of cases Salbe auf der Grundlage von Birkenteer für Psoriasis Preis to chronic plaque psoriasis.
The sudden appearance of the papular lesions in response to streptococcal infection could either be the first manifestation of psoriasis in a previously unaffected individual or an acute exacerbation of long-standing plaque psoriasis. For more information, go to Psoriasis. The exact pathophysiologic mechanism in guttate psoriasis is undetermined. Guttate psoriasis is believed to result from an immune reaction triggered by a previous streptococcal infection in a genetically susceptible host.
Studies indicate the importance of chromosome 6 in determining the resultant psoriatic phenotype. Interactions of HLA-C with killer immunoglobulin—like receptors KIR on natural killer cells or natural killer T cells can be deregulated by streptococcal infection. T lymphocytes and cytokines are believed to cause the characteristic inflammatory changes appreciated on histopathologic examination of lesions.
Psoriasis was originally classified as a Th1 disease, but Th17 cells have also been recognized to have an important role.
Studies are also proposing a role for antimicrobial peptides and dendritic cells in the pathogenesis of psoriasis. Cathelicidin LL is especially thought to lead to activation of dendritic cells, inducing production of interferons.
Elevated levels of the cathelicidin LL have been reported in patients with plaque and guttate psoriasis compared with healthy controls. There was no significant difference in serum levels of inflammatory cytokines and LL between the plaque type and guttate guttate Psoriasis vulgaris group, but a positive correlation between disease activity and cytokine levels was noted. An autoimmune phenomenon has also been postulated to underlie guttate psoriasis because some streptococcal products and components have been found to cross-react with normal human epidermis.
Furthermore, Langerhans cell migration appears to be impaired during an acute episode of guttate psoriasis. International surveys on the guttate form of psoriasis among patients with psoriasis have found a click the following article range of prevalences, from 1.
A study has shown that the prevalence of psoriasis correlates with the distribution and mortality of streptococcal epidemics. Guttate psoriasis is the second most guttate Psoriasis vulgaris psoriasis variant in children. The onset of the guttate psoriasis skin lesions often is acute, with multiple papules erupting on the trunk and the proximal extremities, in a centripetal fashion.
Guttate Psoriasis vulgaris lesions are often accompanied by slight pruritus. In most cases of guttate psoriasis, a history of an antecedent streptococcal infection, usually of the upper respiratory tract eg, pharyngitis or tonsillitisweeks prior to the eruption can be elicited.
Multiple other infectious agents have been implicated, although episodes http://mgv-frohsinn1904.de/jibuzamaq/behandlung-von-psoriasis-ohanyan.php guttate Psoriasis vulgaris psoriasis attributed to them are not as frequent as those attributed to streptococci.
Associated organisms include the following:. Drug therapy, including biologic agents, may sometimes precipitate a guttate-type flare.
The most commonly implicated medications include lithium, beta-blockers, antimalarial drugs, and nonsteroidal anti-inflammatory drugs. A positive family history of psoriasis may be present, and guttate Psoriasis vulgaris outcome is generally good. Examination of the skin reveals characteristic lesions consisting of multiple, discrete, mm in diameter, droplike papules with a salmon-pink guttate Psoriasis vulgaris. A fine scale, which is usually absent in guttate Psoriasis vulgaris lesions, may be appreciated on the more established ones, as shown in the image below.
The lesions of guttate psoriasis appear guttate Psoriasis vulgaris on the trunk and the proximal extremities, progressing in guttate Psoriasis vulgaris centripetal fashion. Lesions are commonly monomorphic and at the same stage of evolution. They may sometimes spread to involve guttate Psoriasis vulgaris face, the ears, and the scalp. The palms and the soles are rarely affected. Nail changes in the form of pits, ridges, and guttate Psoriasis vulgaris oil-drop sign, which are Psoriasis-Behandlung bei Kindern Salbe of chronic psoriasis, may be absent.
Additional findings may include pharyngeal or perianal erythema in cases associated with acute streptococcal infections. Ledoux et al emphasize a careful examination, including the perianal region, in guttate Psoriasis vulgaris being examined for guttate psoriasis.
The etiology of guttate psoriasis is not well understood. Genetic as well as environmental factors have been implicated in its pathogenesis.
As in other types of psoriasis, genetic predisposition seems to play die helfen heilen Psoriasis important role in the development of an acute guttate psoriasis flare. Compared with control populations, a significant excess of HLA-BW17 has been found in patients with guttate psoriasis.
Other researchers have found an increase in HLA-B13 positivity. Moreover, the inability to produce normal amounts of antibody to streptolysin-O by HLA-B13—positive individuals might explain their high prevalence of guttate psoriasis. These patients experience psoriasis at markedly higher rates than control subjects. Thus far, psoriasis is the only disease associated with HLA-C gene guttate Psoriasis vulgaris. Proteomic and immunohistochemistry studies have demonstrated that guttate psoriasis and chronic plaque psoriasis are phenotypically distinguishable in their protein expression patterns.
Guttate Psoriasis vulgaris association of guttate psoriasis with streptococcal infection guttate Psoriasis vulgaris been guttate Psoriasis vulgaris for more than 50 years. The streptococcal serotypes in these patients are similar to those seen in the general population.
Aside from group A streptococci, Lancefield guttate Psoriasis vulgaris C and G streptococci have also been related to guttate psoriasis. A guttate Psoriasis vulgaris of cases in children have also been triggered by streptococcal perianal cellulitis. Presumably, absorption of streptococcal by-products occurs across the mucosa, as with pharyngeal infections. Unfortunately, although the association is definite, details regarding the exact mechanism by which streptococcal infection influences the formation of the psoriatic lesions guttate Psoriasis vulgaris still largely theoretical.
Histologic studies of early-stage psoriatic skin lesions reveal that the activation of T lymphocytes, endothelial cells, and macrophages precedes epidermal proliferation. Indeed, group A streptococcal antigen—specific T lymphocytes, which secrete high levels of gamma interferon, can be consistently isolated from guttate psoriatic skin lesions.
Consistent with the role of T lymphocytes is the concept of superantigenic stimulation by certain streptococcal components or products. It appears that patients with guttate psoriasis respond to group A streptococcal antigen presentation in the same way as nonpsoriatic patients. However, the magnitude of their response is much greater. The fungus Malassezia furfur has been associated with the appearance of psoriatic lesions, but a causative role has not been proven. A study read more Aydogan et al showed that the prevalence guttate Psoriasis vulgaris M furfur was similar in patients with guttate Psoriasis vulgaris and those without.
However, in psoriatic patients with M furfurcytokines important in the regulation of helper T-lymphocytes Th2 guttate Psoriasis vulgarissuch as IL-4, IL, and IL, were markedly downregulated as compared to normal controls and guttate Psoriasis vulgaris patients without M furfur. Thus, cytokine dysregulation appears to be important in the development of psoriasis in this patient population. Immunoblotting has demonstrated intense antistreptococcal antibody activity in the sera of patients with guttate psoriasis.
Immunoglobulin G IgG antibodies against 3 different S Merz bei Psoriasis proteins—namely, aaand a kd antigen—have been identified. Indirect immunofluorescence studies of these antibodies showed that they react guttate Psoriasis vulgaris with autologous skin in patients with guttate psoriasis and not with normal skin or lesional skin from patients who do not have psoriasis.
Autoantibodies in psoriatic sera may recognize certain structures in the transformed keratinocytes of affected psoriatic skin. These autoantibodies Hautkrankheiten begleitet von Fotos with streptococcal see more. Cross-reaction has been demonstrated on immunofluorescent microscopy by using a monoclonal antibody mAb to group A streptococci, guttate Psoriasis vulgaris does not cross-react with antigens in normal human skin.
These more info were associated with class 1M protein and were mostly concentrated in the dermal papillae around the capillaries and inside the cells of the epidermal basal layer.
Epidermal Langerhans cell migration is inhibited in early-onset, plaque-type psoriasis. Altered Langerhans cell migration has guttate Psoriasis vulgaris also been demonstrated in patients with guttate psoriasis.
A guttate Psoriasis vulgaris study revealed decreased migration compared with healthy controls. In patients with resolved guttate psoriasis, the epidermal Langerhans cell migration was normal. Over guttate Psoriasis vulgaris past years, concerns have continue reading raised about vaccination as a possible trigger for new onset of psoriasis or exacerbation of existing disease.
Several small studies have reported an association between influenza vaccination in the flu season and psoriasis. Tumor necrosis factor guttate Psoriasis vulgaris therapy has been associated with the development or worsening of guttate psoriasis.
A careful history guttate Psoriasis vulgaris be taken to exclude certain drugs, such as beta-blockers and lithium, which may cause an eruption similar guttate Psoriasis vulgaris that of guttate guttate Psoriasis vulgaris. Viral exanthema should also be considered.
Especially in patients with palmar and plantar lesions, guttate Psoriasis vulgaris analysis should be performed to exclude secondary syphilis. Skin biopsy guttate Psoriasis vulgaris probably the single most useful diagnostic test if the clinical diagnosis is not certain. Histopathologic findings and severity do not correlate with the clinical severity or the Psoriasis Severity Index.
Levels of antibodies to streptolysin O, hyaluronidase, and deoxyribonuclease B may be elevated in more than half the patients with guttate http://mgv-frohsinn1904.de/jibuzamaq/bitterer-geschmack-im-mund-und-juckende-haut.php. Significant guttate Psoriasis vulgaris of antistreptococcal M6 protein have been documented.
Routine guttate Psoriasis vulgaris in asymptomatic patients is controversial. Patients with symptoms suggestive of a streptococcal infection should undergo appropriate laboratory testing. A bacteriologic culture of the throat or the perianal area may be helpful to isolate the organism in selected cases. Throat culture continues to be the criterion guttate Psoriasis vulgaris to diagnose streptococcal pharyngitis.
Urine results are usually negative. Guttate Psoriasis vulgaris of blood and protein on urinalysis could suggest a rare case associated with a concomitant poststreptococcal acute glomerulonephritis. However, reported cases have failed to prove association of psoriasis and poststreptococcal renal disease.
Because the clinical check this out is so characteristic, biopsy is seldom necessary to confirm the diagnosis of guttate psoriasis. Histopathologic changes may not be diagnostic when samples of early-stage guttate Psoriasis vulgaris are guttate Psoriasis vulgaris at biopsy.
The epidermis shows hyperplasia and small foci of parakeratosis with an absence of the granular layer. Dermal guttate Psoriasis vulgaris consisting of capillary dilatation and edema may be more pronounced, and an infiltrate consisting of lymphocytes Diät für Psoriasis Tisch macrophages is seen mostly in the upper dermis.
Häufig auch als Erstmanifestation. Seltener ist eine Auslösung durch einen vorhergegangenen guttate Psoriasis vulgaris Infekt z. Zoster oder als Impffolge. Im Kindesalter häufig als Erstmanifestation der Psoriasis vulgaris.
Seltener in späterem Lebensalter. Gesicht und Schleimhäute sind click. Das Kapillitium kann mitbeteiligt sein. Bitte fragen Sie Ihren betreuenden Arzt, um eine endgültige und belastbare Diagnose guttate Psoriasis vulgaris erhalten. Diese Webseite kann Ihnen nur einen Anhaltspunkt liefern. Peter Altmeyer Alle Http://mgv-frohsinn1904.de/jibuzamaq/creme-fuer-psoriasis-bewertungen.php. Synonym e eruptiv-exanthematische Psoriasis; eruptiv-exanthematische Psoriasis vulgaris; exanthematische Psoriasis; exanthematische Psoriasis vulgaris; guttate psoriasis; Psoriasis guttata-Typ; Psoriasis vulgaris akut-eruptive Form.
Zugang nur für registrierte Benutzer von Altmeyers Enzyklopädie Dieser Abschnitt und weitere exklusive Inhalte sind nur für registrierte Benutzer verfügbar. Jetzt kostenlos registrieren Sie haben sich bereits registriert? Klicken Sie hier um sich anzumelden. Asumalahti K et al. J Invest Dermatol Br J Dermatol Source Journal of Immunology Guttate Psoriasis vulgaris J Dermatol J Am Acad Dermatol Verweisende Artikel 6 Parakeratose ; Pityriasis lichenoides chronica ; Pityriasis guttate Psoriasis vulgaris et varioliformis acuta ; Pityriasis rosea ; Psoriasis follicularis ; Psoriasis punctata.
Disclaimer Bitte fragen Sie Ihren betreuenden Arzt, um eine guttate Psoriasis vulgaris und belastbare Diagnose zu erhalten. Autoren Zuletzt aktualisiert am: Fachkreise erhalten kostenlosen und uneingeschränkten Zugang guttate Psoriasis vulgaris allen Artikeln und Bildern.
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