psoriasi sg onz
TRANSCRIPT
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GONZALO BARRANCO JIMENEZ1 16/10/2013
Psoriasis
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GONZALO BARRANCO JIMENEZ2
DEFINICION:
La psoriasis es una dermatosis inflamatoria eritematodescamativa crónica caracterizada por un trastorno en la proliferación y diferenciación epidérmica.
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EPIDEMIOLOGÍA
Enfermedad cutánea inflamatoria crónica
Muy frecuente (1-3% población)
Incidencia bimodal
Causa desconocida (?)
Antecedentes familiares (1/3)
Curso crónico enfermedad incurable aunque Controlable
Gran variabilidad clínica y evolutiva
Gran impacto en la calidad de vida
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GONZALO BARRANCO JIMENEZ4
ETIOLOGÍA
Factores hereditarios, inmunológicos y ambientales
Factores genéticos(predisposición pero se discute el mecanismo)
Factores desencadenantes
Traumatismos
Infecciones
Fármacos
Psicológicos
Climáticos
Endocrino y metabólicos
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DIAGNÓSTICO
Historia clínica
Exploración física
Anatomía patológica solo en casos dudosos
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MANIFESTACIONES CLÍNICAS
No es contagiosa
Afecta a piel y mucosas
Lesiones cutáneas
Pápula o placa eritematodescamativa
Lesiones mucosas infrecuentes
Lesiones ungueales 20-40 % casos
Más frecuentes en manos que en pies
Artritis psoriásica
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GONZALO BARRANCO JIMENEZ7
PATRONES DE PRESENTACIÓN
Psoriasis en placas
Psoriasis en gotas
Psoriasis eritrodérmica
Psoriasis pustulosa
Psoriasis palmo-plantar
Psoriasis acral
Psoriasis invertida
Psoriasis de cuero cabelludo
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PSORIASIS EN PLACAS
Forma más frecuente
Placas 1-30 cm: cualquier zona de la piel (rodillas,
codos, región lumbosacra y cuero cabelludo)
Duración hasta meses o años
Brotes sucesivos: extensión a tórax y extremidades
Confluencia de lesiones
Grandes placas con bordes
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PSORIASIS EN GOTAS
Pequeños puntos <1 cm localizadas preferentemente en tronco
Prurito ocasional
Niños y jóvenes
Aparición brusca tras padecer infección estreptocócica de
vías respiratorias superiores
Duración 2-3 meses - Desaparición espontánea (salvo en
casos de brotes recurrentes)
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PSORIASIS ERITRODÉRMICA
Lesiones generalizadas (>90% superficie)
Como complicación de una forma crónica secundaria a una quemadura solar, exceso UVA, infección sistemica,bacteriana o vírica
Afectación sistémica (fiebre, leucocitosis ,aumento de los G.blancos, desequilibrio electrolítico, déficit proteico)
Lesiones generalizadas (>90% superficie): eritema intenso, exfoliación masiva y alteraciones de la termorregulación y del equ hidroelectrolítico y cardiovascular.
También se puede incluir la forma pustulosa generalizada
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PSORIASIS PUSTULOSA
Aguda e infrecuente
Junto con otros tipos de psoriasis tras factores desencadenantes, suspensión corticoterapia sistémica
Placas eritematosas
Pequeñas pústulas estériles
Curso ondulante (forma de psoriasis previa / eritrodérmica)
Afectación estado general - Alteración pruebas complementarias
Sin tratamiento correcto
Puede ser mortal
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PSORIASIS PALMOPLANTAR
Brotes de pústulas estériles sobre base eritematosa, simétricamente en palmas, plantas y talones
Pústulas grandes
Escamas y costras marrones
Callosidades amarillentas fisuras muy dolorosas e invalidantes
Ocasionalmente dolor torácico medio por osificación del cartílago entre clavícula-1ª costilla-esternón
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PSORIASIS ACRAL
Extraña e infrecuente
Erupción pustulosa en torno a las uñas (sobre todo manos)
Extensión proximal
Destrucción y pérdida de uñas
En casos muy evolucionados
Osteolisis falange distal
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PSORIASIS INVERTIDA
Afectación grandes pliegues cutáneos (axilares,
genitocrurales, interglúteos, submamarios) y ombligo
Placas eritematosas intensas, uniformes, lisas,
brillantes, de bordes definidos sin escamas
Ocasionalmente fisura dolorosa en el fondo del
pliegue con riesgo de sobreinfección
Frecuente coexistencia con psoriasis vulgar
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PSORIASIS EN CUERO CABELLUDO
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GONZALO BARRANCO JIMENEZ29
ARTROPATÍA PSORIÁSICA
Diferentes patrones:
Oligoartritis asimétrica
Poliartritis simétrica parecida a artritis reumatoide
Artritis mutilante
Características generales
Rigidez matutina
Afectación ungueal
Dolor articular
Dactilitis (dedos en salchicha)
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GONZALO BARRANCO JIMENEZ32
TRATAMIENTO
TOPICO Y SISTEMICO.
El tratamiento tópico indicado en la mayoría de los casos, debe ser lo bastante potente para producir un efecto rapido,para acortar duración de tto y conseguir refuerzo positivo(que aumenta el cumplimiento).
El tto sistémico se emplearan las formas mas extensas ,graves y rebeldes
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PsoriasisLeve
PsoriasisGrave
PsoriasisModerada
• Hidratación cutánea.• Corticoides Tópicos: (uso restringido en cara y
pliegues >50g/sem, no >4 sem)• Queratoliticos(Salicilico,urea)• Alquitranes• Ditranol.(nunca en cara, pliegues, formas
pustulosas o eritrodérmica)• Análogos de la Vit D.(aumenta la eficacia UV y
minimiza efectos 2º corticoides)Calcipotriol• Retinoides tópicos(Tazatoreno)
• Fototerapia (+/- retinoides sistémicos en psoriasis crónica en placas) UVB-BE en P.Gota.
• Ciclosporina: (eritrodermia, P. inestable/resistente a Tx convencional). Vigilar TA y FG.
• Acitretino: (P. pustulosas y palmoplantar). Vigilar FH, PL, ACO 2 años tras inicio Tx.
• Metotrexato: (eritrodermia, P placa estable, Apso). Vigilar Hgma, FH, ACO 3 meses tras Tx.
• Otros tratamientos sistémicos.
TERAPIA BIOLOGICA
(solo si contraindica o no responde o
aparece efectos 2º con los anteriores)16/10/2013
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Tratamiento de la psoriasis.
No llega nunca a ser “curada” , sino sólo
“controlada”
No se deben administrar corticoides sistémicos por que
pueden provocar Psoriasis Pustulosa
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Tratamiento de la psoriasis.1.- t. biológico.
Proteínas que imitan a proteínas naturales.
Obtenidas mediante recombinación de ADN
¿Cómo actúa?
Bloquea selectivamente, mecanismos moleculares específicos implicados en patogenia de la psoriasis.
¿En que casos está indicado?
Psoriasis en placa Moderada/severa que no responde a tratamiento clásico o con efectos secundarios.
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Ustekinumabstelara
Nombre genérico: Ustekinumab.
Nombre comercial: Stelara.
Laboratorio: Janssen-Cilag International NV Grupo terapéutico. Denominación: Inhibidores de la interleucina. Código ATC: L04AC.
Vía de administración: Subcutánea.
Tipo de dispensación: Diagnóstico Hospitalario. En cada comunidad autonómica se decidirá el tipo de dispensación.
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