PHYSIOTHERAPY IN

DERMATOLOGY
PRAISY ROY
MPT FINAL YEAR
PSORIASIS:

 Chronic inflammatory skin disease.

 Causes raised, red, scaly patches on skin.
 World prevalence – 2%
 Men and women develop at equal rates.
TYPES:
PSORIASIS VULGARIS:
 Most prevalent type – 90%
 Sharply demarcated
 Erythematous
 Silvery scales

INVERSE PSORIASIS:
 Also called flexural psoriasis
 Affects the folds of the skin
 Erosive, erythematous plaques and patches
GUTTATE PSORIASIS:
 Small erythematous plaques
 Acute onset
 Affects children or adolescents
 Triggered by group – A streptococcal infections

PUSTULAR PSORIASIS:
 Multiple coalescing pustules
 Affect hands and feet
 2 distinct types – 1) psoriasis pustulosa palmoplantaris (PPP)
2) acrodermatitis continua of Hallopeau
Erythrodermic psoriasis:
 90% of the body is erythematous and inflamed
 Can develop on any kind of psoriasis type
 Medical emergency
MANAGEMENT:
 Chronic relapsing disease; long term therapy
 Categorized into mild, moderate and severe.
 Mild: topical treatments, OTC and prescription creams and
shampoos.
 Moderate to severe: combination of treatment strategies
1. Topical treatments – glucocorticoids and vit D analogues
2. Phototherapy
3. Systemic medications – inhibitors and immunomodulators
4. Biologic drugs – target specific inflammatory pathways;
administered SC or IV.
PHOTOTHERAPY:
 Moderate to severe psoriasis.
 Used either on its own or in combination with topical
medicines

Therapeutic regimens:
1. The Goeckerman regimen –
 Coal tar applications
 Total body UVB radiations
 Once a day as suberythemal or E1 dose
2. The Ingram or Leeds regimen –
 Coal tar bath before irradiation with MED of UVB
 Psoriatic lesions covered with dithranol
 Wavelength of 311nm – most beneficial

3. PUVA Therapy –
 Psoralen plus ultraviolet A
 Involves exposure of the skin to UVA light with usage of
psoralen

4. Balneophototherapy –
 Warm water bath containing sea salt or common salt
 Exposure to UV light while bathing or immediately afterwards
5. Narrow band UVB phototherapy-
 Skin is only exposed to UVB light wavelengths between 311
and 313 nanometers
 Reduced risk of side effects

Long term use leads to skin damage and increased risk of skin
cancer.
ACNE VULGARIS:
 Inflammatory disorder of the pilosebaceous unit
 Affects face, chest, upper arms and back mostly
 Hypersensitivity of the sebaceous glands to a normal
circulating level of androgens
 Urban populations more affected
 Manifestations –
Grade 1: Comedones
Grade 2: Inflammatory lesions present as a small papule with
erythema.
Grade 3: Pustules.
Grade 4: Many pustules coalesce to form nodules and cysts.
Management:
 Aim of the treatment – 1) control and treat existing acne lesions,
2) prevent permanent scarring
3) limit the duration of the disorder
4) minimize morbidity
 Treatment strategies –
1. Topical treatment – 1) topical retinoids (mild)
2) topical anti-inflammatory agents
3) topical antibiotics
2. Hormonal therapy – OCPs
3. Complementary and Alternative Medicines (CAMs)
4. Laser therapy, light sources and photodynamic therapy
HYPERHIDROSIS:

 Excessive sweating
 Palmoplantar, axillae, facial, or cervical region
References
 Does light therapy (phototherapy) help reduce psoriasis symptoms?
[Internet]. Ncbi.nlm.nih.gov. 2020 [cited 20 January 2020]. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK435696/
 Rendon A, Schäkel K. Psoriasis Pathogenesis and Treatment. International
Journal of Molecular Sciences. 2019;20(6):1475.
 About Psoriasis | National Psoriasis Foundation [Internet]. Psoriasis.org. 2020
[cited 20 January 2020]. Available from: https://www.psoriasis.org/about-
psoriasis
 Sutaria A, Masood S, Schlessinger J. Acne Vulgaris [Internet].
Ncbi.nlm.nih.gov. 2019 [cited 20 January 2020]. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK459173/
 Fox L, Csongradi C, Aucamp M, du Plessis J, Gerber M. Treatment Modalities
for Acne. Molecules. 2016;21(8):1063.