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THE HISTORY OF PSORIASIS

Prof. Dr. Alfredo Buzzi

Emeritus Professor and Dean at the School of Medicine, University of Buenos Aires

Psoriasis is a dermatological condition that affects about 1 to 2% of the population.It is considered a chronic proliferative skin disease which is genetically determined and ofunpredictable course. Lesions are manifested as papules and as erythematous plaquescovered by thick scales which are easily removed. The lesions are usually symmetricallydistributed on the joints such as elbows and knees. The following clinical forms can be observed1) gutarda psoriasis in which many small papular injuries suddenly develop one to three weeksafter a streptococcal pharyngitis; 2) inverse psoriasis in which plates are developed inintertriginous areas; 3) pustular psoriasis, manifested by surface pustules; 4) erythrodermia inwhich the condition affects all over the skin; 5) psoriastic arthritis where arthritis might bepresent in 10 to 15 % of psoriasis cases.

The first historical notion of psoriasis is included in the Holy Bible, In the Old Testament, theDeuteronomious, makes reference to the leprous diseases which might have probably includedthis condition.

Dermatology has been to greater extent a set of symptomatic conditions much more than agroup of specific diseases at least up to The Modern Age in medicine. In fact it was almostimpossible in most cases until dissemination of clinical microscopy and histochemistry to draw aclear distinction between symptomatic skin disorders in which skin lesions are only a secondarymanifestation disease or certain organic pathology and specific dermatological conditions whichoriginate in the skin and are confined to it.

The word psoriasis derives from a greek term psora= itching. Hippocrates of Cos ( 468-377

BC) refers to psoriasis al though its nature had not yet been separated from other skinconditions including even leprosy. This misunderstanding spread throughtout several centuriesand as a result of thus patients were abandoned and isolated from the community.

The greek physician Galen of Pergamon ( 130-200 BC) uses the term Psoriasis vulgaris torefer to all dermo and epidermopathies accompanied by pruritus.It was just in 18 th (eighteen century ) when the English dermatologist Robert William ( 1757-1812) included psoriasis in the erythematous squamous conditions. In 1841 thanks to the workof Ferdinand to Von Hebra (1816-1880) and Moritz Kaposi ( 1837- 1902) from the school ofVienna was psoriasis definitely set apart from leprosy and their clinical and anatomopathologicalcharacteristics were separately described.

In the XIX century the interrelation of psoriasis and arthritis was described for the first time byJ ean Louis Alibert (1768-1837) in the 1818 Pierre Bazin ( 1807- 1878) described psoriasisarthritique in 1860. In 1937 Seghers and Robinson considered psoriatic arthritis as a clinicalentity.

Nevertheless the etiology and mechanisim of arthritis remained unknown during the lastcenturies.

Revista Latinoamericana de Psoriasis y Artritis Psorisica 2011, 4: 1-3

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The History of Psoriasis 2

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The fast growth of skin cells was known. Some authors theorized on emipirical grounds aboutthe genetical component of the disease.

As far as it is known the evolution of the treatment for psoriasis reveals that it began with topicalapplications of the kind of salicylic acid. Since 1950 local applications and systemic use ofcorticosteroids was implemented. UVA light and antimetabolite methotrexate were introduced

between 1970 and 1980. Vitamin D3 in topical applications, retinoids and cyclosporin becamepopular in the 1990s. The latest advances have been the use of biological therapies and lasertreatment.

The pathogenesis of the disease had a turning point in the mid 1980s where it was focalized inthe study of an alteration in the inmune system. Altered cells atack healthy skin cellsmisidentifying them as strange-the affected skin the skin aims at repairing itself generatingnew cells, but it does seven times more quickly than healthy skin. In free of psoriasis individualsskin cells mature and are deleted every 28 days or so. In the psoriatic skin cells are rapidly moveto the skin surface in a period of 3 to 6 days. The body cannot eliminate epidermical cells fastenough and this process results in the formation of surface skin lesions. The elimination cycle of28 to 30 days of normal skin speeds up to 3 days and necrotic skin plaques start to show.

HISTORY OF SOME CLINICAL AND HISTORICAL SIGNS OF PSORIASIS

Koebner PhenomenomHerry Koebner ( 1834- 1904) was a German dermatologist and a disciple to Ferdinand VonHebrad ( 1816- 1880). He introduced the concept that the skin of psoriatic patients was prone todevelop lesions after several years of local traumas, including animal bites or tattoos.

Brocq methodic scalingLouis Brock ( 1856- 1929) was a leading French dermatologist who worked at Sain LouisHospital in Paris. He introduced the plate methodic scaling with the curettage technique

discovering in that way the sign of haemorragic partner .

Munro microabscessesWilliam J on Munro ( 1829- 1908) an Australian physician who studied in London Vienna andParis described microabscesses in psoriatic epidermis associated to this name.

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REFERENCES

1.- Willam, R: On cutaneous diseases. Volumen I. Londres, 1808.

2.- Hebra, F.: Atlas der Hautkrankheiten. Vienna, 1856-1876.

3.- Kaposi, M.: Pathologie und Therapie del Hautkrankheiten. Vienna, 1880.

4.- Cecil, R.: Tratado de Medicina Interna. Por J .C. Bennett y F. Plum. Mc Graw-Hill. Vol II,1997.

5.- Mettler, C.C.: History of Medicine. Pgs. 662-683. Blokiston Co, 1947.

6.- Sierra X editor: Historia de la Dermatologa. Barcelona, 1994. Pgs. 251-257.

7.- Buzzi, A.; Doisenbant, A.R.: Evolucin Histrica de la Medicina. Panamericana, BuenosAires, 2008.