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For thousand of years, many properties of the fungi have been used for the benefits of man. The fungi are biologically simple organisms that adapt to environmental conditions and can reduce many living beings. However, despite their beneficial properties, there is a variety of fungi capable of causing pathological process in the body.

 Psoriasis is a chronic dermatosis characterized by well defined , erythematous , scaly plaque with silvery scales and an unpredictable course .
ETIOLOGY & PATHOGENESIS
The cause of this chronic dermatosis still remains an enigma . Theories about the pathogenesis run parallel to the fashionable concepts in cell biology – the current vogue being cytokines and adhesion molecules . Some biochemical abnormalities have been detected – these could either be the cause or may be the effect of the disease . There is often a genetic predisposition and the disease may sometimes be precipitated by an obvious trigger .
Genetics
Studies of family trees have suggested that psoriasis is inherited as an autosomal dominant trait with an incomplete penetrance ; but there is also evidence to suggest that it may have a polygenic inheritance . Psoriasis by itself is genetically heterogeneous .
A child with one affected parent has a 15 % chance of eventually developing the disease , but if both parents are affected this risk rise of 3 – fold . If non – psoriatic parents have a child with psoriasis , the risk of subsequent children developing psoriasis is 10 % . The disorder is concordant in 70 % of monozygotic twins but only in 20 % of dizygotic twins .
Genetic predisposition is further supported by studies on linkage to HLA . Early onset psoriasis shows an obvious hereditary element with linkage to HLA _ CW6 ( 20 times risk of developing   psoriasis ) . The association are much less with adult onset psoriasis .
TRIGGERS FACTORS or CAUSES
TRAUMA : In active psoriasis , lesion of psoriasis appear in skin damaged by scratches , surgery , injury etc . ( Koebners’s or isomorphic phenomenon ; iso means similar , morph means form ) .
INFECTION : Haemolytic streptococcal infection is known to precipitate attack of guttate proriasis . HIV infection often worsens psoriasis or triggers episodes of explosive psoriasis .
DRUGS : Anti – malarial , lithium ,  & beta blockers worsen psoriasis . Patient on corticosteroid therapy ( both systemic & topical ) may experience a “ rebound “ (exacerbation ) when the steroid are withdrawn . non steroid anti inflammatory drugs which are often used in patients with psoriasis because of concomitant may also aggravate the skin lesions .
OTHERS :Sunlight helps about 90 % of patient tseen by the frequent improvement of psoriasis during pregnancy with post – partum relapses . Cigarette smoking & alcohol may have an independent effect in precipitating psoriasis . Emotion upsets seem to cause some exacerbation too .
Epidermal cell Changes
Two changes are notable in psoriasis :
Increased epidermal proliferation : This is due to an excessive number of germinative cells entering the cell cycle as well as due to a decrease in cell cycle time
Altered epidermal cell maturation : The most visible manifestation of abnormal keratinisation is the presence of nuclei in the stratum corneum .
DERMAL CHANGES
Two important changes :
The dermal capillary loops in psoriasis are abnormally dilated and tortuous.
Fibroblast in psoriatic lesion proliferate more rapidly and produce more ground substance .
BIOCHEMICAL CHANGES
Cyclic nucleotides , arachidonic acid , polyamins , proteinases ,
IMMUNOLOGICAL CHANGES
T lymphocyte play a central role .
CLINICAL FEATURES
. Occures at any age
. Female tend to develop psoriasis earlier than man
. ratio of male : female is equal
. worse in winter
. A few patients , however , complain of summer aggravation
MORPHOLOGY
Well demarcated , erythematous , scaly indurated plaque . The colour is deep PINK to RED , the quality of this colour is sometimes lost in dark – skinned individual . The psoriatic plaque are often encircle by clear halo – the ring of WORONOFF .
The lesion pathogonomonically have silveary white scales , though the amount of scaling can be variable . In some cases the scsles are healed up , the so called RUPIOID scaling . Scaling is accentuated by grafting the lesion with a glass slide – this test is useful in diagnosing uncertain lesion ( Grattage test ) . A useful bed side test to confirm the diagnosis is the AUSPITZ sign .
This is performed by gradually scraping off the silvery white scales ( STEP - A ) . After the scsle have been removed , a glossy membrane appears ( STEP – B ) . On removal of the membrane , puncate bleeding points become apparent ( STEP – C ) .
The lesions of psoriasis are well defined , initial ly being discoid . When they merge , annular & gyrate lesion may be seen . The sharp demarcation of lesions is of special diagnostic significance on the scalp , flexures , & on the uncircumscised penis where other evidence of psoriasis , like characteristic scaling , may be absent .
The size & number of lesions can be variable ; when multiple lesion may be symmetrical .
SITES OF PREDILECTION
It can occur at any part of the body .
Common & early sites of involvement are the  scalp & the pressure points ( knees , elbow ) & the lower back .
PATTERNS OF INVOLVEMENT
Plaque Psoriasis : This is the commonest type of psoriasis . The lesion variable from few millimetres to several centimeters , may be single or multiple . The site of prediction are the scalp , pressor point & lower back .
Guttate Psoriasis : This pattern of psoriasis is commonly seen in children & adolescents . The attack is often precipitated by streptoccal tonsillitis . The lesion appear as crops of tiny psoriasiform papule on the trunk . The lesion either clear or they may eventuate into plaque psoriasis .
Rupioid Psoriasis : these psoriatic plaques have massive healed – up scales – the lesions appear limpet –like & cone shaped .
MODIFICATION BY SITE
SCALP : The scaling may be massive especially on the occiput . Frequently the whole scalp is diffusely involved & there is on overflow beyond the scalp margin . sometimes the scaling is asbestose –like , being firmly adherent to scalp .This entity is called PITYRIASIS AMIANTACEA .
PENIS : In uncircumcised males , psoriatic plaques on the glans lack scales but the colour & well defined edge are characteristic .
FLEXURAL PSORIASIS : Psoriasis the groin , vulva , axillae , infra-mammary folds & gluteal cleft ( all flexure area ) is most frequently seen in elderly females . Scaling is understandably less in this moist areas , but the colour & demarcation are retained .  Sometimes the depth of fold is fissured . Flexure psoriasis needs to be differentiated from intertrigo .
PSORIASIS OF HANDS AND FEET : Psoriasis of the palms & soles appears as bilaterally symmetrical erythematous plaques . It may sometimes closely resemble eczema , but can be distinguished by a sharp edge at the wrist & absence of vesicles .
NAILS :Nail involvement is frequent ( more the half the patients ) . The most frequent manifestation is pitting : small regularly placed pits as seen on the thimble . Other changes seen are ONYCHOLYSIS ( separation of nail plate from nail bed ) , subungual hyperkeratosis ( accumulation of keratinous material under the nails ) , thickening of the nail plate & discolouration of nail plate.
COMPLICATION
1 . ERYTHRODERMIC PSORIASIS : The psoriatic plaque lose their definition and the skin becomes universally & uniformly red ; there may be marked scaling .
2. PUSTULAR PSORIASIS :  Psoriasis can be complicated by the appearance of sterile pustules . Pustulation may be trigged by the irritant effect of topical therapy or withdrawl of tropical or systemic corticosteroids . The postulation can occur in localized areas as seen in palmoplanter psoriasis or can be generalized . the latter variety , VON ZUMBUSCH’S pustular psoriasis is a rare & serious condition accompanied by constitutional symptoms .
3 . PSORIATIC ARTHROPATHY : Arthritis occurs in about 10 % of psoriasis patients .
INVESTIGATION
Histopathology :
. Parakeratosis (nuclei return in the horny layer )
. Regular acanthosis ( thicking of vible epidermis ) with thinning of epidermis over dermal papilla ( this is responsible for the Auspitz sign ) .
. Collection of polymorphs in the epidermis forming micro – abscesses .
. Dilatation & tortuosity of capillary loops in the dermal papilla ( cause of Auspitz sign ) .
. Lymphocytic infiltrate in the upper dermis .
DIAGNOSIS
Diagnosis is based on three main clinical criteria :
. Definition ( well defined ) of lesion .
. Colour ( deep red ) of lesion .
. Scaling ( silvery ) with positive grattage test & Auspitz sign .
. In case of doubt , a biopsy is helpful .
POINTS OF FOCUS : clinical feature of psoriasis
. OCCUR AT ANY AGE
. ERYYHEMATOUS  , WELL DEFINED PLAQUE WITH CHARISTICALLY SILVERY SCALES ,ACCENTUATED BY GRATING THE LESION ; Auspitz sign positive .
. SCALP & PRESSURE POINTS  frequently involved .
. PATTERN SEEN : plaque , guttate ,  rupioid lesion ; lesion may be modified by site .
. ASSOCIATIONS : Nail changes , arthritis .
. COMPLICATION :Erythroderma , pustular psoriasis.
COMPLICATION
PSORIASIS SHOULD BE DIFFERENTED FROM :
. Discoid eczema : lesion of discoid eczema are not as well defined as psoriasis . Lesion are exudative & are crusted ( of psoriasis where the lesion shows scaling ) & are very itchy ( psoriasis may or may not be itchy ) .
. Seborrhoeic eczema : Scalp involvement in seborrhoeic eczema is more diffuse , less lumpy & lesions do not spill over onto the forehead . Flexural lesions of seborrhoeic dermatitis are less well defined , when compared to psoriasis & are more exudative .
. Pityriasis rosea : The lesions of pityriasis rosea are oval & tend to run along the rib lines . Scaling is present at periphery of the lesion ( collarette ) & a large patch heralds the eruption ( herald patch ) .
. Secondary syphilis : The secondary eruption of syphilis is usually precided by history of primary chancre on the genitalia . The full picture is completed by the presence of mucosal lesions , lymphadenopathy , coppery scaly lesions on the palms & soles & condyloma lata at mucocutaneous junctions .
TREATMENT
The treatment of psoriasis should be individualized depending on the age & sex of the patient & the type , extent , duration of psoriasis .
GENERAL MEASURES
Reassurance & emotion support are invaluable . physical & mental rest may enhance the effect of the specific management of acute episodes . At present there is no permanent cure for psoriasis – all treatment are suppressive , only including remission . They do not prevent relapse , which are generally the rule . It is important to stress to the patient that the disease is not contagious & is benign . It is equally important to inform the patient about the natural course of the disease .
TYPE OF PSORIASIS                                    TREATMENT OF CHOICE                                       ALTERNATIVE TREATEMENT 
1.Localised            short – contact         topical steroid
Stable plaque        dithranol TAR
2 . Extensive         UVB , PUVA              methotrexate ,
Stable plaque                                           cyclosporine ,
                                                                   Etretinate
3 . Widespread      UVB , PUVA             tar
Small plaque
4 . Guttate             antibiotic and           weak tar
                               Emollients while           preparation
                               Erupting ; PUVA            mild local
                                                                        Steroids .
5 . Facial               mild topical
                                   Steroids
6 . Flexur              mild to moderately        
                                 Potent steroids +
                               Anti fungal
7 . Pustular            topical moderately        methotre-
Psoriasis of            potent or potent                   xate
Hands & feet            steroids                       ( small                                                                 
                                                                          Doses )
8 . Acute eryth-       methotrexate +       acitretin ( if
-rodermic , unstable        topical                available )
Or generalized           bland application  cyclosporinA
Pustular
PUVA
. Variation of PUVA : Some innovations of PUVA therapy are :
*PUVA solution : This make use of solar energy as source of UVA .
* Topical PUVA /PUVA solution : Graded UV exposer , 1 hour after application of topical psoralen .
* Bath PUVA : Another way to deliver the psoralen is by adding it to bath water .
Advantage :
. Reduce cost
. Major  advantage of topical
 PUVA & bath PUVA are :
*Lack of systemic effect ( especially nausea )
* Lower UVA dose
* No eye protection needed
Indication
         *Palmoplanar psoriasis
         * Extensive plaque psoriasis
         * Psoriatic erythroderma

p align=”justify”1.Use Cream moisturizers without fragrance.br /2.Clean your skin daily, but not overdo it, because it will cause to shed skin’s natural moisturizers.br /3.Limit the use of hot water and soap. If you have “winter itch,” take short lukewarm showersbr /4.Protect yourself from the wind.br /5.Avoid Extreme cold : Cold temperatures can cause skin disorders or frostbite. Visit doctor immediately if you develop colour changes in your hands or feet followed by pain or ulceration.br /br /Lastly visit a dermatologist, if you face any disease of skin./p