Psoriasis, Deep folliculitis, Carbuncles


Psoriasis is chronic, inflammatory hyper proliferative skin disease. Skin consists of different layers including epidermis, dermis and hypodermis, and these layers are further subcategorized. Epidermis consists of five sublayers (stratum basale, stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum) New cell formation owes to stratum basale. As new cells form, old cells die off, and come to the upper surface of skin. These dead cells on the upper skin are enriched with keratin, and protects our skin from ultraviolet radiation and dehydration. As the new cells form and come to the upper surface, old dead cells shed off and are replaced by new cells. 


In psoriasis, there is increased proliferation of cells in the lower surface. New cells replace the old cells even before keratin formation. These newly formed cells lack keratin so they are unable to provide protection to the skin. Water evaporates from the skin and an itching sensation is felt. Due to this itching sensation and dryness a scaly layer is formed there. 

Mechanism of Psoriasis:

Due to rapid proliferation old cells before cell death (keratin formation) comes to the upper surface. These cells are less protective and cause itching.

Causes of Psoriasis:

  • Psoriasis is a genetic disease.
  • Infection may cause psoriasis
  • Exposure to sunlight
  • Drugs or medications
  • Skin trauma
  • Excessive rubbing

Skin examination:

Skin biopsy is performed. A piece of skin is tested under a microscope. If the nucleus is seen in the cells present on the upper layer then it confirms that a layer of alive cells is present on the skin. Usually a layer of dead cells enriched with keratin is present on the epidermis of skin. 

Management of Psoriasis:

It is a genetic, chronic, hyper proliferative disease which can’t be eradicated. Steroids should be avoided, steroids temporarily subside psoriasis, and have long term side effects.Rather than systemic treatment skin lubricants and emollients are preffered to moisturize the skin patch. If these psoriatic patches are severe and affect one’s look then retinoids are prescribed.Retinoids are immunosuppressants and prevent skin proliferation. Immunosuppressants or immunomodulators slow down the cells growth and in this way psoriatic patch subsides.Topical creams containing steroids in a minor ratio can be used. Moreover, UVA and UVB rays can be used. Exposure to UVA and UVB causes cell death. Immunosuppressants intake is the most potent therapy for psoriasis.

Treatment of Psoriasis:

  • Skin emollients
  • Retinoids
  • Topical steroids
  • Immunosuppressants
  • immunomodulators
  • UVA and UVB exposure

Deep folliculitis

Deep folliculitis also known as furuncle or boil is an infection of the hair follicle. Single hair follicle is involved. Hair follicle lies deep in the skin .Whenever hair is plucked from skin bacteria finds way to the follicle and after reaching the follicle it causes infection. In case if only redness is seen it is known as superficial folliculitis, it subsides on its own. If pus formation occurs in that area it is called deep folliculitis.


  • Antibiotics
  • Analgesics


If multiple hair follicles are involved. Infection rises from each adjacent hair follicle along with pus formation. Pus drains from multiple openings of adjacent hair follicles. Carbuncle formation occurs in people with weak immunity. Diabetic and HIV patients are more prone to carbuncle formation due to weak immunity. 



Excise the area involved in carbuncle along with hair follicle. Once epidermis is removed a new layer of skin forms there and antibiotics are prescribed to prevent infection.

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