Psoriasis is a systemic inflammatory disease driven by T-lymphocytes, arising from a complex interaction between numerous genetic factors and environmental influences. A genetic predisposition, combined with triggering factors, initiates an abnormal immune response that leads to the development of initial psoriatic skin lesions. Additionally, it is an immune-mediated disease in which the skin inflammatory changes are dependent on immune cells and their cytokines, the interaction of dermal dendritic cells with activated TH-1 and TH-17 T cells, along with various cytokines and growth factors, leads to the epidermal hyperplasia and dermal inflammation observed in psoriasis patients. There are several types of psoriasis such as plaque (psoriasis vulgaris), flexural and/or intertriginous (inverse psoriasis), seborrheic, scalp, acrodermatitis of hallopeau, palm and/or soles, generalized pustular psoriasis, guttate, and erythrodermic. Plaque psoriasis is the most prevalent form, about 8 in 10 people with psoriasis have this kind.
The diagnosis of psoriasis is based on the characteristic psoriatic lesions and not on laboratory tests. Psoriasis is traditionally classified into mild, moderate, or severe disease. Assessment typically includes measures of symptoms and involvement such as body surface area (BSA), Psoriasis Area and Severity Index (PASI), or Physician’s Global Assessment (static PGA). Additionally quality-of-life measures, such as the Dermatology Life Quality Index (DLQI) or Short Form (SF-36) Health Survey. To roughly estimate the extent of body surface area (BSA) involvement in psoriasis, consider the following approximations: the size of your palm is about 1% BSA, involvement on the head and neck is around 10% BSA, both upper limbs account for roughly 20% BSA, the trunk (front and back combined) is about 30% BSA, and both lower limbs constitute approximately 40% BSA.
Treatment Overview:
The treatment approach for psoriasis involves addressing its underlying pathophysiology. Key strategies include utilizing agents that modulate the abnormal immune response, such as topical corticosteroids and biologic agents. Furthermore, therapies targeting cell turnover, like retinoids, are effective in managing psoriasis. Moreover, the treatment of psoriasis depends on the type, location, and extent of disease. All patients should be educated to avoid excess drying or irritation of their skin and to maintain adequate cutaneous hydration. A topical vitamin D analogue such as calcipotriene and a retinoid (tazarotene) are also effective in the treatment of mild psoriasis and have mainly replaced other topical agents such as coal tar, salicylic acid, and anthralin.
Ultraviolet (UV) light, whether from natural sources or artificial sources, presents an effective therapeutic option for several psoriasis patients with widespread symptoms. Clinical practice commonly utilizes Ultraviolet B (UVB), narrowband UVB, and Ultraviolet A (UVA) light alongside oral or topical psoralens (PUVA). The therapeutic efficacy of UV light in psoriasis is due to its immunosuppressive properties, however, it is significant to recognize that UV light is also mutagenic and may increase the risk of both nonmelanoma and melanoma skin cancers.
Methotrexate demonstrates effectiveness, particularly in those individuals with Psoriatic Arthritis. Acitretin, a synthetic retinoid can be used in those cases where immunosuppression needs to be avoided. Apremilast functions by inhibiting phosphodiesterase type 4 and is approved for treating both psoriasis and PsA. However, caution is advised when administering it in individuals with renal failure or depression.
Psoriasis presents as a chronic condition with no known cure. It's crucial to recognize the potential for significant comorbidities to accompany this condition. Tailoring treatment approaches to individual patients is key, accounting for factors such as disease severity, patient risk profiles, age, and concurrent health conditions. Goals of treatment for the patient should include control of psoriasis (skin normalization and increase pliability of skin), decrease or clearing of erythema, papules, plaques, and scales, and improving quality of life. The expanding array of treatment options, including the introduction of several biologic therapies, enhances the tools available for managing psoriasis. Looking ahead, the ongoing research and advancements in therapeutic approaches hold promise for enhancing the well-being of those navigating this dermatological condition.
Psoriasis
Psoriasis is a systemic inflammatory disease driven by T-lymphocytes, arising from a complex interaction between numerous genetic factors and environmental influences. A genetic predisposition, combined with triggering factors, initiates an abnormal immune response that leads to the development of initial psoriatic skin lesions. Additionally, it is an immune-mediated disease in which the skin inflammatory changes are dependent on immune cells and their cytokines, the interaction of dermal dendritic cells with activated TH-1 and TH-17 T cells, along with various cytokines and growth factors, leads to the epidermal hyperplasia and dermal inflammation observed in psoriasis patients. There are several types of psoriasis such as plaque (psoriasis vulgaris), flexural and/or intertriginous (inverse psoriasis), seborrheic, scalp, acrodermatitis of hallopeau, palm and/or soles, generalized pustular psoriasis, guttate, and erythrodermic. Plaque psoriasis is the most prevalent form, about 8 in 10 people with psoriasis have this kind.
The diagnosis of psoriasis is based on the characteristic psoriatic lesions and not on laboratory tests. Psoriasis is traditionally classified into mild, moderate, or severe disease. Assessment typically includes measures of symptoms and involvement such as body surface area (BSA), Psoriasis Area and Severity Index (PASI), or Physician’s Global Assessment (static PGA). Additionally quality-of-life measures, such as the Dermatology Life Quality Index (DLQI) or Short Form (SF-36) Health Survey. To roughly estimate the extent of body surface area (BSA) involvement in psoriasis, consider the following approximations: the size of your palm is about 1% BSA, involvement on the head and neck is around 10% BSA, both upper limbs account for roughly 20% BSA, the trunk (front and back combined) is about 30% BSA, and both lower limbs constitute approximately 40% BSA.
Treatment Overview:
The treatment approach for psoriasis involves addressing its underlying pathophysiology. Key strategies include utilizing agents that modulate the abnormal immune response, such as topical corticosteroids and biologic agents. Furthermore, therapies targeting cell turnover, like retinoids, are effective in managing psoriasis. Moreover, the treatment of psoriasis depends on the type, location, and extent of disease. All patients should be educated to avoid excess drying or irritation of their skin and to maintain adequate cutaneous hydration. A topical vitamin D analogue such as calcipotriene and a retinoid (tazarotene) are also effective in the treatment of mild psoriasis and have mainly replaced other topical agents such as coal tar, salicylic acid, and anthralin.
Ultraviolet (UV) light, whether from natural sources or artificial sources, presents an effective therapeutic option for several psoriasis patients with widespread symptoms. Clinical practice commonly utilizes Ultraviolet B (UVB), narrowband UVB, and Ultraviolet A (UVA) light alongside oral or topical psoralens (PUVA). The therapeutic efficacy of UV light in psoriasis is due to its immunosuppressive properties, however, it is significant to recognize that UV light is also mutagenic and may increase the risk of both nonmelanoma and melanoma skin cancers.
Methotrexate demonstrates effectiveness, particularly in those individuals with Psoriatic Arthritis. Acitretin, a synthetic retinoid can be used in those cases where immunosuppression needs to be avoided. Apremilast functions by inhibiting phosphodiesterase type 4 and is approved for treating both psoriasis and PsA. However, caution is advised when administering it in individuals with renal failure or depression.
Psoriasis presents as a chronic condition with no known cure. It's crucial to recognize the potential for significant comorbidities to accompany this condition. Tailoring treatment approaches to individual patients is key, accounting for factors such as disease severity, patient risk profiles, age, and concurrent health conditions. Goals of treatment for the patient should include control of psoriasis (skin normalization and increase pliability of skin), decrease or clearing of erythema, papules, plaques, and scales, and improving quality of life. The expanding array of treatment options, including the introduction of several biologic therapies, enhances the tools available for managing psoriasis. Looking ahead, the ongoing research and advancements in therapeutic approaches hold promise for enhancing the well-being of those navigating this dermatological condition.
References:
Law, R. M., & Gulliver, W. (n.d.-b). accesspharmacy-mhmedical-com.j. https://accesspharmacy-mhmedical-com.jerome.stjohns.edu/content.aspx?sectionid=271955913&bookid=3097#1205349588
Mayo Foundation for Medical Education and Research. (2024b, May 17). Psoriasis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845
Lawley, L. P., Cheeley, J. T., & Swerlick, R. A. (n.d.). https://accesspharmacy-mhmedical-com. https://accesspharmacy-mhmedical-com.jerome.stjohns.edu/content.aspx?sectionid=262791247&bookid=3095#274787244