Psoriasis
Psoriasis is a chronic systemic proliferative and inflammatory condition of the skin. It is characterised by erythematous plaques covered with silvery scales, particularly over the extensor surfaces, scalp and lumbosacral region. Targeted therapies for psoriatic arthritis: an update for the dermatologist – PubMed. It is caused by an overactive immune system that mistakenly attacks healthy skin, accelerating their turnover from weeks to days, resulting in the cutaneous manifestations.
This disorder can also commonly affect the joints, eyes and tendon attachments (enthesis). It does not have a cure, and intervention is aimed at symptom control. The condition affects millions of people worldwide and is one of the most prevalent skin conditions to exist. Global burden and future trends in psoriasis epidemiology: insights from the global burden of disease study 2019 and predictions to 2030 – PubMed. The disease has substantial variation in prevalence by age, sex and geography. It is, however, primarily a disease of adults; the sex distribution does not follow a consistent global pattern, with some reporting slightly higher rates in women and others indicating a male predominance.
The aetiology of psoriasis is multifactorial, involving genetic (Presence of HLA-Cw6 genes and family history), immunologic and environmental factors. Although the precise cause remains incompletely understood, the condition is widely recognised as an immune-mediated disorder that triggers symptoms in genetically predisposed individuals. Plaque Psoriasis – StatPearls – NCBI Bookshelf.
What are the signs and symptoms?
Psoriasis presents as well-defined erythematous plaques covered with silvery scales, commonly over the scalp and extensor surfaces of the extremity. It may be itchy but is less common and severe than with atopic dermatitis (eczema). The lesions of psoriasis are distinct from other entities and are classically very well circumscribed, circular, red papules or plaques with a grey or silvery-white, dry scale. In addition, the lesions are typically distributed symmetrically on the body. Update on psoriasis: A review – PMC
There are various forms of psoriasis which include plaque psoriasis, pustular psoriasis, erythrodermic psoriasis, guttate psoriasis and inverse psoriasis. It is beyond the scope of this patient context information to discuss these individually, but more information can be found here if of specific interest. A brief summary of clinical types of psoriasis – PMC. Plaque psoriasis is the most common and accounts for 80-90% of all cases. Plaque Psoriasis – StatPearls – NCBI Bookshelf
The systemic nature of the disease means it can have a diverse set of clinical features with multisystem involvement. This includes the musculoskeletal system in a condition termed psoriatic arthritis. The disease can cause joint swelling and pain, commonly in the hands and feet along with tendon attachment sites (enthesis). Dactylitis is common and leads to localised, painful swelling of a finger or toe Psoriatic Arthritis – StatPearls – NCBI Bookshelf. Other common extra-articular sites include the nails; pitting (small, thimble-like dents); discoloration (yellow/brown ‘oil-drop’ spots); thickening, brittleness and onycholysis (separation from the nail bed) are common. Nail Psoriasis – PubMed. Ocular features including uveitis (eye inflammation), inflammatory bowel disease (such as Crohn’s or colitis) and elevated risk of cardiovascular and metabolic comorbidities The Risk of Systemic Diseases in Those with Psoriasis and Psoriatic Arthritis: From Mechanisms to Clinic – PMC
How is it diagnosed?
Usually, diagnosis is made of the clinical symptoms, appearance and site of lesions. Histopathology (skin biopsy) is rarely needed, but in the case of atypical features, it may help differentiate from other dermatosis conditions.
Multisystem checks will be dependent on a patient’s concurrent symptoms. This may include a blood test to look for levels of inflammation in the blood and/or the presence of certain antibodies that can help confirm a diagnosis. Metabolic and cardiovascular risk factors may be investigated and treated where necessary. Psoriasis and Cardiometabolic Diseases: The Impact of Inflammation on Vascular Health – PMC
How is it treated?
There is no cure for psoriasis, but there are multiple effective treatment/management options. Topical therapy is the standard of care for mild to moderate disease.
- Emollients form the backbone of therapy for psoriasis. They help hydrate the skin, reduce scaling and improve barrier function. They are combined with other topical therapies and have been shown to improve the efficacy and penetration of these other topical agents. Therapeutic moisturizers as adjuvant therapy for psoriasis patients – PubMed.
- Topical corticosteroids, are highly effective in reducing inflammation and are antiproliferative, slowing doing the rate of skin cell turnover. Topical Therapies in Psoriasis – PMC
- Alternative topical therapies include coal tar, dithranol and retinoids (vitamin A derivatives); all of these work to reduce local inflammation and slow down skin cell turnover. These therapies can be combined to have a quicker mode of action and better long-term efficacy. Topical Therapies in Psoriasis – PMC
- For patients that don’t respond to the above treatment or with severe symptoms, systemic treatment with the use of DMARD’s (commonly methotrexate / cyclosporine) Comparing the effectiveness and drug persistence of methotrexate, cyclosporine, and acitretin for psoriasis – PubMed and biologic therapy (Adalimumab, Risankizumab and Ustekinumab) can be considered. They work by inhibiting specific proteins involved in cell turnover and reducing plaque build-up.
Phototherapy uses controlled medical ultraviolet light to slow rapid skin cell growth. It has a favourable safety profile over other systemic treatment options and has been shown to be have a high clinical efficacy. Phototherapy for Psoriasis in the Age of Biologics – PubMed
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