Dermatology Notes About Psoriasis

Summary:

This Dermatology Notes About Psoriasis explains that Psoriasis is an immune-mediated disease that causes chronic inflammatory lesions on the skin and can also lead to systemic manifestations. Psoriasis is also an independent risk factor for cardiovascular disease. The management of psoriasis and psoriatic arthropathy has been transformed with specific biological therapies. The clinical presentations of psoriasis can vary, from chronic stable plaques to pustules on the hands and feet to unstable erythroderma.

Excerpt:

Dermatology Notes About Psoriasis

Introduction

Psoriasis is now considered to be a genetically determined inflammatory systemic autoimmune disease. It is characterized by plaques of diseased skin often at sites of minor friction (elbows/knees), which occur next to areas of clear ‘normal’ skin. Plaques of psoriasis are clinically well‐demarcated and are erythematous (dilated dermal blood vessels) with a white surface scale (rapid keratinocyte proliferation). Psoriasis not only affects the skin but can also lead to seronegative arthritis in approximately 8–30% of patients. However, there is an increasing body of evidence that psoriasis is also associated with other important comorbidities such as type 2 diabetes (1.4‐fold increased risk), cardiovascular disease (CVD), metabolic syndrome, obesity, non‐alcoholic fatty liver disease (NAFLD), depression, and reduced quality of life.

The pathogenesis of psoriasis is complex; nonetheless, it is largely accepted that the disease is mediated by the dysregulation of T‐helper lymphocytes. The development of psoriasis is multifactorial, with multiple potential susceptibility factors in a genetically at‐risk individual. This combination of susceptibility factors and genetic predisposition results in an interactive web of immune cells/chemical cytokines impacting on skin cells and leading to disease. Increased understanding of these complex cellular changes has led to the introduction of multiple targeted biological therapies that are now used to manage severe psoriasis and psoriatic arthritis (PA).

Globally 1–2% of the population is affected by psoriasis (125 million people in UK/USA/Japan alone). A child who has one parent with psoriasis has a one in four chance of developing the disease. If one identical twin has psoriasis, there is a 70% chance that the other will also be affected; however, only a 20% chance exists in dizygotic twins.