Written by Justin Ayob and Antonio Ortega
Psoriasis is an autoimmune disease meaning that your immune system attacks healthy cells in your body by mistake. It is chronic and appears on the skin. Many types of psoriasis exist such as plaque psoriasis which is raised, red patches with silvery buildup of dead skin. Existing treatments are light therapy, topical and systemic medications. Another method called soaking is used as well to help loosen up and remove mucous from the plaques.
Some triggers of psoriasis are stress, skin injury, medications such as lithium and quinidine, infections, diet, and weather. The 7 types of psoriasis are plaque psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, erythrodermic psoriasis, nail psoriasis, and psoriatic arthritis
Starting off with non-drug treatment, there is ultraviolet light therapy. This causes activated T cells in the skin to die which will allow a decrease in scaling and inflammation. Another method is UVB phototherapy which is used for mild to moderate psoriasis symptoms. Other treatments include photo-chemotherapy and laser light therapy
For drug treatment, many topical medications are used such as steroids, vitamin d analogues, anthralin, retinoids, salicylic acid, coal tar and moisturizers. If a more severe case of psoriasis is present, topical calcineurin inhibitors are used such as protonic, elides, methotrexate, cyclosporine, hydroxyurea.
2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
https://www.rheumatology.org/Practice-Quality/Clinical-Support/Clinical-Practice-Guidelines/Rheumatoid-Arthritis (accessed 2020 Mar 18).
American College of Rheumatology Guidelines for Screening, Treatment and Management of Lupus Nephritis.
https ://www.rheumatology.org/Practice-Quality/Clinical-Support/Clinical-Practice-Guide lines/Lupus-Nephr itis (accessed 2020 Mar 18).
Americ an Academy of Dermatology . Psoriasis Clinical Guidelines. Section 1-6.
http s://w ww.aad.org/practicecenter/quality/clinical-guidelines/psoriasis (accessed 2020 Mar 18).
Written by: Hillary Pham, Jae Chang
Psoriasis is a skin condition where skin cells can build up and form a scaly, dry patch that can be extremely itchy and bothersome for individuals. There are many events that can trigger these scratchy patches, most of which are usually cold weather and stress. The most frequently occurring type of psoriasis which accounts for 90% of the disease is psoriasis vulgaris, and the most common symptoms that present with psoriasis are itchiness, redness, and even dryness within the patch region. Since the understanding and knowledge of psoriasis have developed over the years, there have been numerous treatments that can help to stop the skin cells from growing rapidly as well as remove any of the dry patchy scales. Ultimately, modern medicine has yet to find a cure for plaque psoriasis, however, there are medicines to help alleviate the effects of psoriasis. Some of which may be topical ointments, light therapy, and even oral medications.
Psoriasis is a papulosquamous skin disease and is categorized as a common immune-mediated disorder. The pathogenesis of psoriasis is triggered by tumor necrosis factor a, dendritic cells, and T-cells. It is stated that for psoriasis with early onset, occurring before the age of 40, individuals with HLA-Cw6 and environmental factors such as strep infections cause the disease state. Associated comorbidities with psoriasis include depression, cardiovascular disease, psoriatic arthritis, Crohn’s disease, DM2 and possibly cancers.
Accurate determination of the prevalence of psoriasis is difficult due to an absence of validated diagnostic criteria of the disease. Studies claim that the rate of occurs are vastly different based on ethnic backgrounds while latitude differences also affect the rate of occurrence due to the beneficial effect of sunlight on the disease. Nevertheless, the prevalence of psoriasis is estimated to be 1.5% to 3% in Europe and Scandinavia with both genders affected equally and 60 cases per 100,000 white individuals affected annually. Furthermore, the average age of onset is around 33 years with 75% of cases occurring before age 46. The age onset variance is slightly earlier in women than men. However, psoriasis can occur at any age.
Calcipotriene is a common medication used in patients who suffer from the plaque psoriasis condition. The pharmacology of Calcipotriene is that it binds to the vitamin D receptors on the skin cells. By doing so, it will activate the ligand-receptor binding and slow down the growth of cell proliferation. This ultimately will allow for cell differentiation in psoriatic skin and reduce the skin cell growth. Because of the mechanism of action of this medication, it may take a couple of weeks for the patient to see the full effect of the medication. Furthermore, since the medication is involved with the vitamin D receptors, it is vital that patients wear appropriate amounts of sunscreen while on this medication to reduce any sunburn and allow for sun protection.
Calcipotriene is extremely useful in patients that have plaque psoriasis by reducing the effects that come with the condition of psoriasis. The dosage form that Calcipotriene comes in is cream, foam, ointment, or even solution, regardless, the strength of this medication only comes as 0.005%. It is to be applied to the affected area (including the scalp or the body) in a thin film, either once or twice daily. It is vital that patients remember that this is only for external use only. Patients should try to avoid contact of the medication with the face and eyes, and if any contact occurs, the patient should rinse thoroughly with water. After topically using the product, the patient should wash hands thoroughly. Like any kind of drugs, there is always a possibility of side effects to occur. The side effects that some patients may experience while on this medication is dry skin, burning, stinging, and irritation.
Although psoriasis is not a disease that causes significant mortality, it is a disease that can affect individual’s quality of life. Those affected by psoriasis will have patches of their skin form scaly, indurated, erythematous plaques. It can affect the joints and nails, and often coexists with other comorbid conditions including obesity, hypertension, hyperlipidemia, and chronic kidney disease. Many patients with psoriasis have been diagnosed with depression. Therefore, it is our responsibility as healthcare workers to provide and recommend appropriate therapy and support. While there are no medications that can cure psoriasis, there are many medications that can alleviate the symptoms of psoriasis. Aside from calcipotriene, there are other potential, future therapies including oral systemic therapies and biologic therapies. While these treatments are still in clinical trial phase, there is hope that there will be therapies in the future that can completely treat psoriasis.
“Calcipotriene.” Lexicomp, 10/15/2021.
Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet. 2007 Jul 21;370(9583):263-271. doi: 10.1016/S0140-6736(07)61128-3. PMID: 17658397
Tokuyama, M., & Mabuchi, T. (2020). New Treatment Addressing the Pathogenesis of Psoriasis. International journal of molecular sciences, 21(20), 7488. https://doi.org/10.3390/ijms21207488
Natalie Eshaghian & Donna Salib
Psoriasis is an immune-mediated skin disease that is seen to cause severe irritation to a person’s body. Many people think that psoriasis is a localized skin condition, however, it is found to be a chronic proliferative inflammatory systemic disease that affects the skin’s surface, as well as the joints, causing psoriatic arthritis and many other issues. Our skin naturally creates skin cells at a specific speed of a few weeks to a month, causing the dead skin cells to fall and the new cells to rejuvenate. However, with psoriasis, the skin cells are working at a quicker speed of days instead of weeks, and instead of the skin cells naturally shedding the keratinocytes it causes a buildup of dead skin cells, which cause dry, itchy and red raised skin scales. (1) The dryness comes from a lack of lipid secretion in the skin cells. Characteristics of psoriasis include red silvery scales, typically in forms of plaques, covering the areas of the scalp, back, elbows, legs and knees, as well as the feet, face and palms. The most difficult part is the look of the psoriasis, as well as the feel since it is usually dry itchy scales. Psoriasis is seen to cause inflammation not only to the skin, but to the joints and different organ systems and tissues. (2) It is typically bothersome to patients to deal with all the effects of psoriasis, and causes indirect effects to a person’s health.
Psoriasis indirectly affects a person’s health in many different ways, such as depression and a poor quality of life. The areas included in psoriasis are very broad and someone having to deal with the disease can suffer tremendously from having to cover the psoriasis. Since psoriasis does not have a complete cure to it, and only offers symptomatic relief, patients often find themselves having trouble coping with the disease. (3) Psoriasis is seen to also be linked with gastrointestinal disease and chronic kidney disease. In addition, patients are to avoid alcohol due to an increased risk to fatty liver. Psoriasis patients have been found to contain other similar comorbidities along with the disease, such as hyperlipidemia, hypertension, coronary artery disease, type 2 diabetes, as well as an increased BMI.
The cause of psoriasis is unknown, however, it is seen to be an autoimmune disease brought about by T lymphocytes, and seen to be associated with HLA antigens. In addition, psoriasis is found to have a genetic factor, since many patients who suffer from psoriasis are found to have familial occurrences. Psoriasis can be induced by chemical, mechanical, and radiational injury as well. However, it is important to note that the winter cold weather can aggravate psoriasis, whereas the summer can improve psoriasis. (3)
Although there is no cure for psoriasis, the treatment options are continuously growing and only becoming better with the results. Psoriasis ranges from mild to severe forms. The more mild forms of psoriasis are seen to be treated with topical treatments such as coal tar, dithranol, corticosteroids, retinol, and vitamin D analog, along with emollients and moisturizers to help with the hydration of the skin. In more severe cases, which is when greater than 10% of a patient’s body surface area is involved or when the psoriasis is in the face, nails, scalp, genitals, and soles since it is harder to treat these areas, a patient will use a systemic drug to treat the disease, such as methotrexate as the first line treatment, as well as cyclosporine, retinoids, fumarates, phototherapy and TNF antagonists. If methotrexate is seen to be or becomes ineffective, then the patient should be switched or used in combination to a biologic treatment, which are infliximab, adalimumab, etanercept, and interleukin antagonists. The first line treatment in biologics is Ustekinumab and an alternative is Secukinumab. Other treatments are Adalimumab, which is used as the first line biologic treatment in psoriatic arthritis. Infliximab is the agent of choice in patients who cannot use other biologic agents. (3) Although biologic treatments are essentially next line therapy in psoriasis, it should be noted that patients are at a higher risk of infection due to biologic’s immunocompromising properties. High precautions are taken to ensure the patient is safe to start biologics, as well as continuing on them, such as various tests, vaccines, and other preventions. In addition, women need to be taking contraceptive measures at child bearing ages to avoid pregnancy while on biologics. Furthermore, it is important to be aware of certain medications that can worsen psoriasis, such as NSAIDs, steroids, chloroquine, lithium, and beta blockers. (3)
Ultimately, psoriasis is a chronic disease that should be treated quickly and effectively to minimize any further health effects. This systemic disease can affect a person tremendously, and it not only helps to treat the person’s symptoms physically, but as well as emotionally. Treatment options are forever growing, and it is important to look at all the options available and choose the correct path in treatment for each patient.
Psoriasis: Causes, triggers and treatments. Available at: https://www.psoriasis.org/about-psoriasis/?gclid=CjwKCAjw9aiIBhA1EiwAJ_GTSqOuW1BTFuNNBqSxlU3Yb-76cHKqv9xtNN0d11bqejKJCKuiiZwzkhoCTd4QAvD_BwE Date Accessed: 3 August 2021
Rendon A, Schäkel K. Psoriasis Pathogenesis and Treatment. Int J Mol Sci. 2019;20(6):1475. Published 2019 Mar 23. doi:10.3390/ijms20061475
(3)Nair PA, Badri T. Psoriasis. In: StatPearls. Treasure Island (FL): StatPearls Publishing
;November 20, 2020.https://www.ncbi.nlm.nih.gov/books/NBK448194/
Psoriasis is a skin condition characterized by numerous clinical manifestations including the formation of plaques (patches of this, red, and scaly skin, dry or cracked skin, itchiness and discomfort, as well as swelling or sore joints. This condition is a chronic disease state that constitutes increased inflammation and the pathogenesis of psoriasis is often connected to genetics that predispose patients to later development. Psoriasis can be further classified into subtypes, including pustular psoriasis, psoriasis vulgaris, erythematous psoriasis, and others. The presence of psoriasis in a patient may also exacerbate other comorbidities; while psoriasis primarily affects the integumentary system, certain symptoms may also lead to increased inflammation of the joints. This clinical manifestation of psoriasis may inadvertently worsen arthritis, as well. In addition, studies have shown that psoriasis has a larger effect on other organ systems, as well. Research indicates that patients with psoriasis are more likely to experience comorbid hypertension, hyperlipidemia, type 2 diabetes, and other metabolic disease states. Many hypothesize that the chronic inflammation present in psoriasis patients may be what accelerates the development of vascular disease.
Due to the autoimmune nature of psoriasis, the numerous treatments available for the disease state require medications that target the patient’s immune system. Monoclonal antibodies are a classification of drug therapy that is most often utilized to assist in the treatment of psoriasis. Adalimumab is one of the most commonly prescribed biologics used in the treatment of psoriasis under the brand name, Humira. Adalimumab is linked to the neutralization of TNF-alpha, preventing it from interacting with its corresponding receptors on cell surfaces. By interfering with the TNF-alpha process, inflammatory cytokines such as IL-6 are prohibited from beginning an inflammatory cascade. In doing so, the mechanism by which psoriasis flare-ups are triggered are then mitigated. However, continued use of biologic medications can lead to immunosuppression, a side effect that must be considered carefully as mild infections can prove to grow complicated.
While biologics are immensely effective in treating autoimmune disorders such as psoriasis, such medications require parenteral administration. This route of administration may be uncomfortable for the patient and may not provide immediate relief of pressing symptoms. It is recommended that psoriasis patients consider topical treatments in tandem with biologics to manage their symptoms and flare-ups. Moisturizers that are emollient by nature are extremely beneficial; such products would be oilier and greasier than a typical moisturizer, but the thick nature of it and the oil base allow for the preservation of the hydration barrier of the skin, ensuring proper moisturization of the skin and plaques.
Psoriasis is a complicated disease state characterized by chronic inflammation due to an autoimmune disorder; such inflammation leads to the formation of thick, scaly plaques that are uncomfortable and itchy. Treatment for psoriasis includes biologics such as adalimumab and though such medications are incredibly potent & beneficial, topical treatments are also utilized to manage psoriasis symptoms.
Psoriasis is an autoimmune disease that involves an inflammatory skin reaction on dry skin. This can result in poor healing and scaly patches in certain areas of the skin, most commonly on the feet. It can also occur on the outside of the elbows, knees or scalp. It affects both men and women equally and develops from adolescence into adulthood, typically from ages 15-35 years old. There are different types of psoriasis, most notably there are 5 different types. This includes plaque psoriasis, guttate, inverse, pustular and erythrodermic. Plaque psoriasis is the most common form of psoriasis patients have. It is the typical raised and red patches on the skin covered with a white build-up of dead skin, particularly on dry patches. Since the patches are dry, they are very itchy and can lead to open wounds after itching since the skin is so susceptible to cracking because it is so dry. Guttate type psoriasis is characterized by small dots that are red. This type of psoriasis is usually triggered by some type of infection, most commonly a strep related infection. Inverse psoriasis occurs within body folds, characterized by small very red and shiny lesions on these areas. Pustular type psoriasis is usually characterized by white colored pustules surrounded by red skin, this occurs usually on the extremities like the hands and the feet. Erythrodermic type psoriasis is the most severe form of it, it can be a result of uncontrolled plaque psoriasis. This includes severe itching and pain on the affected areas that can cause total skin detachment. Patients with other autoimmune diseases are at a higher risk to develop psoriasis as it is autoimmune in nature as well. Chronic inflammation is a key characteristic in psoriasis as in many autoimmune diseases such as inflammatory bowel disease, making these patients at a 7 times higher risk of developing psoriasis. In psoriasis, it is important to use prophylactic therapy in order to control the inflammation. Many steroidal creams and ointments are used to control itching and inflammation of the area to prevent progression of disease and cracking of the skin. It is extremely important to keep the affected areas moisturized and controlled. Biologics such as TNF-alpha blockers and IL-6 blockers can be used in severe cases to control inflammatory cytokines mediators, regulating unnecessary immune response from the body. Light therapy can also be used and is highly recommended in patients that have uncontrolled symptoms. Currently, there is no known cure for psoriasis and the treatment regimen for patients is lifelong and can be on and off depending when a patient has flares. Sometimes worsening of the patient’s psoriasis can be triggered from stress or can be triggered from certain spicy foods. It is also important to monitor lifestyle choices and urge a patient to avoid triggers and keep a daily journal about their psoriasis to recognize the triggers and do their best to avoid said triggers. If left uncontrolled, damage to the skin can affect other parts of the body, the affected areas can become infected and that can cause a cascade of issues.
Weigle N, McBane S. Psoriasis. Am Fam Physician. 2013;87(9):626-633.
Psoriasis is an immune-mediated disease that causes inflammation of the skin that leads to severe symptoms such as raised plaques and scales on the skin. Psoriasis usually occurs because of an overactive immune system that speeds up the rate skin cells grow and die. Normally, regular skin cells grow and shed off within the time frame of a month. However, in patients that have psoriasis, this skin cell cycle of growth and shedding usually lasts only 3 or 4 days. Because of this expedited skin cell growth cycle, patients with psoriasis usually experience their skin cells to pile up on the surface of their skin. This causes itching, burning, and stinging in the places of their bodies that develop these plaques. Usually, plaques and scales are most commonly found on the elbows, knees, and scalp.
One of the main goals for effective treatment of psoriasis is to aim to stop skin cells from growing too quickly and to remove the scales that have already formed on the surface of the skin. Options for the treatment of psoriasis have to take in how severe the individual condition is and includes treatments such as creams, ointments, light therapy, or oral as well as injected medication. The most common drugs that are frequently prescribed for the treatment of psoriasis are corticosteroids. These drugs are most frequently prescribed for mild to moderate psoriasis however long-term use of these corticosteroids can have severe side effects. Corticosteroids come in the forms of ointments, creams, gels, and lotions. More mild corticosteroids are recommended for more sensitive areas such as your face. Topical corticosteroids are usually used during flare ups or when the condition gets very severe. Salicylic acid Is also used to promote the shedding of scales and helps smooth the skin. The effectiveness of salicylic acid is my modest at best due to their harsh side effects such as skin irritation and temporary hair loss. Prescription retinoids containing the synthetic form of vitamin A can also help treat psoriasis by reducing the formation of patches of raised skin, however these medications don't work as quickly as steroids and can sometimes cause dryness and irritation.
For more severe or difficult to treat cases of psoriasis certain physicians may recommend light therapy. PUVA which includes the drug psoralen combined with ultraviolet a light is the most effective treatment for difficult or severe cases of psoriasis. During this treatment the patient usually stands in a cabinet containing 24 or more 6-foot-long UVA bulbs. The patient should wear goggles or protection from the light rays, and the treatment usually lasts anywhere from one minute to half an hour. At first patients have treatments either two or three times a week and most psoriasis patients will have improvement in symptoms after 12 to 24 treatments. In approximately 90% of severe cases, PUVA is effective in clearing psoriasis as long as treatments are continued to keep their condition under control. However, this form of treatment has certain risks and side effects such as burning itching, nausea, as well as skin aging and skin cancer. All of these side effects should be considered when recommending PUVA treatment for patients.
“About Psoriasis.” Www.Psoriasis.Org, www.psoriasis.org/about-psoriasis/.
“PUVA (Photochemotherapy) | DermNet NZ.” Dermnetnz.Org, 2019, dermnetnz.org/topics/puva-photochemotherapy/.
Written by: Denise Cotter and Niyati Doshi
Psoriasis is an autoimmune or immune-mediated disease which causes skin cells to replicate up to 10 times faster than normal. It presents as bumpy red patches covered with white scales and can appear anywhere on the skin but often appear on the scalp, elbows, knees, and lower back. The newly made skin cells are being produced so quickly that the old cells do not have the chance to fall off beforehand. It is not contagious and it affects over 7 million Americans. There is no way to control or prevent psoriasis since it is based on your immune system and your genes. However, there are some things that may trigger psoriasis if you are already predisposed to it including: stress, smoking, drinking, drug use, injury to the skin, strep infection, medications, diet, and weather. Triggers vary from person to person so it may be wise to track what brings on psoriasis for an individual.
There are five types of psoriasis (plaque, guttate, inverse, pustular, and erythrodermic), with plaque psoriasis being the most common. Plaques are often itchy and painful. When dealing with psoriasis no matter which type someone has it can be difficult to manage because while there is something physically present it also takes an emotional toll. Individuals may not want to leave their house for fear of being judged or mocked because of the way their skin looks and having this stress may cause a flare up or make the psoriasis worse. Some ways to manage psoriasis is to keep skin moisturized (using a humidifier and moisturizing skin with creams), cold showers, diet change.proper nutrition and sunlight. When talking about medical treatment it is important to know that what works for one person may not work for another. Topical therapies include corticosteroids, vitamin D analogues, tazarotene, emollients, salicylic acid, anthralin, and coal tar. Phototherapy is another therapy that may be used to treat, but it cannot be done on those with photosensitivity disorders, taking photosensitizing medication, or people at risk for skin cancer. Natural products have been proven to help relieve symptoms but their extract mechanism is not fully understood. They should be taken at least 2 hours apart from any prescription or OTC medication to avoid the potential for a drug interaction.
Since psoriasis is a chronic inflammatory systemic disease it can put you at risk for other diseases such as psoriatic arthritis, heart disease, strokem, diabetes, depression, and liver disease just to name a few. Many people do not realize but our skin is the largest organ and due to the amount of inflammation that is going on it can affect other organ systems. Psoriatic arthritis is a chronic inflammatory disease of the joints and places where tendons and ligament connect to bone. Symptoms include fatigue, tenderness, pain, stiffness, swelling of the fingers or toes, reduced range of motion, and redness and/or pain in the eyes. While there are many factors that we cannot change (i.e. gender, age, ethnicity, FH), there are some things we can (i.e. weight, physical activity, smoking, alcohol consumption, and stress).
Ayala-Fontánez N, Soler DC, McCormick TS. Current knowledge on psoriasis and autoimmune diseases. Psoriasis (Auckl). 2016;6:7-32. Published 2016 Feb 22. doi:10.2147/PTT.S64950
Psoriasis is a common chronic inflammatory skin disease characterized by raised, red, scaly plaques. It is a multifactorial disease, with a predominant genetic component, but environmental exposures, comorbidities, and behavioral factors also play a role. As such, it has a complex pathophysiology, involving tumor necrosis factor-alpha (TNF-A) and interferons (IL)-alpha, IL-23, and IL-12 as part of the cytokine-driven innate immune response.
There are several subtypes of psoriasis that have different causes and manifestations. Their treatments depend on location and severity, but ultimately must be individualized according to the preferred extent of disease control and medication tolerance. Topical therapies, like emollients, corticosteroids, vitamin D analogs, tazarotene, calcineurin inhibitors, and anthralin, are used for limited or mild iterations of the disease (<3% of body surface area) but may be used in combination with systemic therapies for symptomatic control. Systemic therapies, like retinoids, methotrexate, cyclosporine, acitretin, apremilast, and biologic agents, are reserved for moderate (3-10% of body surface area) to severe (>10% of body surface area) disease as disease-modifying agents. Ultraviolet irradiation as a form of phototherapy has well-established efficacy and safety but its availability and high initial cost may serve as barriers to treatment.
According to the American Academy of Dermatology (AAD) guidelines, the optimal topical agent should be individualized to which vehicle (creams, ointments, solutions, gels, foams) the patient is likely to use and to be the most adherent to. Topical therapy can be used intermittently and chronically, but should follow the principle of using the least amount of medication for the shortest period of time that produces relief. Although emollients are important adjuncts to minimize irritation and itchiness, corticosteroids remain the cornerstone of psoriasis topical treatment. They are available in multiple strengths, formulations, and combinations, making them easily adjustable if disease control is inadequate or if the medications are intolerable. Topical corticosteroid products are classified according to their inherent potencies, ranging from groups 1-5.
The AAD guidelines also realizes that non-biologic systemic therapies are still prevalent today due to their cheap costs, widespread availability, and ease of administration, despite lower efficacy than the newer biologic agents. Biologic agents consist of TNF-A inhibitors, IL-17 inhibitors, and IL-23 inhibitors. They can be used either as monotherapy or in conjunction with other topical or systemic agents. They have demonstrated a high benefit-to-risk ratio but their high costs and reservation for moderate-severe psoriasis potentially limits their use. There are currently 11 biologic agents approved for the treatment of psoriasis and/or psoriatic arthritis. They are all administered IV from twice a week to once every three months and carry potential adverse events, like upper respiratory infections and urinary tract infections, due to their immunosuppression.
Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Journal of the American Academy of Dermatology. 2009;61(3):451-485. doi:10.1016/j.jaad.2009.03.027.
Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Journal of the American Academy of Dermatology. 2011;65(1):137-174. doi:10.1016/j.jaad.2010.11.055.
Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. Journal of the American Academy of Dermatology. 2019;80(4):1029-1072. doi:10.1016/j.jaad.2018.11.057.
Psoriasis is an immune mediated disease causing appearance of raised, red, scaly, patches that seem to be thicker and inflamed when compared to skin with eczema. Although scientists do not know the exact cause of psoriasis, it is well documented that the immune system and genetics play a big role in its development in addition to triggers causing it to flare. Patients with psoriasis experience an abnormal growth of skin cells resulting in build-up of lesions. Both men and women develop psoriasis at equal rates and it’s also seen in all racial groups but at varying rates. According to current studies, it affects more than 8 million Americans. The most common age of onset is typically between 15 and 35, however, it can develop at any age. Psoriasis is not contagious and its lesions are not infectious. The diagnosis of psoriasis is based on a physical examination done by a provider and can sometimes include a biopsy examination under a microscope to diagnose. Psoriasis skin appears thicker and inflamed when compared to skin with eczema.
The five types of psoriasis include plaque, guttate, inverse, pustular and erythrodermic. Plaque psoriasis is the most common type and appears as raised, red patches covered with a silvery white buildup of dead skin cells. This is most often seen on the scalp, knees, elbows and lower back. It is itchy and painful and many times can crack and bleed. Guttate psoriasis appears as small, dot-like lesions and often starts in childhood or young adulthood. This type of psoriasis can be triggered by a strep infection and is the second-most common form. Inverse psoriasis may appear smooth and shiny and as red lesions found in folds of the body such as behind the knee, under the arm or in the groin. Often times, people presenting with inverse psoriasis also have another type of psoriasis elsewhere on the body presenting at the same time. Pustular psoriasis is characterized by white pustules surrounded by red skin and can occur on any part of the body but is most often seen on the hands or feet. Erythrodermic psoriasis is an uncommon, aggressive, inflammatory form of psoriasis that often affects most of the body surface. It leads to widespread, fiery redness that can cause severe itching and pain as well as make the skin peel off in sheets. Erythrodermic psoriasis occurs in 3% of people who have psoriasis during their life time and generally appears in those who have unstable plaque psoriasis.
Management of Psoriasis. UpToDate, Accessed May 22 2020.
The PowerPoint focuses on how psoriasis can affect overall health and how to manage it. Psoriasis is an autoimmune disease that causes the skin cells to reproduce too quickly; it causes the formation of raised, red, scaly patches on the skin that can appear anywhere on the body. Anyone can get psoriasis, but certain genes have been linked to the disease. Exposure to triggers can cause an exacerbation. Common triggers are stress, food allergies, infection, skin trauma, change in weather, and certain medications.
The different type of psoriasis include plaque, guttate, pustular, inverse, and erythrodermic. A variety of treatment options are available; decisions depend on the type of psoriasis, where it is on the body, and possible side effects. Patients respond different to each treatment and will often have to try several before finding the right one. The options include topical treatment (e.g. corticosteroids, vitamin D3, retinoids, and coal tar), phototherapy, or systemic treatment (e.g. retinoids, cyclosporin, methotrexate, and biologics). Non-pharmacological strategies for managing psoriasis include keeping the skin moisturized, cold showers, proper nutrition, and staying healthy overall. While psoriasis mostly affects the skin, it can also put patients at risk for other disease such as psoriatic arthritis, heart disease, stroke, diabetes, metabolic syndrome, etc. There is also a high prevalence of depression and anxiety disorder related to psoriasis; patients may benefit from joining support groups and attending counseling. It’s also important to manage modifiable risk factors such as weight, physical activity, smoking, alcohol consumption, and stress. Overall, psoriasis is a disease that requires many lifestyle changes for management.
Psoriasis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/psoriasis/advanced#tab-overview. Accessed May 22, 2020.
Psoriasis is an autoimmune disease, which is not contagious. It doesn't spread from one person to the other. Psoriasis presents with red raised scaly patches on the skin and it can be present anywhere on the skin. This disease is immune mediated or can be through genetics. There are five different types of psoriasis: plaque psoriasis (the most common one), guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis. There is no cure for psoriasis, but there are many medications that are used to help cope with the psoriasis and the itching that occurs from it. Along with that, patients must be able to cope with this disease mentally and physically. Some ways to manage this disease are non-pharmacological things such as moisturizing the skin, cold showers, taking in sunlight (but making sure not to take in too much sunlight), proper diet and nutrition. Some medical treatments for psoriasis are topical steroids, phototherapy (UV light), systemic medications (oral, injections or infusions), and biologics. The key thing to take away from these medical treatments is that it is patient dependent. Something might work for patient 1 but not for patient 2, therefore trial and error is definitely needed.
Psoriasis is an inflammatory disease which mainly affects the skin, however it also affects the inside of your body. Some conditions that can occur due to psoriasis are psoriatic arthritis, ******, diabetes, depression, metabolic syndrome, etc. Psoriatic arthritis is a medical condition that occurs due to psoriasis in 30% of the patients. It is a chronic inflammation in the joins and the places where tendons and ligaments connect to the bone. This also causes a lot of swelling, pain, fatigue, and stiffness in the joints. Early diagnosis and treatment is recommended because if left untreated it can lead to permanent joint damage. Psoriasis can lead to heart disease too due to the inflammation, causing damage to the arteries and causing blockage.
There are certain risk factors for psoriasis, some are modifiable but some are non-modifiable. The modifiable risk factors are weight, physical activity, smoking, drinking, stress, etc. On the other hand, the non-modifiable risk factors are gender, age, family history, and ethnicity. By changing some of these factors can better help you control your disease state and keep it manageable.
About Psoriatic Arthritis. What Is Psoriatic Arthritis? - National Psoriasis Foundation. https://www.psoriasis.org/about-psoriatic-arthritis. Accessed May 22, 2020.