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Psoriasis, Citations - Coggle Diagram
Psoriasis
Incidence/ Prevalence
World wide prevalence (2%)
Lower prevalence in Asian and some African populations
11% in Caucasian and Scandinavian populations
Inflammation of joints results in psoriatic arthritis that develops in 40% of psoriasis patients
Guttate psoriasis affects children or adolescents
Treatments
Over-the-Counter Topicals
Tar containing products
Antiseptic, antibacterial, and anti-seborrheic properties
Softens and loosens scaly/ crust areas of the skin
Salicylic acid
Sheds outer layer of skin
Phototherapy
Used in lesions that cover < 10% of the body and oral therapy
Ultraviolet light B→ natural sunlight
Psoralen + UVA (PUVA) → slows excessive skin cell growth
Contraindicated in children but can be used in patients over 10 or 16 years old
Topical Non-Steroidals
Anthralin (Anthra-Derm)
Inhibits DNA synthesis and mitosis in epidermis
Reduce psoriatic lesions (ointment, cream)
FDA approved for > 12 y/o
Calcipotriene (Dovonex)
Reduces the abnormal growth of keratinocytes
Synthetic Vitamin D works by binding to vitamin D
Safe for pregnant patients
Topical corticosteroid (mild disease)
Safe for pregnant patients
Systemic (used when topical medications or phototherapy do not work)
MTX (methotrexate)
Inhibits enzyme involved in rapid growth of skin cells
Contraindicated in pregnant women due to teratogenicity
Do not take if immunodeficient, pregnant/nursing, abnormal kidney, pregnant, undergoing radiation therapy
Cyclosporine
Acitretin (Soriatane)
Synthetic form of Vit A
Contraindicated in pregnant women due to teratogenicity
Biologics (Injection/ IV infusion)
T-Cell inhibitors
Enbrel
Humira
Pathogenesis
Neovascularization and formation of new blood vessels
Initiation phase triggered by trauma, infection, or drugs
Sustained inflammation
Uncontrolled keratinocyte proliferation
Dysfunctional T-cell differentiation
Labs and Other Testing
Psoriatic Arthritis Screening Test
Dermatologist orders biopsy
-Tissue taken from body to examine it properly under microscope
Distinguishes psoriasis from eczema
Serologic testing
Run Blood tests and x-rays
Rule out forms of arthritis if patient has swollen and painful joints
Other treatments
Complementary and Integrative Medicine
Diet and Nutrition
Obesity= common comorbidity
Active and Mindful Lifestyle
Physical activity reduces risk of psoriatic disease
Integrative approaches to care
Physical therapy/ acupuncture to relieve psoriasis
Risk Factors
Genetic Factors
60-90% heritability
Genetic variations in CX3CL1 / CX3CR1 influence susceptibility to psoriasis development
1300 genes in psoriatic lesions
Type I psoriasis (psoriasis before 40) has stronger genetic basis
Environmental Factors
Diet
Smoking
Microbial infections (fungus, virus, bacteria)
Drinking
Chemical irritants
Mental stress
UV radiation
Trauma
Screening and Diagnosis
Physical examination
Expert dermatologist can diagnose plaque psoriasis based on evaluating morphologic appearance
Psoriasis Epidemiology Screening Tool (PEST)
Validates screening for psoriatic arthritis
Clinical Manifestations
Signs
Thickened, pitted or ridged nails
Swollen and stiff joints
Dry cracked skin that bleeds/ itches
Small scaling spots
commonly seen in children
Symptoms
Large, dry erythematous scaling patches that are white or silver on top
Indicates plaque psoriasis
1/3rd of patients will develop in adult life
Intense burning
Psoriasis Vulgaris
Inverse psoriasis
Affects skin folds of groin, buttocks, breasts
Pustular psoriasis
Red skin patches covered with white pustules
Psoriasis pustulosa palmoplantaris (PPP)
Affect palms and soles
Acrodermatitis continua of Hallopeau
Affects nail apparatus
Guttate Psoriasis
Triggered by group-A streptococcal infection
Common in young children and young adults
Located: trunk, arms, legs
Erythrodermic psoriasis
Covers 90% of total body surface with inflammation and redness
Citations
Rendon, A., & Schäkel, K. (2019). Psoriasis Pathogenesis and Treatment. International journal of molecular sciences, 20(6), 1475.
https://doi-org.proxy.libraries.uc.edu/10.3390/ijms20061475
Zeng, J., Luo, S., Huang, Y. and Lu, Q. (2017), Critical role of environmental factors in the pathogenesis of psoriasis. J Dermatol, 44: 863-872. doi:10.1111/1346-8138.13806
Alshobaili, H. A., Shahzad, M., Al-Marshood, A., Khalil, A., Settin, A., & Barrimah, I. (2010). Genetic background of psoriasis. International journal of health sciences, 4(1), 23–29.