Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1997. Revised and updated, August 2014.
Psoriasis is a chronic inflammatory skin condition characterised by clearly defined, red and scaly plaques (thickened skin). It is classified into several subtypes.
Psoriasis affects 24% of males and females. It can start at any age including childhood, with peaks of onset at 1525 years and 5060 years. It tends to persist lifelong, fluctuating in extent and severity. It is particularly common in Caucasians but may affect people of any race. About one-third of patients with psoriasis have family members with psoriasis.
Psoriasis is multifactorial. It is classified as an immune-mediated inflammatory disease (IMID).
Genetic factors are important. An individual's genetic profile influences their type of psoriasis and its response to treatment.
Genome-wide association studies report that the histocompatibility complex HLA-C*06:02 (previously known as HLA-Cw6) is associated with early-onset psoriasis and guttate psoriasis. This major histocompatibility complex is not associated with arthritis, nail dystrophy or late-onset psoriasis.
Theories about the causes of psoriasis need to explain why the skin is red, inflamed and thickened. It is clear that immune factors and inflammatory cytokines (messenger proteins) such as IL1 and TNF are responsible for the clinical features of psoriasis. Current theories are exploring the TH17 pathway and release of the cytokine IL17A.
Psoriasis usually presents with symmetrically distributed, red, scaly plaques with well-defined edges. The scale is typically silvery white, except in skin folds where the plaques often appear shiny and they may have a moist peeling surface. The most common sites are scalp, elbows and knees, but any part of the skin can be involved. The plaques are usually very persistent without treatment.
Itch is mostly mild but may be severe in some patients, leading to scratching and lichenification (thickened leathery skin with increased skin markings). Painful skin cracks or fissures may occur.
When psoriatic plaques clear up, they may leave brown or pale marks that can be expected to fade over several months.
Certain features of psoriasis can be categorised to help determine appropriate investigations and treatment pathways. Overlap may occur.
Typical patterns of psoriasis.
Post-streptococcal acute guttate psoriasis
Small plaque psoriasis
Chronic plaque psoriasis
Unstable plaque psoriasis
Flexural psoriasis
Scalp psoriasis
Sebopsoriasis
Palmoplantar psoriasis
Nail psoriasis
Erythrodermic psoriasis (rare)
Psoriasis
Generalised pustulosis and localised palmoplantar pustulosis are no longer classified within the psoriasis spectrum.
Patients with psoriasis are more likely than other people to have other health conditions listed here.
Psoriasis is diagnosed by its clinical features. If necessary, diagnosis is supported by typical skin biopsy findings.
Medical assessment entails a careful history, examination, questioning about the effect of psoriasis on daily life, and evaluation of comorbid factors.
Validated tools used to evaluate psoriasis include:
The severity of psoriasis is classified as mild in 60% of patients, moderate in 30% and severe in 10%.
Evaluation of comorbidities may include:
Patients with psoriasis should ensure they are well informed about their skin condition and its treatment. There are benefits from not smoking, avoiding excessive alcohol and maintaining optimal weight.
Mild psoriasis is generally treated with topical agents alone. Which treatment is selected may depend on body site, extent and severity of psoriasis.
Most psoriasis centres offer phototherapy with ultraviolet (UV) radiation, often in combination with topical or systemic agents. Types of phototherapy include
Moderate to severe psoriasis warrants treatment with a systemic agent and/or phototherapy. The most common treatments are:
Other medicines occasionally used for psoriasis include:
Systemic corticosteroids are best avoided due to a risk of severe withdrawal flare of psoriasis and adverse effects.
Biologics or targeted therapies are reserved for conventional treatment-resistant severe psoriasis, mainly because of expense, as side effects compare favourably with other systemic agents. These include:
Many other monoclonal antibodies are under investigation in the treatment of psoriasis.
Oral agents working through the protein kinase pathways are also under investigation. Several JAK (Janus kinase) inhibitors are under investigation for psoriasis, including tofacitinib and the TYK2 (tyrosine kinase 2) inhibitorBMS-986165; both are in Phase III trials for psoriasis.
See the rest here:
- Why Jews With Psoriasis Might Think Twice About Seeking Treatment in Jordan - December 20th, 2013 [December 20th, 2013]
- Skin conditions leave emotional scars - December 20th, 2013 [December 20th, 2013]
- Psoriasis Free Forever Review | How This Program Helps People Treat The Root Causes Of Their Psoriasis Symptoms ... - December 20th, 2013 [December 20th, 2013]
- Psoriasis | University of Maryland Medical Center - December 20th, 2013 [December 20th, 2013]
- Psoriasis Treatment, Symptoms, Pictures, Types, Prognosis ... - December 20th, 2013 [December 20th, 2013]
- Psoriasis - National Library of Medicine - PubMed Health - December 20th, 2013 [December 20th, 2013]
- Psoriasis: MedlinePlus - U.S. National Library of Medicine - December 20th, 2013 [December 20th, 2013]
- Psoriasis - Wikipedia, the free encyclopedia - December 20th, 2013 [December 20th, 2013]
- Psoriasis Symptoms, Treatment, Causes, Medication Information ... - December 21st, 2013 [December 21st, 2013]
- Psoriasis Free For Life Review - Watch This Before You Buy - Video - December 21st, 2013 [December 21st, 2013]
- Natural Psoriasis Relief in Seattle, Washington - Video - December 21st, 2013 [December 21st, 2013]
- PSORIASIS VULGARIS - Video - December 21st, 2013 [December 21st, 2013]
- Top 5 Powerful Home Remedies For Psoriasis - Video - December 21st, 2013 [December 21st, 2013]
- Psoriasis feedback after hijama - Video - December 21st, 2013 [December 21st, 2013]
- 9 Home Remedies For Scalp Psoriasis - Video - December 22nd, 2013 [December 22nd, 2013]
- Manga - Psoriasis - Video - December 22nd, 2013 [December 22nd, 2013]
- How to treat psoriasis | In Good Shape - Interview - Video - December 22nd, 2013 [December 22nd, 2013]
- Best Scalp Psoriasis Treatment - Video - December 22nd, 2013 [December 22nd, 2013]
- Sandoz begins Phase III clinical trial for biosimilar adalimumab - December 23rd, 2013 [December 23rd, 2013]
- Psoriasis - Wikipedia, la enciclopedia libre - December 23rd, 2013 [December 23rd, 2013]
- What Is Psoriasis? - December 23rd, 2013 [December 23rd, 2013]
- Psoriasis Treatment Medical Course - Video - December 23rd, 2013 [December 23rd, 2013]
- Healing Psoriasis Hypnosis Session - Video - December 23rd, 2013 [December 23rd, 2013]
- Natural Farm cure for Skin Problems like Psoriasis - Video - December 26th, 2013 [December 26th, 2013]
- Psoriasis - 100% Natural Treatment Shivax® - December 27th, 2013 [December 27th, 2013]
- Psoriasis Symptoms, Causes, Treatment - What is psoriasis ... - December 28th, 2013 [December 28th, 2013]
- 79 PSORIASIS SYMPTOMS HOMEOPATHY TREATMENT K N SRIDHAR P3 - Video - December 28th, 2013 [December 28th, 2013]
- 79 PSORIASIS SYMPTOMS HOMEOPATHY TREATMENT K N SRIDHAR P2 - Video - December 28th, 2013 [December 28th, 2013]
- 79 PSORIASIS SYMPTOMS HOMEOPATHY TREATMENT K N SRIDHAR P1 - Video - December 28th, 2013 [December 28th, 2013]
- Can Acupuncture treat psoriasis and other scalp disorders? - Video - December 28th, 2013 [December 28th, 2013]
- Psoriasis - Wikipédia - December 31st, 2013 [December 31st, 2013]
- Psoriatic nails - Wikipedia, the free encyclopedia - December 31st, 2013 [December 31st, 2013]
- How to Cure Psoriasis - Psoriasis Symptoms, Treatment, Causes, Medication Information - Video - December 31st, 2013 [December 31st, 2013]
- Psoriasis Chronicles - Dealing with Depression, Anxiety and Anger - Video - January 2nd, 2014 [January 2nd, 2014]
- How to Prevent Psoriasis Flare-Ups - January 4th, 2014 [January 4th, 2014]
- Psoriasis Treatment | Health Plus | Studio N - Video - January 4th, 2014 [January 4th, 2014]
- Ayurvedic Remedy for Psoriasis - By Panditha Elchuri - Video - January 4th, 2014 [January 4th, 2014]
- Silica Gel For Psoriasis / Neurodermatitis - Video - January 4th, 2014 [January 4th, 2014]
- comment traiter son psoriasis détail oubliés - Video - January 4th, 2014 [January 4th, 2014]
- Psoriasis tends to relapse after stopping Methotrexate, shown in a case at Life Force - Video - January 4th, 2014 [January 4th, 2014]
- hiking nevada Health and Wellness Enthusiast Dawn Talks About Managing Plaque Psoriasis hiking watch - Video - January 5th, 2014 [January 5th, 2014]
- Guttate psoriasis - Wikipedia, the free encyclopedia - January 7th, 2014 [January 7th, 2014]
- Biofeedback May Help Control Stress-Related Diseases - January 8th, 2014 [January 8th, 2014]
- Psoriasis can be managed with proper treatment - January 10th, 2014 [January 10th, 2014]
- CNN anchor: How I fight psoriasis - January 10th, 2014 [January 10th, 2014]
- Psoriasis - My Home Remedies - January 10th, 2014 [January 10th, 2014]
- Psoriasis: MedlinePlus en español - January 10th, 2014 [January 10th, 2014]
- Psoriatic arthritis - Wikipedia, the free encyclopedia - January 10th, 2014 [January 10th, 2014]
- CNN anchor Zain Verjee: How I fight psoriasis - January 11th, 2014 [January 11th, 2014]
- Testimonio psoriasis - Video - January 14th, 2014 [January 14th, 2014]
- Heroin addict with severe Psoriasis - Video - January 15th, 2014 [January 15th, 2014]
- biospray for Psoriasis - Video - January 15th, 2014 [January 15th, 2014]
- Psoriasis - Psoriasis Free For Life - Video - January 15th, 2014 [January 15th, 2014]
- 8 Cure For Scalp Psoriasis - Video - January 15th, 2014 [January 15th, 2014]
- Learn about plaque psoriasis, guttate psoriasis, inverse ... - January 16th, 2014 [January 16th, 2014]
- Psoriasis - Symptoms, Triggers, and Causes of Psoriasis on WebMD - January 16th, 2014 [January 16th, 2014]
- Psoriasis Causes, Symptoms, Treatments, Home Remedies - January 16th, 2014 [January 16th, 2014]
- Psoriasis Treatment - Dermasis Psoriasis Cream - My Honest Review - Video - January 16th, 2014 [January 16th, 2014]
- TV Commercial Psoriasis Speaks Couple Looking At Rings In Jewelery Store Emotional - Video - January 16th, 2014 [January 16th, 2014]
- TV Commercial Humira Psoriasis Medication Salon Clearer Skin is Possible - Video - January 16th, 2014 [January 16th, 2014]
- Psoriasis Symptoms, Causes and Treatment Pictures Slideshow - Video - January 16th, 2014 [January 16th, 2014]
- Psoriasis - Medscape Reference - January 19th, 2014 [January 19th, 2014]
- 5 Home Remedies For Scalp Psoriasis - Video - January 19th, 2014 [January 19th, 2014]
- Ikonsulta Mo: Medical Advise on Psoriasis - Video - January 19th, 2014 [January 19th, 2014]
- Patient Recruitment: Television Campaign for Severe Psoriasis - Video - January 23rd, 2014 [January 23rd, 2014]
- Patient Recruitment: Television Campaign for resistant, summertime Mild to Moderate Psoriasis - Video - January 23rd, 2014 [January 23rd, 2014]
- Dr stephen ferguson ND PhD chronic fatigue psoriasis cured - Video - January 23rd, 2014 [January 23rd, 2014]
- Noir Naturals Age of Innocence (Unscented) Goat's Milk Lotion for Psoriasis Relief - Video - January 23rd, 2014 [January 23rd, 2014]
- New biologic drugs offer relief for psoriasis sufferers - January 24th, 2014 [January 24th, 2014]
- Psoriasis traitement appliquer le lait pour le corps ISO UREA MD Vidéo La Roche Posay INFO PSO - Video - January 24th, 2014 [January 24th, 2014]
- Psoriasis - Video - January 24th, 2014 [January 24th, 2014]
- Coping with psoriasis - Video - January 26th, 2014 [January 26th, 2014]
- Exfoliative Dermatitis/Psoriasis Vulgaris with Psoriatic Arthritis with English Subtitles - Video - January 26th, 2014 [January 26th, 2014]
- Psoriasis skin care routine 2014 - Video - January 27th, 2014 [January 27th, 2014]
- How to treat psoriasis effectively - By Franziska Ringpfeil, Board Certified Dermatologist - Video - January 28th, 2014 [January 28th, 2014]
- My Psoriasis 411: Apple Cider Vinegar Tutorial for Scalp Treatment - Video - January 29th, 2014 [January 29th, 2014]
- 12 Best and Worst Foods for Psoriasis - January 31st, 2014 [January 31st, 2014]
- Psocial Psoriasis en radio Tagoror - Video - January 31st, 2014 [January 31st, 2014]
- Psocial Psoriasis en Canarias Hoy - Video - January 31st, 2014 [January 31st, 2014]
- Psoriasis Natural Treatment that Workswww savevid com - Video - January 31st, 2014 [January 31st, 2014]