A Review of the Clinical Variants and the Management of Psoriasis (original) (raw)
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Psoriasis - A Clinicopathological Correlation in a Tertiary Care Hospital
https://www.ijhsr.org/IJHSR\_Vol.10\_Issue.12\_Dec2020/IJHSR\_Abstract.02.html, 2020
Background-Psoriasis is a group of common chronic inflammatory and proliferative skin conditions associated with systemic manifestations in many organ systems. Its prevalence is poorly defined in India and its presentation varies with different stages and can simulate various other conditions also. Materials and Methods-This retrospective study was conducted to study the clinical and histomorphological variants of psoriasis and incidence of age and sex distribution in various types of psoriasis in a tertiary care hospital. 9 parameters were used to assess and categorize the various types of psoriasis-1) Hyperkeratosis 2) Parakeratosis 3) Munro's microabscesses 4) Pustule of Kogoj 5) Supra-papillary thinning 6) Elongated rete ridges 7) Inflammatory infiltrate in the dermis 8) Capillary proliferation and dilatation 9) Spongiosis Results-A male preponderance with maximum cases in the 31-40 years age group was found in our study. The predominant histological type was that of Psoriasis vulgaris (63%) followed by Chronic Plaque Psoriasis (18%). Amongst the cutaneous features of psoriasis, Scales were the most common (92%) followed by plaques (83%). The most commonly involved site was that of the upper extremities (79%). Amongst the epidermal histopathological features of psoriasis, acanthosis was seen in 100% cases followed by hyperkeratosis in 95% cases. The dermal features showed dermal infiltration in 97% cases. Conclusion-Psoriasis has multiple relapses and remissions and also varied clinical presentations. Its diagnosis at the earliest is important to halt its progression and histomorphology helps in that. This study concluded that even though most changes occur in the epidermis in cases of psoriasis, there are a few dermal changes too which can aid the pathologist in arriving at the diagnosis. This study also helped in finding the prevalence of this disease in India, as there is paucity of the same in our country. Thus overall, this study helped in finding the various histomorphological features which are diagnostic of psoriasis as well as their incidence in various subtypes of psoriasis. It also adds to the data of the disease in our country and will help in better clinical management as well as triage of patients.
The main objectives of this review article are to discuss different aspects of psoriasis including its etiology, pathogenesis, co-morbidities, complications and management etc. and to discuss about psychosocial impact & quality of life in the patients of psoriasis. Psoriasis is one of the most common dermatologic diseases affecting upto 2.5 % of world population. The disease psoriasis, most commonly manifests on the skin of the elbows, knees, scalp, lumbosacral areas, intergluteal clefts and glans penis. In 30% of patients, the joints are also affected. The skin is the important organ of communication with the external world and have an eternal relationship with mind (psyche). Therefore, more than a cosmetic nuisance, psoriasis produces anxiety, depression and other psychological problems that affect the quality of life. Psychological factors have traditionally been associated with the onset, development and persistence of psoriasis. Stress is emphasized as one of the major important factors in the initiation or exacerbation of psoriasis. Patients of psoriasis always experience physical, mental and socio-economic embarrassment in the society. This embarrassment leads to mental stress which further causes aggravation of pre-existing disease. Psoriasis is now considered a complex, chronic, multifactorial, inflammatory disease with involvement of immunological, genetic and environmental factors. Keywords: Psoriasis, Pathogenesis, Molecular inflammation, Psychosocial, Rasayana
INTERNATIONAL JOURNAL OF PHARMACY & LIFE SCIENCES Psoriasis: A comprehensive review
Psoriasis is fundamentally an inflammatory skin condition with reactive abnormal epidermal differentiation and hyperproliferat ion affecting 2-3 % of world " s population. Pathophysiology of the disease includes main ly the activation and migrat ion of T cells to the dermis triggering the release of cytokines (tumor necrosis factor-alpha TNF-alpha, in particular) which lead to the inflammat ion and the rapid production of skin cells. The possible factors and triggers causing psoriasis include emotional stress, skin injury, systemic infections, certain med ications and intestinal upsets. Various types of psoriasis have been reported such as plaque psoriasis, psoriatic arthritis, scalp psoriasis, flexu ral psoriasis, guttate psoriasis, pustular psoriasis, nail psoriasis, erythrodermic psoriasis which can be diagnosed by clinical findings such as skin biopsies etc. Therapeutic agents that either modulate the immune system or normalize the differentiation program of psoriatic keratinocytes are suggested for treating psoriasis. Based on the type of psoriasis, its location, extent and severity there are various treatment regimens available for psoriasis such as topical agents, phototherapy, systemic agents, and homeopathic approach which can help to control the symptoms. This review aims to cover each and every aspect of the disorder Psoriasis and details of particularly plaque psoriasis as about 80% of people who develop psoriasis have plaque psoriasis.
A Clinico-Pathological Study of Psoriasis and Psoriasiform Dermatitis
Journal of Evidence Based Medicine and Healthcare
BACKGROUND Psoriasis is a chronic skin condition, which can have varied presentation either per se or because of various treatment modalities, which can closely simulate any different dermatological conditions. Hence, a clinicohistopathological correlation is necessary for confirmation of diagnosis and treatment. Very few studies are available in the indexed journals on this subject matter. The present study is aimed to study the clinical and histological features of psoriasiform dermatitis and psoriasis. METHODS This was a longitudinal study consisting of 60 subjects divided into two classes based on clinical diagnosis. Class A patients with diagnosed psoriasis and class B subjects with psoriasiform dermatitis. Many patients have had specific examination and skin biopsy. RESULTS Majority of the cases (40 %) were in the age group of 31 - 40 years. Most common clinical diagnosis was psoriasis (56.7 %) followed by allergic contact dermatitis (13.3 %), pityriasis rosea (8.3 %), lichen ...
Medical Clinical Update
Background Psoriasis is a chronic inflammatory skin disease with a strong genetic predisposition and autoimmune pathogenic traits. Psoriasis vulgaris is also called plaque-type psoriasis, and is the most prevalent type. Psoriasis vulgaris is chronic inflammatory disease and characterized by periods of attack and remission. The chronicity of psoriasis vulgaris can affect patient’s quality of life. Case presentation A 33-year-old male came to Unggul Karsa Medika Hospital’s outpatient department with itchy, scaly, red plaques all over his body except his palms, soles, and face. The patient went to the dermatologist because his symptoms were getting worse and worse. Dermatologic examination concludes the lesions as multiple, generalized, discrete, circumscriptive, elevated, dry, regular-discoid erythematous plaques with psoriasiform scales located at the patient’s head, ears, nape, back, chest, belly, both arms and legs. Conclusion The diagnosis of psoriasis vulgaris was made based on h...
INTERNATIONAL JOURNAL OF PHARMACY & LIFE SCIENCES Psoriasis: A comprehensive review
2020
Psoriasis is fundamentally an inflammatory skin condition with reactive abnormal epidermal differentiation and hyperproliferat ion affecting 2-3 % of world"s population. Pathophysiology of the disease includes main ly the activation and migrat ion of T cells to the dermis triggering the release of cytokines (tumor necrosis factor-alpha TNF-alpha, in particular) which lead to the inflammat ion and the rapid production of skin cells. The possible factors and triggers causing psoriasis include emotional stress, skin injury, systemic infections, certain med ications and intestinal upsets. Various types of psoriasis have been reported such as plaque psoriasis, psoriatic arthritis, scalp psoriasis, flexu ral psoriasis, guttate psoriasis, pustular psoriasis, nail psoriasis, erythrodermic psoriasis which can be diagnosed by clinical findings such as skin biopsies etc. Therapeutic agents that either modulate the immune system or normalize the differentiation program of psoriatic keratin...
Clinical and Histopathological Characteristics of Psoriasis in Dr
2017
Background: Psoriasis is a chronic inflammatory skin disease characterized by alterations in epidermal growth and differentiation. Its primary cause remains unknown, and its clinical and histopathological characteristics sometimes change from time to time. The study aimed to reveal the clinical and histopathological characteristics among psoriasis patients in Dr. Hasan Sadikin General Hospital Bandung. Methods: This study involved 162 medical records of psoriasis patients who visited the Department of Dermato-Venereology and 40 medical records of psoriasis patients who visited the Department of Pathological Anatomy of Dr. Hasan Sadikin Hospital, from 2009 to 2013. Medical record data were collected to describe the patient’s clinical and histopathological characteristics of psoriasis. The collected data were analyzed by frequency distribution. Results: From the clinical medical records, the characteristics found among the psoriasis patients were: 14 (8.6%) having familial history, 16...
2012
Nowadays it is accepted that psoriasis is a chronic, recurrent, immune-mediated inflammatory disease, with a recognised genetic predisposition. The primary immune defect appears to be an increase in cell signalling via chemokines and cytokines that act upregulating gene expression, causing keratinocyte hyperproliferation. T lymphocytes and their cytokines and chemokines appear to be the driver of lesion development and persistence, although other cells, such as endothelial cells, dendritic cells, neutrophils and www.intechopen.com Psoriasis-A Systemic Disease 70 keratinocytes play also an important role, along with other cytokines and growth factors (Chen, de Groot et al.; Wollenberg, Wagner et al. 2002; Sano, Chan et al. 2005). Currently, it is proposed that psoriasis development depends on skin infiltration of T helper (Th)1/Th17 cells that stimulate macrophages and dermal dendritic cells to release mediators that sustain inflammation and cause abnormal keratinocyte proliferation. Interleukin (IL)-23 has the potential to activate Th17 cells, stimulating their survival and proliferation and serving as a key master cytokine regulator in psoriasis (Blauvelt 2008). Th17 cells secrete IL-17, IL-21 and IL-22, with the latter mediating IL-23 induced acanthosis and dermal inflammation (Zheng, Danilenko et al. 2007; Kunz 2009).Therefore, the IL-23/Th17 axis seem to play an important role in psoriasis and explains the hyperplasia of psoriatic keratinocytes (by IL-22), and why neutrophils appear in a chronic inflammatory disease, such as psoriasis (IL-8 production induced by IL-17) (Di Cesare, Di Meglio et al. 2009). More recently, functional interactions between IL-33 and mast cells were also found to contribute to inflammatory conditions, such as psoriasis (Xu, Jiang et al. 2008; Castellani, Kempuraj et al. 2009; Theoharides, Zhang et al. 2010). Nonetheless, the immunologic target molecule that would allow to classify psoriasis as an autoimmune disease, as well as, the events that trigger the inflammatory process, remain to be determined. Patients with psoriasis require an individual management and long-term planning of therapeutic strategies. The ratio risk versus benefit, and the cost-effectiveness of the different treatments should be carefully evaluated. The therapy is chosen in accordance with skin type, clinical history, patient's age, severity of psoriasis and the response to previous treatments. Topical agents are, usually, chosen for milder forms and limited psoriasis; phototherapy, photochemotherapy and systemic agents for moderate and severe psoriasis. Biological therapies, the more recent therapies for psoriasis, are particularly used for severe psoriasis. 2. Epidemiology Psoriasis affects about 125 million of people worldwide (National Psoriasis Foundation), is common in Caucasians and affects equally men and women. The prevalence of psoriasis in the population of Northern Europe and Scandinavia is 1.5-3%. While relatively common in Japanese, it is less common in Chinese, Eskimos, West Africans and North American blacks, and very uncommon in North American and South American natives and aboriginal Australians (Langley, Krueger et al. 2005). The causes for these variations are likely to be genetical and environmental; actually, population-based and twin studies indicate psoriasis as an heritable disease with a polygenic mode of inheritance, with variable penetrance (Elder, Nair et al. 1994). The prevalence of psoriasis seems to be affected by latitude (Vazquez, Carrera et al. 2006). The onset of psoriasis can be at any time of life and, afterwards, it usually persists for life. The mean age of onset of psoriasis vulgaris is at 33 years, and 75% of the patients develop psoriasis before 46 years of age (Nevitt and Hutchinson 1996). It has been also suggested that psoriasis onset is bimodal, with a peak at 16-22 and the other peak at 57-60 years of age. The age of onset is slightly earlier in women than in men. Psoriasis is a relapsing disease, although natural remission occurs in about one-third of the psoriatic patients (Farber and Nall 1974).