INTERNATIONAL JOURNAL OF PHARMACY & LIFE SCIENCES Psoriasis: A comprehensive review (original) (raw)
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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.
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
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).
Treatment and Management of Psoriasis: A review
Zenodo (CERN European Organization for Nuclear Research), 2021
Psoriasis is a common, chronic inflammatory skin disease affecting many people of the world now a days. Psoriasis is principally an immunological T lymphocyte-driven disease, relating both the distinctive and T-cell-mediated immune systems. The mostly affected sites comprise the scalp, extensor surfaces of the knees and elbows, umbilicus, genitalia, anterior lower legs and nails. This disease can significantly impact on a patient's quality of life and is connected comorbidities comprise psoriatic arthritis, obesity and the metabolic syndrome, diseases of cardiovascular system and liver with fats. Provided treatment is depends on disease severity, quality of life, patient preference, relevant comorbidities and efficacy of the treatment. Treatment such as topical emollients, tar, analogues of vitamin D and corticosteroids are first line for local/mild disease. Psoriasis cannot be fully cured once it affects a person but can be managed by proper taking care of the skin according to the doctors. Patient counseling can also add benefits in the management of psoriasis.
Psoriasis pathophysiology and impact on life
International Journal Of Community Medicine And Public Health, 2018
Psoriasis is a chronic skin disorder with various morphology, distribution, severity, and course of disease. The goal of the management is to control disease activity to a level that allows a sufficient quality of life with minimal toxicity from the treatment itself. Unfortunately, 25% of patients suffering from psoriasis experience major psychological distress. Its chronic nature with associated comorbidities has a negative impact on quality of life. We conducted this review using a comprehensive search of MEDLINE, PubMed and EMBASE from January 1996 to March 2017. The following search terms were used: psoriasis, pathogenesis of psoriasis, psoriasis management, quality of life in psoriasis patients. We tried to study the pathogenesis, and management of psoriasis, and understand its effect on the quality of life of patients. Due to the chronic nature and its obvious visibility on skin, many patients suffer from major psychological adverse effects. In majority of the time the health ...
Current Trends in Treatment and Management of Psoriasis: An Updated Review
International Research Journal Of Pharmacy, 2018
Psoriasis is a proliferative autoimmune skin disease which is affecting 2% of worldwide population. It is characterized by itching, skin rashes and red scalps with white scales on the skin. Though, different types are reported, common existing form of psoriasis is plaque psoriasis. The epidemiology of disease seems to be remains unknown, but the incidence varies, surrounded by the different countries. The pathophysiology of the disease appears as drastic cellular changes occur both in epidermis and dermis which narrates to keratinocyte hyperproliferation. Earlier available medications like emollients and some keratolyitic agents has not proven promising role in controlling the disease burden. But, in advance regimen, with wide range of therapeutic mediators like coal tar, anthranilin, calcineurin inhibitors, methotrexate, retinoids, cyclosporine are proven to be effective in treating mild psoriasis to severe psoriasis. In recent years, phototherapy has once again emerged as most recommended due to ease of treatment and its intoxications. Hence, this review emphasizes the therapeutic agents available in market and its effectiveness in controlling the psoriasis.
Puri A, Sengupta S, Sharma B, Sabharwal R, Kapoor K. Update on Psoriasis. J Sci Soc 2013;40:121-7
2013
Psoriasis is a common skin disorder characterized by focal formation of raised plaques that constantly shed scales derived from excessive growth of skin epithelial cells. The disease is characterized by a series of linked cellular changes in the skin: hyperplasia of epidermal keratinocytes, vascular hyperplasia and ectasia, and infiltration of T lymphocytes, neutrophils, and other types of leukocyte in the affected skin. Psoriasis is now considered as a T cell-mediated inflammation of the skin. Types of psoriasis that may be clinically encountered include plaque psoriasis, guttate psoriasis, erythrodermic psoriasis, pustular psoriasis, nail psoriasis, psoriatic arthritis, and scalp psoriasis. Psoriasis is believed to be genetically linked but can also be triggered by mechanical, ultraviolet, and chemical injury; various infections; prescription drug use; psychological stress; smoking; and other factors.
Psoriasis and Its Treatment: A Review
Journal of Biological and Chemical Chronicles
The psoriasis is chronic skin disease that causes the symptoms like abnormal skin cell growth, red circles, patches etc. It is also known as erythematous papules with silvery scales. The two types of study are used for the pathologic changes on the cellular levels. The most of cases comes in the age observed age in between the ages of 15 and 30. In the study, the reason for psoriasis disease is due to a genetic susceptibility as well as an environmental response. The estimated annual cost $32.5 billion for treating psoriasis in United States. There are number of available marketed treatment for psoriasis in different formulations like topical and systemic formulations. But, topical formulation was considered as best potent method as compared with systemic one due to the less adverse effects and targeted methods. Herbal, homeopathic approaches are also helps to control the growth of psoriasis with low side effects as compared with topical allopathic drugs.
An Approach for the Treatment of Psoriasis: Pharmacological & Non-Pharmacological Therapy
International journal of engineering applied science and technology, 2020
Psoriasis is non-pandemic contamination and having a repulsive skin issue, which can likewise incorporate an entire arrangement of the individual. It is long-lasting running auto-immune sicknesses that were described by white to red shading patches of unusual skin with the patches of flaky and irritated. They were shed prematurely in as little as 7 days to 10 days. Commonly involved sites for the psoriasis are the sacral region, upper back, scalp, gluteus, umbilicus, underneath the privates and bosoms, shins and sacrum, and the extensor surfaces of furthest points, particularly on the knees and elbows, palms, fingers and toes, soles. The common symptoms of psoriasis are dry skin, painful swollen joints, depression, signs of pustular psoriasis, itching, and burning sensation, and genital lesions, etc. The lesion can be seen as a pink to salmon-color plaque which is covered by loose adheres of silver-white scale. There is also an epidermal thickening (which is also called as acanthosis), and it is in the regular downward elongation of rete ridges. These kinds of changes predominantly happen at the time development progress of keratinocytes which are instigated by inflammatory messengers which influence three subtypes of WBC. These inflammatory messengers help in the incitement of the keratinocytes and hence it causes transformations of qualities that are associated with the skin capacities for development or the advancement of psoriasis. Major of treatment for psoriasis are set to the standardization of skin just as decrease or freeing from the plaques, papules, and erythema, and furthermore scales.