Psoriasis : What Is It ? Natural Treatment, Etiology, Management Advice, and Advice For Patient

Psoriasis : What Is It ? Natural Treatment, Etiology, Management Advice, and Advice For Patient

Psoriasis is a chronic inflammatory and proliferative disorder of the skin clinically manifested as well-circumscribed, erythematous papules and plaques covered with silvery scales typically located over the extensor surfaces and scalp. While specific systemic and environmental factors are known to influence the disease, it hasunpredictable course with spontaneous improvement and exacerbations of lesions.

Immune system dysfunction in the background of a genetic predisposition is believed to be at the core of the disease process.

Epidemiology Psoriasis affects 1-2% the population in all geographic regions. The Male and female ratio is 1 to 1 and the peak age of onset is in the 20s

Etiology and Pathogenesis

Despite being the subject of intensive research over the years, the precise etiology of psoriasis still remains unknown. Genetic factors can be implicated on the basis of population surveys, twin studies (65% concordant in monozygotic twins) and analysis of pedigrees. The precise mode of inheritance is uncertain, thought to be polygenic.

Provocating factors : A number of factors may provoke onset or aggravation of psoriasis.

Stress - Many patients report an increase in the psoriasis severity with psychological stress.

Trauma - All types of trauma can lead to the development of plaque psoriasis (eg, physical, chemical, surgical, infective, and inflammatory). The development of psoriatic lesions at a site of injury is known as the Koebner phenomenon.

Infection – An acute eruption of guttate psoriasis may be provoked by streptococcal pharyngitis. HIV infection may be associated with increase in disease severity.

Drugs - Lithium, withdrawal of systemic corticosteroids, beta-blockers, antimalarials, and NSAIDs may cause flare of the disease.

Sunlight – although sunlight is generally considered to be beneficial for most of the patients, strong sunlight may worsen the disease in a small minority.

Alcohol - Alcohol is considered a risk factor for psoriasis, particularly in young to middle-aged males.

Endocrine – the disease state may fluctuate with hormonal changes. Psoriasis may begin during puberty. Pregnancy may improve the disease while a flare may occur during post-partum period.

Pathogenesis of Psoriasis

The alterations in psoriasis includes activation of T- lymphocytes against unknown antigen → increased cytokine release → increased accumulation and activation of lymphocytes and antigen-presenting cells (APCs), neutrophils which results in increased proliferation of keratinocytes. Accelerated epidermal cell proliferation results from recruitment of a large proportion of resting cells into the proliferative cycle.

The pathology of psoriasis reflects the underlying immune-mediated inflammation and cellular hyperproliferation.

Histopathologic features

- Hyperkeratosis with parakeratosis (presence of nucleated keratinocytes in the stratum corneum due lack of maturation of cells since rapid transit time do not permit normal maturation of cells). Reduced or absent granular layer.
- Acanthosis with elongation of rete ridges and a corresponding upward elongation of dermal papillae.
- Infiltrate: Mononuclear in dermis and polymorphs in the upper epidermis forming collections called ‘microabscess of Munro’.
- Upper dermal vasculature shows dilatation and tortuosity.

Types of presentations : the patients may present in a variety of ways with overlapping features being not uncommon.

1. Chronic plaque psoriasis (psoriasis vulgaris). The commonest type of psoriasis,presenting with typical plaques of psoriasis of the extensors surfaces like knee, pretibial area elbows and trunk, back and scalp. The plaques stay for months to years without progression that is why it is called stable plaque.

2. Guttate psoriasis (acute eruptive psoriasis). Generally uncommon but appears in childhood and young adults. Acute eruption of drop-shaped lesions distributed widely over the body. Usually it follows streptococcal throat infection.

3. Flexural psoriasis (psoriasis inversa): lesions are present over the flexors and intertriginous areas (axilla, groin, umbilical region, inframammary folds) the lesions may be moist and lack the typical scaling.

4. Generalized pustular psoriasis may occur as an explosive eruption of generalized pustules with systemic disturbances. This may follow withdrawal of systemic steroid therapy or application of irritants

5. Pustular psoriasis. May be localized or generalized. Localized pustular psoriasis usually presents with persistent pustular eruptions of the hands and feet.

6. Erythrodermic psoriasis (more than 90% of the body surface area affected).

Psoriasis may present with Erythroderma (exfoliative dermatitis). There is generalized inflammatory erythema with profuse scaling. The mortality is very high without proper care( exfoliative dermatitis and it management)

7. Arthropathic psoriasis. Arthritis may accompany any variety of psoriasis in about ten per cent of patients. Psoriatic arthritis may take several forms. The commonest type is asymmetrical oligoarthritis, other types are: symmetrical seronegative rheumatoidlike disease , distal interphalangeal involvement( most characteristic, but relatively rare), axial skeletal involvement, and a destructive mutilating form (arthritis mutilans)

The typical lesions of psoriasis have the following features;

The lesions are very well marginated with distinct border and are raised above the surface. The plaques usually have a diameter of one to several centimeters and have a round or oval shape. The lesions may merge together to give rise to geographic patterns. The lesions are covered with silvery white, mica-like, loosely adherent scales which, on removal may reveal punctate bleeding points (Auspitz sign)

Symmetry: the lesions are symmetrically disposed on extensor surfaces of the body. Typical
sites of affection are the elbows, knees, shin, knuckles, sacral areas and scalp.

Management of psoriasis

Topical therapy is generally indicated when psoriasis is limited to less than 20% of the body surface.
Explain to the patient the recurrent nature of the disease.

Anthralin

Salicylic acid ointment has been traditionally used for its keratolytic effect. Either alone or in combination with coal tar or topical corticosteroids, salicylic acid (2% to 10%) helps to soften and remove psoriatic scale.

Coal tar 5-10% Ultraviolet Radiation although coal tar has been used to treat psoriasis for decades, its mechanism of action is still not well understood. Some studies have shown that coal tars inhibit DNA synthesis, thus acting as a cytostatic

Moisturizer (Vaseline, urea 10 ointment of cream) and expose to sun. Moisturizer (Emollients) help to hydrate, soften, and loosen psoriatic plaques. A strong topical steroid once or twice daily, cover with salicylic acid 2- 10 if necessary.

Urea 10% cream or ointment as an emulsifier, aqueous cream in folds. - Treat any super infection with betadine or antibiotics if necessary.

Vitamin D3 analogues: Calcitriol and Calcipotriol, act by regulating keratinocyte proliferation and maturation. Retinoids Tazarotene, available in 0.05% and 0.1% gels, is a topical retinoid for the treatment of psoriasis; can regulate keratinocyte proliferation and maturation. Main side effect is irritation. Special precaution: women of child-bearing age.

PUVA photo chemotherapy -also known as PUVA, a photosensitizing drug methoxsalen (8-methoxypsoralens) is given orally, followed by ultraviolet A (UVA) irradiation to treat patients with more extensive disease. UVA irradiation utilizes light with wavelengths 320-400 nm. PUVA, decreases cellular proliferation by interfering with DNA synthesis, and also induces a localized immunosuppression by its action on T lymphocytes.

Therapy usually is given 2-3 times per week on an outpatient basis, with maintenance treatments every 2-4 weeks until remission. Adverse effects of PUVA therapy include nausea, pruritus, and burning. Long-term complications include increased risks of photo damage and skin cancer. PUVA has been combined with oral retinoid derivatives to decrease the cumulative dose of UVA radiation to the skin.

Systemic therapy

In severe cases, retinoids, methotrexate, cyclosporine, and hydroxyurea may be used. Systemic corticosteroids are generally contraindicated, and they can exacerbate a very severe type of psoriasis called pustular psoriasis, which has a high rate of mortality.

Psoriasis : What Is It ? Natural Treatment, Etiology, Management Advice, and Advice For Patient 2018-12-24T06:20:00-08:00 Rating: 4.5 Diposkan Oleh: David Maharoni