- Patients with psoriasis have a lifelong illness that may be very visible and emotionally distressing. There is a strong need for empathy and a caring attitude in interactions with these patients.
- Psoriasis is a progressive T-lymphocyte–mediated systemic inflammatory disease that results from a complex interplay between multiple genetic factors and environmental influences. Genetic predisposition and precipitating “trigger” factors play a role in the “march of psoriasis.” This march of innate and adaptive immune responses result in clinical expressions (e.g., keratinocyte proliferation) and is possibly responsible for psoriatic comorbidities.
- Diagnosis of psoriasis is usually based on recognition of the characteristic psoriatic lesion and not based on laboratory tests.
- Treatment goals for patients with psoriasis are to minimize signs such as plaques and scales, alleviate symptoms such as pruritus, reduce the frequency of flare-ups, ensure appropriate treatment of associated comorbid conditions such as psoriatic arthritis or clinical depression, and minimize treatment-related morbidity.
- Management of patients with psoriasis generally involves both nonpharmacologic and pharmacologic therapies.
- Nonpharmacologic alternatives such as stress reduction and the liberal use of moisturizers may be very beneficial and should always be considered and initiated when appropriate.
- Pharmacologic alternatives for psoriasis include topical agents, phototherapy, and systemic agents (both traditional agents and newer biologic response modifiers).
- Pharmacologic therapy is generally guided by the severity of disease, advancing from topical agents to phototherapy to systemic agents as needed.
- Rotational therapy (i.e., rotating systemic drug interventions) is a means to minimize drug-associated toxicities. However, continuous treatment has replaced rotational or sequential therapy and is now the standard of care for many dermatologists.
- Some biologic response modifiers (BRMs) have proven efficacy for psoriasis; however, there are differences among these agents, including mechanism of action, duration of remission, and adverse-effect profile. BRMS are often used for moderate-to-severe psoriasis and may be first-line therapy especially if comorbidities exist.
On completion of the chapter, the reader will be able to:
Discuss the etiology of psoriasis, including genetic and immune changes and predisposing factors.
Describe the pathophysiology of psoriasis, including the types of psoriasis.
Describe the comorbidities and risks for patients with psoriasis.
Discuss the clinical presentation, including diagnostic considerations.
Compare and contrast the treatment modalities for psoriasis, including topical therapies, systemic therapies, and phototherapies.
Recommend an appropriate treatment plan for a patient with psoriasis.
Recommend appropriate monitoring parameters for a patient with psoriasis.
Formulate appropriate counseling information for a patient with psoriasis.
Psoriasis is a chronic disease that waxes and wanes. It is never cured, and it is now known to be associated with multiple comorbidities including heart disease, diabetes, and the metabolic syndrome. The signs and symptoms of psoriasis may subside totally (go into remission) and then flare up again (exacerbation). Triggers include stress, seasonal changes, and some drugs. Disease severity may vary from mild to disabling. Psoriasis imposes a burden of disease that extends beyond the physical dermatologic manifestations.
Patients with ...