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Source: Law RM, Gulliver WP. Psoriasis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7999031. Accessed June 24, 2012.

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  • Chronic inflammatory skin disease characterized by recurrent exacerbations and remissions of thickened, erythematous, and scaling plaques.

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  • T lymphocyte–mediated inflammatory disease resulting from genetic predisposition coupled with precipitating factors that trigger abnormal immune response.

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  • Receptors on T lymphocytes interact with antigens on surface of antigen-presenting dendritic cells and macrophages.
  • Activated T cells migrate into skin and secrete cytokines (e.g., interferon-γ and interleukin 2 [IL-2]) that induce pathologic skin changes.
  • Genetic component may involve human leukocyte antigens (HLA) Cw6, TNF-α, and IL-3.

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  • Affects about 2% of population in United States and Europe.
  • Worldwide prevalence varies between 0.1–3%, with variations due to racial, geographic, and environmental differences.
  • Affects males and females equally; onset usually before age of 40.

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  • Factors implicated in development of psoriasis:
    • Skin injury
    • Infection
    • Drugs
    • Smoking
    • Alcohol consumption
    • Obesity
    • Psychogenic stress
  • Therapies that may exacerbate psoriasis:
    • Lithium
    • β-blockers
    • Antimalarials
    • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Withdrawal of corticosteroids

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Signs and Symptoms

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  • Well-demarcated, erythematous, red-violet skin lesions at least 0.5 cm in diameter; typically covered with silver flaking scales.
  • May be single lesions at predisposed areas (e.g., knees and elbows) or generalized over wide body surface area (BSA).
  • Pruritus may be severe and require treatment to minimize excoriations from frequent scratching.
  • Psoriatic arthritis involves both psoriatic lesions and inflammatory, arthritis-like symptoms.
    • Distal interphalangeal joints and adjacent nails most commonly involved, but knees, elbows, wrists, and ankles may also be affected.

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Means of Confirmation and Diagnosis

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  • Characteristic skin lesions on physical examination
  • Classification as mild, moderate, or severe based on BSA affected and Psoriasis Area and Severity Index (PASI) measurements.

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Diagnostic Procedures

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  • Skin biopsies not diagnostic of psoriasis.

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Differential Diagnosis

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  • Minimize or eliminate skin lesions.
  • Alleviate pruritus
  • Reduce frequency of flare-ups.
  • Avoid adverse treatment effects.
  • Provide appropriate counseling (e.g., stress reduction).

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  • Figure 1: Treatment algorithm for mild to moderate psoriasis
  • Figure 2: Treatment algorithm for moderate to severe psoriasis

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Figure 1.
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Treatment algorithm for mild to moderate psoriasis. Reprinted with permission from Wells BG, DiPiro JT, Schwinghammer TL, et al. Pharmacotherapy Handbook. 8th ed. New York: McGraw-Hill, 2012.

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Figure 2.
Graphic Jump Location

Treatment algorithm for moderate to severe psoriasis. Reprinted with permission from Wells BG, DiPiro JT, Schwinghammer TL, et al. Pharmacotherapy Handbook. 8th ed. New York: McGraw-Hill, 2012.

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  • Stress reduction (e.g., guided imagery, stress management)
  • Nonmedicated moisturizers
  • Oatmeal baths
  • Avoidance of harsh soaps and detergents
  • Cleansing with tepid water, preferably with lipid- and fragrance-free cleansers
  • ...

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