SKINIPEDIA - Skin Encyclopedia: Psoriasis Study

Abstract

Psoriasis is a chronic inflammatory skin disease. Associated comorbidities or risks may include psoriatic arthritis, obesity, depression, smoking, diabetes, hyperlipidemia, an increased risk of cardiovascular disease with myocardial infarction, or an increased risk of lymphoma. The clinical presentation of psoriasis can range from the more common red scaling elevated plaques on the elbows, knees, or scalp to the less common superficial pustules scattered on the palms or soles, or in rare cases widespread pustules on the body. More specifically, the clinical spectrum of psoriasis includes the plaque, guttate, small plaque, inverse, erythrodermic, and pustular variants. The determinants of the clinical severity of psoriasis, the risk of comorbidities, and the quality of life of a psoriatic patient are influenced by multiple factors. At the minimum, these include variations in the quality and type of psoriasis, the quantity of skin involved, and the distribution of skin lesions (including special areas such as the scalp, nails, face, intertriginous regions, and palmoplantar surfaces). Objective measures used to quantify the severity of psoriasis, including the body surface area involved, Physician’s Global Assessment, Psoriasis Area and Severity Index, and quality of life measures, are all assessments that can be useful in guiding approaches to management and therapeutics. In this paper, we review the clinical spectrum of psoriasis, the differential diagnoses, measures and determinants of severity, and the recommendations on when to refer a patient to a specialist in psoriasis. We also briefly review the comorbidities, and note the importance of referring the psoriatic patient to the internist/general practitioner for evaluation and management for these comorbidities.

Copyright © 2009 S. Karger AG, Basel

Psoriasis is a chronic inflammatory disorder of the skin that can affect a person at any age. It can present in various patterns and forms. The most common morphologic presentation of psoriasis is that of the plaque type, with the second form being the pustular type. Its course is variable and unpredictable. It may be episodic with short or long periods of reported complete clearance, or be unrelenting and persistent with waxing and waning of activity influenced by identifiable or unidentifiable triggers and alleviators. Initially it may be indolent and virtually unrecognizable as ‘psoriasis’ by the patient or physician, only to present itself in a more classic presentation during times of emotional, physical, or medical stress.

Throughout history, psoriasis has been understood and misunderstood as a disease solely of the skin. Its consequences on the social, psychological, physical, and spiritual fabric of the individual and those close to him/her have been increasingly recognized. However, by the end of the 20th century, the psoriasis model had evolved to become a disorder of the skin and joints. Accepted as the consequence of an immune system gone awry, psoriasis has become a model of a skin disease with ‘systemic inflammation’. Much work is now being done to understand the association of comorbidities with psoriasis and their impact on the patient and society. With the advances in technology and medical research, the current pathogenetic model for psoriatic disease includes a combination of genetic predisposition, immunologic dysfunction, and keratinocyte factors that lead to the formation of psoriasis. Along with these, the roles of the peripheral and central nervous systems, vascular system, adaptive and innate immune systems, environmental factors, and infectious agents contribute to the formation of psoriasis. In this paper, we will review the clinical spectrum, the differential diagnosis, and the severity of psoriasis as they relate to quality of life, therapeutic options, and signs that indicate when further evaluation by a dermatologist or a specialist in psoriatic disease is warranted.

Psoriasis Study Part II continues here.

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