Psoriasis: A Genetic Disease
Psoriasis is a genetic disease due to a misstep occurring in the way that a gene works. It is an autoimmune disease, meaning it has an abnormal response to a body part. Psoriasis is an inflammatory skin condition. Color change associated with the plaques is more obvious where there is little scaling of the skin . There are many different forms of psoriasis this disease can be found just about anywhere on the body. It is also associated with other health
Psoriasis And Oral Medications
Psoriasis is a common autoimmune disorder that causes red, thick, inflamed patches of skin. The patches are often covered in whitish silvery scales called plaques. In some cases, the affected skin will crack, bleed, or ooze. Many people feel burning, pain, and tenderness around the affected skin.
Psoriasis is a chronic condition. Even with treatment, psoriasis will never fully go away. Therefore, treatment aims to reduce symptoms and to help the disease enter remission. Remission is a period of little to no disease activity. This means there are fewer symptoms.
There are a range of treatment options available for psoriasis, including oral medications. Oral drugs are a form of systemic treatment, which means they affect your whole body. These drugs can be very strong, so doctors typically only prescribe them for severe psoriasis. In many cases, these drugs are reserved for people who havent had much success with other psoriasis treatments. Unfortunately, they can cause a variety of side effects and issues.
Read on to learn more about the most common oral medications and their side effects and risks.
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Which Medicines Taken By Mouth Or Injected Work Best To Treat A Skin Condition Called Plaque Psoriasis
Key messages
After six months of treatment, medicines called biologics seem to work best to clear patches of psoriasis on the skin.
Longer studies are needed to assess the benefits and potential harms of longer treatment with medicines that are injected or taken by mouth to treat psoriasis.
More studies are needed that compare these types of medicines directly against each other.
What is psoriasis?
Psoriasis is an immune condition that affects the skin, and sometimes the joints. Psoriasis speeds up the production of new skin cells, which build up to form raised patches on the skin known as plaques. Plaques can also be flaky, scaly, itchy, and appear red on white skin, and as darker patches on darker skin tones. Plaque psoriasis is the most common form of psoriasis.
How is psoriasis treated?
Treatments for psoriasis depend on how bad the symptoms are. Around 10% to 20% of people with moderate or severe psoriasis will need to take medicines that affect their immune system, to help control the psoriasis. These medicines are called systemic treatments, because they affect the whole body. These are usually taken by mouth or injected.
Why did we do this Cochrane Review?
There are three different types of systemic medicines to treat psoriasis:
We wanted to find out about the benefits and potential harms of taking systemic medicines to treat psoriasis, and to see if some medicines work better than others.
What did we do?
How up to date is this review?
What did we find?
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Not Alone: Relations And Similarities Of Psoriasis With Other Autoimmune And Autoinflammatory Disorders
The highlights outlined so far show that both adaptive and innate immune processes contribute to psoriasis. Their balance and fine-tuning seem to determine the development of certain clinical forms of the disease, but also organ-specific manifestations. On the one hand, the outlined long-term systemic inflammatory processes probably contribute to the pathogenesis of important metabolic, cardiovascular, and mental concomitant diseases. In these areas, the evidence of a causal relationship is becoming increasingly clear and numerous publications prove this. A more detailed overview can be found elsewhere in this thematic focus. On the other hand, the contoured adaptive and innate immune mechanisms are not specific for psoriasis. Rather, many of them have been foundin varying degrees and weightingsin a whole range of other autoimmune and autoinflammatory diseases. In any case, although this interplay of different components of the immune system is certainly not yet fully understood, parallels with other chronic inflammatory and autoimmune diseases emerge that underpin our current view of psoriasis as a systemic disease.
Similar functional imbalances between Th17 and regulatory T cells as well as similar central cytokines including TNF, IL-23, and IL-17A, but also IL-1, IL-6, IL-17F, and IL-21 contribute to both diseases . Such striking parallels result in the response of both disorders to the same therapies.
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Quit Or Reduce Smoking And Alcohol Consumption
Both smoking and alcohol consumption dehydrate the body. If you are a habitual smoker and drinker, psoriasis will affect you much worse than others. The worst part about tobacco and alcohol is that they will hinder other things you do to deal with psoriasis. Getting rid of the habit is the best thing you can do for long-term health. In the short term, the results will reflect the severity of psoriasis.
While quitting cold turkey is not for everyone, you should at least try to moderate the amount of tobacco and alcohol you have. If you have had a night of heavy drinking, remember to hydrate yourself continuously. The same goes for smokers who smoke throughout the day. The benefits of not smoking and drinking will show up in every aspect of your life.
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How Does Psoriatic Disease Affect The Immune System
Psoriatic disease is an immune-mediated disease that includes psoriasis, along with other comorbidities such as psoriatic arthritis and related systemic inflammation. In people living with psoriasis and/or PsA, the immune system is triggered and activated, acting as though there are harmful pathogens attacking the body.
This inflammation can present with noticeable signs such as discoloration of the skin or swelling around joints. However, the overactive immune system may also lead to inflammation a person cannot see. It can affect in the body, organs and systems and lead to other health conditions associated with psoriatic disease. Comorbidities of psoriatic disease include cardiovascular disease, metabolic syndrome, obesity, hypertension , type 2 diabetes, anxiety and depression, and more.
Researchers who study psoriatic disease are still working to identify the substances inside the body that trigger this immune response. One possibility could be certain kinds of bacteria acting as antigens . For example, sometimes streptococcal infection can trigger a case of guttate psoriasis. Another possible antigen could be antimicrobial peptides, molecules made by the body that are a part of the immune system and that work as antibiotics. *
Supporting Acts: Indispensable Players In The Ensemble Of Psoriasis Immunology
Autoantigen presentation alone does not suffice to induce the psoriatic cascade in genetically predisposed individuals. Rather, costimulatory effects of various gene products orchestrate the activation of the actual autoimmune response. Such risk gene variants modulate inflammatory signaling pathways , peptide epitope processing and/or Th/c17 differentiation .
Table 1. Genetic factors implicated in psoriasis.
These genetic variations create costimulatory signals which modulate innate and adaptive immune mechanisms and shape the proinflammatory environment. In sum and in conjunction with the appropriate HLA molecules and autoantigens, they may eventually exceed the thresholds for activation and maintenance of pathogenic autoimmune and autoinflammatory responses in psoriasis . Likewise, regulatory mechanisms involving programmed death -1 signals have emerged recently as modulators of chronic inflammation in psoriasis . However, the complex interactions of various players are by no means fully understood. Therefore, they are listed here only as a whole.
The autoantigens described so far cannot fully explain the genesis of psoriasis. To give just one example of the latter notion: Psoriatic lesions can also occur in vitiligo foci that do not contain melanocytes . Alterations of resident cell types such as vascular endothelial cells or the cutaneous nervous system are also involved in the disease process . Further research is certainly needed here.
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What Is The Difference Between Scalp Eczema And Scalp Psoriasis
Scalp eczema and scalp psoriasis can look very similar. Theyre both inflammatory skin conditions. Scalp psoriasis typically has well-defined plaques, while scalp eczema is much itchier, even before you see the rash.
Your healthcare provider can tell the difference between scalp eczema and scalp psoriasis during an examination.
A note from Cleveland Clinic
Scalp psoriasis is an autoimmune condition that causes thick patches of skin to develop on your scalp or the skin around your scalp. You may feel self-conscious, and it can be unpleasant if its itchy or painful. However, it isnt contagious, and treatments can help your symptoms improve. Its important to pay attention to your skin, including your scalp. Contact your healthcare provider as soon as you notice any plaques developing on your scalp.
Lifestyle Changes Can Help Too
Eating a healthy diet that includes limiting alcohol consumption, quitting smoking, getting regular exercise, maintaining or reaching a normal weight, and managing stress with yoga, meditation or other mindbody practices may also help reduce inflammation and your risk of psoriatic disease comorbidities.
âMany of these comorbid conditions can be reversed by treating psoriasis and making the right lifestyle changes,â says Dr. Mehta, who emphasizes that taking small steps each day can lead to better heath.
âI tell my patients, âEach day, please do one thing for your psoriasis, one thing for your mind and one thing for your body,ââ he says.
References:
1. Elmets CA, Leonardi CL, Davis DMR, Wu JJ, Hariharan V, Menter A, et al. Joint AAD-NPF Guidelines of Care for the Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities. Published February 13, 2019. J Am Acad Dermatol. Doi.org/10.1016/j.jaad.2018.11.058
2. Takeshita J, Grewal S, Langan SM, Mehta NN, Ogdie A, Van Voorhees A, Gelfand JM. Psoriasis and Comorbid Disease Part I. Epidemiology. March 2017. J Am Acad Dermatol. Doi.org/10.1016/j.jaad.2016.07.064
3. Mathew AJ, Chandran V. Depression in Psoriatic Arthritis: Dimensional Aspects and Link with Systemic Inflammation. Published April 22, 2020. Rheumatology and Therapy. Doi.org/10.1007/s40744-020-00207-6
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Zagazig University Faculty Of Medicine Rheumatology
Zagazig UniversityFaculty of Medicine Rheumatology and Rehabilitation DepartmentSerum Interleukin-23 Level in Patients With Rheumatoid Arthritis and its Correlation with Disease Activity and Severity Protocol of thesisSubmitted for partial fulfillmentOf M.Sc. DegreeIn Rheumatology and RehabilitationByEnas Tawkal EldesokyMB.B.ChResident of Rheumatology and RehabilitationAt Dekrens General HospitalUnder supervision of Pro. Dr.
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How Is Psoriasis Treated
There are several different kinds of treatments for psoriasis. The treatment you choose will depend on the extent and severity of your symptoms, your age, how bothersome the signs are to you, other medical conditions you might have, and any other medications or supplements youre taking. Many people find that combining various forms of treatment improves their control over the disease.
Mild plaque psoriasis: You can treat mild cases of plaque psoriasis at home by using topical treatments such as creams or ointments that suppress inflammation, reduce redness and scaling. These products include corticosteroids , coal tar preparations, vitamin D3 cream salicylic acid, and synthetic psoriasis drugs called calcipotriene tazarotene.
Moderate to severe plaque psoriasis: If your condition worsens despite home treatment, your doctor might prescribe ultraviolet light therapy. This treatment can reduce scale, redness, and itching in up to 80 percent of people with moderate stage psoriasis. Your doctor might also suggest treating you with a systemic or biological medication that suppresses the immune system. Systemic medications are taken by mouth and include traditional synthetic psoriasis drugs such as methotrexate, acitretin, or retinoids. Biologics injected medications that block immune system cells from attacking healthy cells in the skin have etanercept , infliximab , and adalimumab . Topical treatment of your choice may be added to these therapies if needed.
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Itchiness can be one of the most debilitating symptoms of psoriasis, making it hard for you to focus on your everyday life. Cortizone-10 Anti Itch Lotion specifically targets that symptom to provide long-lasting relief to irritated skin. Included in the product is maximum strength hydrocortisone, a leading ingredient in treating itchiness. The hydrocortisone is combined with seven different types of moisturizers and two vitamins to hydrate the skin while helping it heal.
Customers say the lotion is the holy grail of aiding their psoriasis because its non-drying, compared to other anti-itch creams on the market, and it relieves their red and irritated skin patches.
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How Does Scalp Psoriasis Affect My Body
Scalp psoriasis causes thick, rough, scaly, dry, discolored plaques to develop on your scalp and the skin around your scalp. The plaques can be itchy or painful. Scalp psoriasis can cause hair loss , and scratching your plaques may worsen that hair loss.
Scalp psoriasis can make you worry about how others look at you. It can also affect your behavior and how you think about yourself. You may become self-conscious or experience stress, anxiety and depression.
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What Is The Difference Between Scalp Psoriasis And Dandruff
Dandruff is a skin condition that affects your scalp. Its itchy, white or yellow flakes on your scalp. Medical researchers arent sure of the exact cause of dandruff, but they think factors may include:
- A yeast called Malassezia that overgrows on your skin.
- An increased level of androgens.
- An increased level of skin lipids.
- An inflammatory reaction.
Scalp psoriasis is an autoimmune disease.
There Are Several Treatments For Plaque Psoriasis
Everyones plaque psoriasis symptoms and triggers are different, so it may take some time for you and your doctor to come up with a treatment plan that works for you. Here are the standard treatments that your doctor will likely recommend:
- Topical medications: These are applied to the skin to help reduce redness, itchiness, and other symptoms of inflammation. Steroids are often used to help reduce overall skin inflammation, while non-steroidslike vitamins and anti-inflammatoriescan help keep the skin healthy during and after flare-ups. Topical creams, lotions, ointments, foams, and sprays are available and provide options for mild to moderate skin psoriasis, Dr. Hicks-Graham says.
- Phototherapy is another option, which uses light to reduce the turnover of skin cellseffectively leading to fewer psoriasis outbreaks and lesions.
- Systemic medications: Sometimes, topicals and phototherapy arent enough, and this is where systemic medications, like biologics, come in. We now have lots of systemic medications that are very effective at clearing more severe skin and scalp diseases and helping prevent joint damage, Dr. Hicks-Graham explains. For example, she notes that both oral and injectable options exist to target the immune system directly, helping to reduce inflammation and minimize flares.
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Setting The Stage: Psoriasis As An Immune
Figure 1. Complex fine-tuning of innate and adaptive immune mechanisms determines onset, course, and activity of psoriasis. As detailed in the text, intricate interactions between components of the innate with components of the adaptive immune system lie at the core of the pathophysiology of psoriasis. Once established, the relative contribution and fine-tuning of various mediators of adaptive and innate immunity determine the clinical manifestation toward chronic stable vs. highly inflammatory and/or pustular psoriasis.
What Is The Best Psoriasis Treatment
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Psoriasis: A Genetic Analysis
IntroductionPsoriasis is a fairly common autoimmune disease in which the body perceives the skin as foreign, and begins to attack it from within. This attack causes skin cells to reproduce rapidly causing red scaly patches of skin that will bleed when it becomes dry and cracked. This is a chronic illness that has no long term treatments, which means that managing flare-ups is extremely difficult. Since the majority of the world is unaware of psoriasis, people who suffer from the disease are often regarded
How To Prevent Autoimmune Disease
You can reduce your risk of autoimmune disease by:
Make sure to get seven to eight hours of sleep each night and take short naps when you need them. Try to avoid long periods when your body fights off an infection or your mind is stressed out. If possible, work on getting regular exercise to help boost the immune system and fight fatigue.
Smoking can weaken your immune system by reducing specific white blood cells in the body. This makes it easier for infection to set in, which is precisely what you dont want when trying to avoid autoimmune disease. Alcohol can lead to nutrient deficiencies that may increase the risk for autoimmune disease.
Tell your doctor or pharmacist before taking any prescription medication, an over-the-counter product, or herbal supplement if youre considering starting a family. This will help prevent accidental exposure of children to drugs that could cause serious side effects before birth, during infancy, or early childhood.
Regular physical activity can help you maintain a healthy weight, reduce stress, and lower your risk for heart disease. Let go of negative emotions like anger to help keep your immune system strong.
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