Psoriasis is a recurring (chronic) autoimmune disease of the skin. In Psoriasis, the immune system functions improperly, leading to overgrowth of skin cells and to other inflammation- related complications. There are many factors associated with psoriasis or increased risk of developing psoriasis, but the exact cause is unknown. The immune system and genetics have an important role in Psoriasis, but other associated factors may vary. The immune system and genetics have an important role in psoriasis, but other associated factors may vary. These include smoking, alcohol consumption (especially in men), some medications (like Lithium and NSAIDs), sunlight, trauma, and others. With one or a combination of these factors present, the immune system is somehow triggered to act inappropriately, resulting in a pattern of symptoms known as psoriasis. For example, normal skin cells mature and fall off of the body in 28-30 days. In psoriasis, skin cells mature in only 3-4 days, and these cells pile on the surface of the skin (forming lesions) instead of falling off the body. It is thought that at least 10% of people have one or more genes that may lead to the development of psoriasis, but only 2-3% actually end of developing the disease. This supports the idea that a combination of genetics, environment, and other factors are what eventually triggers psoriasis. Some triggers (or events/factors that lead to development of psoriasis symptoms) are: stress, some medications (like Lithium, some NSAIDs, and antimalarial drugs, etc.), and injury to the skin.
Symptoms of Psoriasis
Psoriasis can occur on any part of the body and can involve small or large areas. The plaques associated with psoriasis are typically raised, red patches, of skin covered with silvery “scales” (dead skin cell build-up with a scale-like appearance). Other symptoms may include itching, depression/anxiety, and arthritis symptoms (a condition known as “psoriatic arthritis”).
Treatment of Psoriasis
Treatment of psoriasis involved management of the disease, treatment of symptoms, and maintenance of overall good health. The goal is to find a medication regimen that reduces or eliminates a patient’s symptoms and leads to fewer flare-ups of the disease. Medications used to treat psoriasis include several classes such as the following:
- Topical treatment: This is the first- line therapy for psoriasis, and these medicines are used to treat and clear plaques associated with psoriasis. Examples of medications used are corticosteroids, calcipotriene, and coal tar.
- Phototherapy: The two main types of phototherapy used are ultraviolet B (UVB) irradiation psoralen plus ultraviolet A (PUVA) irradiation. Light is used to treat plaques in moderate to severe psoriasis or in the psoriasis that does not respond to topical therapy.
- Systemic treatment: This treatment is started when psoriasis patients have failed topical and phototherapy. Systemic treatment includes drugs like Methotrexate, cyclosporine, and Soriatane.
- Biologic therapy: biologic medications are systemic therapies that directed target specific parts of immune system, modifying the inappropriate action of these parts. Biologics are used in patients who have failed other types of therapy or who still have symptoms even after improvement and stabilization on other therapies. They are available as infusions, at home injections and oral therapies.
- Phosphodiesterase-4 Enzyme Inhibitor: Therapy that works to regulate inflammation within the cell. This medication does not increase the risk of infection like many of the biologic therapies. Otezla is the only drug currently marketed for Psoriasis and Psoriatic Arthritis in this class.
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