World Psoriasis Day 29 Octobre 2022
Chronic plaque psoriasis is the most common type of this ailment and therefore, has the most treatment options. Usually, a doctor can easily diagnose this form of psoriasis just by looking at it, although in some cases, a biopsy is necessary. This type of psoriasis tends to occur all over the body, causing the most irritation and frustration.
Are There Complications Of Psoriasis
In some people, psoriasis causes more than itchiness and red skin. It can lead to swollen joints and arthritis. If you have psoriasis, you may be at higher risk of:
- Use medicated shampoo for scales on your scalp.
Other steps you should take to stay as healthy as possible:
- Talk to your healthcare provider about lowering your risk for related conditions, such as heart disease, depression and diabetes.
- Lower your stress with meditation, exercise or seeing a mental health professional.
Lotions Medications And Light And Laser Treatments Can Help
Chronic inflammation in the body does not always make itself apparent. It may produce no symptoms, but still be quietly causing damage. Such quiet inflammation may be encouraging the buildup of plaques of atherosclerosis in your arteries, or driving your thyroid gland to become underactive or overactive.
Psoriasis is different, however. In this chronic inflammatory disease, immune cells attack the skin, causing visible, uncomfortable lesions. It is an autoimmune condition: the immune system, which is your defense against foreign microbes and chemicals, mistakenly starts attacking your own tissues.
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What Are Other Types Of Psoriasis
Plaque psoriasis is the most common type. About 80% to 90% of people with psoriasis have plaque psoriasis.
Other, less common types of psoriasis include:
- Inverse psoriasis appears in skin folds. It may look like thin pink plaques without scale.
- Guttate psoriasis may appear after a sore throat caused by a streptococcal infection. It looks like small, red, drop-shaped scaly spots in children and young adults.
- Pustular psoriasis has small, pus-filled bumps on top of the red patches or plaques.
- Sebopsoriasis typically appears on the face and scalp as red bumps and plaques with greasy yellow scale. This type is a cross between psoriasis and seborrheic dermatitis.
Plaque Psoriasis And Its Reach: The Scalp And Beyond
According to the American Academy of Dermatology, at least 50 percent of people with plaque psoriasis will experience a bout of scalp psoriasis. Plaque psoriasis on the scalp may require different treatment than plaque psoriasis on other parts of the body.
Medicated ointments, shampoos, and careful removal of scales can help treat scalp psoriasis. Sometimes, systemic medications must be used to clear plaque psoriasis on the scalp.
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Pathogenesis Of Chronic Plaque Psoriasis
Collectively, a pathogenic cross-talk between DCs, T cells, and keratinocytes, sustained by type I IFNs, IL-23, IL-12, IFN-, IL-17, TNF-, and IL-22, and possibly supported by other immune cell players, causes keratinocyte production of pro-inflammatory molecules, as well as concurs to derange proliferative and differentiative programs of the epidermis. This becomes a self-amplifying loop, where these products and altered homeostasis act back on T cells and DC to perpetuate the cutaneous inflammatory processes.
Approach To The Patient
Evidence-based guidelines35 on the treatment of patients with chronic plaque psoriasis were published in 2004 by the Finnish Dermatological Society. Recommendations for the management of psoriasis in primary care, based on these guidelines, the evidence cited above, and considering common practice among American dermatologists, are shown in Figure 9.35
Management of Chronic Plaque Psoriasis
Algorithm for the management of chronic plaque psoriasis, based on recent guidelines,35 current evidence, and common practice among American dermatologists.
Management of Chronic Plaque Psoriasis
Algorithm for the management of chronic plaque psoriasis, based on recent guidelines,35 current evidence, and common practice among American dermatologists.
For the initial treatment of psoriasis on limited areas of skin, the most effective treatment is a combination of potent topical steroids and calcipotriene. This recommendation, however, is based on limited evidence.18,29,30 An alternative would be to start with a potent topical steroid, calcipotriene, or a topical retinoid alone. Calcipotriene and topical retinoids can be used long-term, but topical steroids must be used intermittently because of their side effects.35
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How Is Plaque Psoriasis Treated
While there’s no cure for psoriasis, Dr. Friedman says there are many treatment options that can clear up these skin lesions.
“The question isn’t how are you going to treat psoriasis, it’s which are you going to pick because we have so many options,” he says. And there are more and better treatments all the time. “We used to be happy clearing someone by 75%, but now we treat to clear it. We have drugs that will get you 99% clear.”
Treatment options include:
- Topical creams and ointments, such as steroid creams
- Systemic treatments, meaning medications used to slow down the immune system
- Biologic medications, or drugs that target areas and are not systemic
- Alternative options, such as salt baths and aloe vera
Psoriasis Lesions From 62 Patients Can Be Classified Into Two Sub
Dermal infiltration by inflammatory cells facilitates development of a cytokine environment that reinforces inflammatory cascades and contributes to keratinocyte hyper-proliferation . This cytokine environment is one factor accounting for in vivo transcriptome differences between lesional and non-lesional skin samples obtained from a given patient , .We expected that the in vivo abundance and activity of cytokines would be linked to characteristic gene expression responses, which could be used as a transcriptional readout to infer upstream signaling activity associated with individual cytokines . We therefore analyzed PP versus PN differences in terms of cytokine activity signatures, which were calculated using cytokine-responsive transcripts identified from cultured keratinocytes exposed to cytokines .
We identified three sets of 1000 transcripts that were induced by IL1- treatment of cultured keratinocytes, induced by IL-17A treatment of keratinocytes and induced by IFN- treatment of keratinocytes. For each set and patient, we calculated the percentage of transcripts elevated in lesional samples as compared to paired non-lesional samples. In , subjects are ordered according to the estimated proportion of cytokine-responsive transcripts elevated in PP skin relative to PN skin .
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Skin Treatments For Chronic Plaque Psoriasis
Chronic plaque psoriasis is the most common type of psoriasis. Although any part of the body may be affected, the most commonly affected sites are the elbows, knees, and scalp. ‘Topical’ treatments are usually tried first. These include vitamin D products, topical corticosteroids, tar-based preparations, dithranol, salicylic acid, and vitamin A products. As chronic plaque psoriasis is a long-term condition, it is important to find out which treatments work best and what adverse effects they have. This review describes average benefits of different treatments, while recognising that individuals will vary in their experience of each treatment.
The evidence was based on 177 studies, which, in total, included 34,808 people. Studies were typically about 7 weeks’ long, but this ranged from 1 week to 52 weeks. Vitamin D products were found to work better than placebo . Potent topical corticosteroids and very potent topical corticosteroids were also effective.
More long-term studies would help doctors and people with psoriasis decide on the best way to treat this chronic condition.
Chronic plaque psoriasis is the most common type of psoriasis, and it is characterised by redness, thickness, and scaling. First-line management of chronic plaque psoriasis is with topical treatments, including vitamin D analogues, topical corticosteroids, tar-based preparations, dithranol, salicylic acid, and topical retinoids.
Light Treatment For Plaque Psoriasis
Light therapy is a common treatment for plaque psoriasis. Because light therapy is nonpharmaceutical, its a popular choice prior to systemic medications.
Some people are able to achieve healing through regular limited sessions of sun exposure, while others fare better using a special light machine.
Check with your dermatologist before treating your psoriasis through exposure to sunlight. Too much sun exposure can burn your skin and make plaque psoriasis worse.
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What Are The Symptoms For Chronic Plaque Psoriasis
Chronic plaque psoriasis expresses itself mainly as a skin condition, although it is a systemic disease. This includes patches of skin abnormalities that can range from specific areas of the body, such as the knees, elbows, and scalp, to an outbreak that affects the entire surface of the skin. Although it is rare for the entire body to be affected, many people will experience outbreaks in several areas at once.
The skin condition appears at first as small, red, raised bumps that will begin to spread across a localized region. As the flare-up continues, the bumps will start joining together and forming a silvery scale over the surface of the skin. These patches will often be extremely itchy and may result in pain if they become infected from over scratching. The plaques can also become flaky and leave layers of dead skin on clothes and across any surface that the patient touches.
The Immune System And Psoriasis
It takes most people with healthy skin about a month for their bodies to produce new skin cells and shed old ones. But when you have psoriasis, your bodys skin cells go through an accelerated cycle.
Thats because people with psoriasis have an overactive immune system, which causes excess inflammation. This inflammation forces your body to produce new skin cells at a much faster rateabout a 4- to 5-day cycle. Thats roughly seven times faster than normal. Skin cells rapidly pile up and get pushed to the surface, as your body is unable to shed them quickly enough.
Those skin cells become the scales and plaques you see on your skinwhich can be silvery, red, itchy, flaky, raised, or inflamed. Thats how inflammation deep down in your body can contribute to symptoms all the way up to your skins surface.
DEFINED: Inflammation is the bodys natural defense system. In normal amounts, it helps your body heal. But too much and your body starts to attack healthy cells.
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Concept Of Remission In Psoriasis
The natural course of the psoriasis can be highly variable, from mild or benign to persistent and aggressive forms. Remission of psoriasis is achieved in longterm efficacious control of skin lesions.
In an expert consensus meeting that was carried out to define goals for treatment of plaque psoriasis with systemic therapy and to improve patient care, 19 dermatologists from different European countries met face-to-face for discussion and to define items through a 4-round Delphi process.
For systemic therapy of plaque psoriasis, 2 treatment phases were defined: the induction phase: treatment period until Week 16 and the maintenance phase: for all drugs, the treatment period after the induction phase. For the definition of treatment goals in plaque psoriasis, change in PASI from baseline until time of evaluation and absolute DLQI were used. After induction and during maintenance therapy, treatment can be continued if a reduction in PASI is 75%. The treatment regimen should be modified if improvement of PASI is < 50%. In a situation where the therapeutic response improved 50% but < 75%, as assessed by PASI, therapy should be modified if the DLQI is > 5, but can be continued if the DLQI is 5.
Treatment Of Chronic Plaque Psoriasis
Patients with this condition can utilize both topical applications that work directly on the skin plaques, or oral drugs that can offer a systemic result. Topical applications include:
- Coal tar
- Topical immune suppressants
This approach can relieve a great amount of the discomfort that is associated with an outbreak, and does have some result in reducing the appearance of the plaques. However, topical applications do not always address the full cause of the skin lesions, and this can lead to a less than optimal treatment plan. Topical applications are also associated with some side effects that can become especially pronounced through over usage of the treatment.
Oral drugs such as cyclosporine and retinoids have been shown as beneficial in controlling the condition. Injections of biologics have been used to good results for condition management, and have shown particular benefits over time, since it is corrective on a systemic level. Some patients may combine topical and systemic treatments for more immediate relief.
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Diagnosing Plaque Psoriasis By Looking At The Skin
Most doctors and nurses can tell if a scaly or rough patch of skin is psoriasis. Sometimes a biopsy or a visit with a dermatologist is needed. During your visit, make sure to point out all of your abnormal patches of skin.
Tell your doctor about your symptoms and what seems to aggravate your skin. Possible triggers of psoriasis include:
- skin trauma
Plaque Psoriasis Treatment And Management
Management options for the treatment of psoriasis include:
- First-line therapy which includes traditional topical therapies – eg, corticosteroids, vitamin D analogues, dithranol and tar preparations.
- Second-line therapy which includes phototherapy, broad-band or narrow-band ultraviolet B light, with or without supervised application of complex topical therapies such as dithranol in Lassar’s paste or crude coal tar and photochemotherapy, psoralens in combination with UVA irradiation , and non-biological systemic agents such as ciclosporin, methotrexate and acitretin.
- Third-line therapy which refers to systemic biological therapies that use molecules designed to block specific molecular steps important in the development of psoriasis, such as the TNF antagonists adalimumab, etanercept and infliximab, and ustekinumab, anti-IL12-23 monoclonal antibody.
There is no strong evidence that any of the interventions have a disease-modifying effect or impact beyond improvement of the psoriasis itself.
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Natural Skin Treatments For Plaque Psoriasis
Because its a chronic condition, many people with plaque psoriasis will try alternative and natural treatment methods. One method that has gained significant attention in the psoriasis community is the mud and salt of the Dead Sea.
Thousands of people a year invest in expensive Dead Sea skin treatments or vacations to attempt to heal their psoriasis. Although the scientific evidence is limited regarding the effectiveness of these treatments, many believe it can help treat plaque psoriasis.
Comorbidities Of Chronic Plaque Psoriasis
Since 1897, when Strauss reported an association between psoriasis and diabetes, emerging epidemiologic studies find additional associations between psoriasis and inflammatory diseases, apart from well-known psoriatic arthritis . The association between psoriasis and inflammatory diseases is stronger in the most severe forms of psoriasis . Comorbidity psoriasis burden includes mainly CVD, metabolic disorders, such as diabetes, dyslipidemia, and metabolic syndrome, inflammatory bowel disease, and kidney disease. The prevalence of traditional CV risk factors such as hypertension, obesity, diabetes, dyslipidemia, metabolic syndrome, and cigarette smoking is increased in patients with psoriasis compared to controls .
Figure 1 Man affected by psoriasis and central obesity.
Although both CV risk factors and CVD are prevalent among psoriatic patients, psoriasis is an independent risk factor for the latters. A large cohort study found that psoriasis is an independent risk for myocardial infarction , also considering other traditional CV risk factors . Two meta-analyses showed that the risks of MI, stroke, and death caused by CVD, collectively termed as major cardiovascular events, is greatest among patients with psoriasis and appear to be greatest among those with severe or longer duration disease . Psoriasis, as an independent CV risk factor, was reported to strongly impact on the Framingham Risk Score for more than 60% of the patients .
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Risk Factors For Chronic Plaque Psoriasis
Chronic plaque psoriasis is a hereditary disease, and cannot be contracted through any outside vectors. It generally follows a history in families, although some patients will experience more severe skin outbreaks, while other may only experience the arthritic condition. However, patients who do develop plaques can go through periods of remission that are marked by occasional flare-ups, and these can be triggered by internal or external mechanisms.
It is thought that environmental conditions do play a part in triggering a plaque outbreak. Airborne allergens, chemicals, and even lighting can trigger the immune system to perceive a danger where there is none. Once the immune system begins to release t-cells, then the rash of plaques will express through the skin.
Other triggers that are associated with flare-ups include:
- Exposure to certain viruses
As an autoimmune disease, chronic plaque psoriasis can be triggered by any condition that causes the immune system to activate. Once this has happened, the progression will continue until the body senses that any threat has passed.
Therapy Of Chronic Plaque Psoriasis
Psoriasis shows a chronic-relapsing course and requires longterm management. Treatments available for psoriasis are various and they can be topical and systemic . Topical therapies include keratolitics, corticosteroids, Vitamin D analogs, retinoids, and topical calcineurin inhibitors, which are reserved for mild forms. Phototherapy, which includes either narrow-band ultraviolet B light and photochemotherapy , and conventional systemic agents such as cyclosporine , methotrexate , and acitretin are reserved for moderate to severe cases. In the event of intolerance, inefficacy, or contraindication to phototherapy or conventional systemic treatments, patients are eligible for biological agents, which include TNF- antagonists , or the anti-IL12/23 monoclonal antibody ustekinumab.
Treatments of chronic plaque psoriasis.
Although criteria for selection of a systemic treatment are well established, the undertreatment in moderate to severe psoriasis is still an open issue. A recent population-based, multinational survey of 3426 patients from 139,948 screened households in North America and Europe found that only 11% of patients with affected BSA > 10% were receiving a systemic agent for psoriasis 52% were receiving topical treatment alone and 37% were untreated.
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