Duke University School of Medicine, Durham, NC, USA.
American family physician (Impact Factor: 2.18). 05/2013; 87(9):626-33.
Source: PubMed


Psoriasis is a chronic inflammatory skin condition that is often associated with systemic manifestations. It affects about 2 percent of U.S. adults, and can significantly impact quality of life. The etiology includes genetic and environmental factors. Diagnosis is based on the typical erythematous, scaly skin lesions, often with additional manifestations in the nails and joints. Plaque psoriasis is the most common form. Atypical forms include guttate, pustular, erythrodermic, and inverse psoriasis. Psoriasis is associated with several comorbidities, including cardiovascular disease, lymphoma, and depression. Topical therapies such as corticosteroids, vitamin D analogs, and tazarotene are useful for treating mild to moderate psoriasis. More severe psoriasis may be treated with phototherapy, or may require systemic therapy. Biologic therapies, including tumor necrosis factor inhibitors, can be effective for severe psoriasis and psoriatic arthritis, but have significant adverse effect profiles and require regular monitoring. Management of psoriasis must be individualized and may involve combinations of different medications and phototherapy.

13 Reads
  • Source
    • "Psoriasis is a chronic, remitting and relapsing, inflammatory skin disease that is often associated with systemic manifestation, especially arthritis [1]. Currently, psoriasis is managed by topical treatment with steroids, immunosuppressants and several other agents. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Psoriasis is a chronic inflammatory skin disease resulting from immune dysregulation. Regulatory T cells (Tregs) are important in the prevention of psoriasis. Traditionally, reactive oxygen species (ROS) are known to be implicated in the progression of inflammatory diseases, including psoriasis, but many recent studies suggested the protective role of ROS in immune-mediated diseases. In particular, severe cases of psoriasis vulgaris have been reported to be successfully treated by hyperbaric oxygen therapy (HBOT), which raises tissue level of ROS. Also it was reported that Treg function was closely associated with ROS level. However, it has been only investigated in lowered levels of ROS so far. Thus, in this study, to clarify the relationship between ROS level and Treg function, as well as their role in the pathogenesis of psoriasis, we investigated imiquimod-induced psoriatic dermatitis (PD) in association with Treg function both in elevated and lowered levels of ROS by using knockout mice, such as glutathione peroxidase-1-/- and neutrophil cytosolic factor-1-/- mice, as well as by using HBOT or chemicals, such as 2,3-dimethoxy-1,4-naphthoquinone and N-acetylcysteine. The results consistently showed Tregs were hyperfunctional in elevated levels of ROS, whereas hypofunctional in lowered levels of ROS. In addition, imiquimod-induced PD was attenuated in elevated levels of ROS, whereas aggravated in lowered levels of ROS. For the molecular mechanism that may link ROS level and Treg function, we investigated the expression of an immunoregulatory enzyme, indoleamine 2,3-dioxygenase (IDO) which is induced by ROS, in PD lesions. Taken together, it was implied that appropriately elevated levels of ROS might prevent psoriasis through enhancing IDO expression and Treg function.
    Full-text · Article · Mar 2014 · PLoS ONE
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Immunogenicity of antitumor necrosis factor-alpha (TNFα) agents has been proven to play a significant role in the variability of clinical responses among patients with chronic inflammatory diseases. However, its clinical impact on the outcome of patients with psoriasis and psoriatic arthritis receiving anti-TNFα treatment is not yet fully clear. Despite the high rates of efficacy of anti-TNFα agents in psoriasis, a substantial proportion of patients remain who experience a primary or secondary failure or significant side effects, which are potentially ascribable to immunogenicity. Areas covered: Topics include immunologic response elicited by anti-TNFα agents, the impact of immunogenicity on treatment response to anti-TNFα and the role played by immunogenicity in the lack of efficacy of anti-TNFα agents (infliximab, adalimumab and etanercept) in psoriasis. Expert opinion: Based on data available in the literature and the clinical experience of the authors, this article suggests the optimal approach to drug monitoring and antidrug antibody assay and the most effective use of biologic immunotherapies in this setting. Immunogenicity should be taken into account in the adoption of therapeutic choices in psoriatic patients, such as anti-TNFα agent intensification, or switching to another anti-TNFα agent or a drug with a different mechanism of action.
    Full-text · Article · Oct 2013 · Expert opinion on biological therapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Psoriasis is a chronic inflammatory skin disease, most commonly resulting in the occurrence of red and silver scaly plaques. Application of differential scanning calorimetry (DSC) should be used as a new method to detect the different stages of the disease and to monitor medications with different anti-psoriatic drugs using patient’s blood plasma. The study included 72 white adults (35 men and 37 women; median age 56 years) with diagnosed psoriasis. According to the psoriasis area severity index (PASI) patients were selected into three groups: symptomless (PASI: 0), mild (PASI: 1–15), and serious symptoms (PASI: >15). According to medication patients were divided into untreated (n = 39) and treated (n = 33) groups. For systemic drug treatment cytostatic therapy (methotrexate, n = 12), retinoid treatment (acitretin, n = 10), and biologic response modifiers (adalimumab, n = 5; infliximab, n = 5; ustekinumab, n = 1) were applied. Denaturation of human plasma components were detected in Setaram Micro DSC II calorimeter. The patients had no third denaturation peak in the untreated mild and serious symptoms groups. In mild symptoms all the thermal parameters altered significantly, while in serious symptoms only the first melting and the calorimetric enthalpy altered significantly compared with symptoms-free states. In case of systematic cytostatic and retinoid drug treatment (methotrexate, n = 12; acitretin, n = 10) cases the DSC scans of patients with symptoms exhibited significant differences (p < 0.05) in melting temperatures and in calorimetric enthalpy compared with the untreated symptoms-free patients. Using biologic response modifier agents (adalimumab, infliximab, and ustekinumab) we had no enough samples for a statistical evaluation for each one, but after the intervention a stronger effect can be seen as in case of systematic drug treatment. In this study blood plasma measurement in psoriatic patients by DSC showed differences between untreated, conventional systemic drug treatment, and application of biologic response modifier agents, but further studies are needed to elucidate these relationships (supported by grant OTKA CO-272).
    No preview · Article · Dec 2013 · Journal of Thermal Analysis and Calorimetry
Show more