Psoriasis - Science topic

Topical oils are also optional, try sesame oil?

Saad Hussein Murad Dietary supplements that may help manage psoriasis include omega-3 fatty acids, found in fish oil, which can reduce inflammation and improve skin health. Vitamin D supplements may also be beneficial, as they help regulate the immune system and skin cell growth. Antioxidants like vitamin E and selenium can protect against oxidative stress, which is linked to psoriasis flare-ups. Some people find relief with turmeric (curcumin), known for its anti-inflammatory properties. Additionally, probiotics might support gut health, which is increasingly recognized as playing a role in immune response and skin conditions like psoriasis. Always consult with a healthcare provider before starting any supplements to ensure safety and effectiveness.

This is something you can easily search on Google scholar. The first hit is a good place to start reading

Cytokine storm is an aggressive Inflammatory response with the release of large amounts of pro-inflammatory cytokines. This is a life threatening systemic Inflammatory response involving highly elevated levels of circulating cytokines with immune cell hyperactivation. All these can be triggered by pathogens,cancers,autoimmune diseases, various treatment modalities. Erythroderma/exfoliative dermatitis is a difficult to control scenarion in dermatology and demonstrates diffuse erythema and scaling of greater than 90% of the body surface area. The most common dermatologic causes like psoriasis/atopic dermatitis may cause cytokine flare-ups. The inflammation thus caused may account for its clinical picture/favorable response to systemic glucocorticoids.

We have to see the skin (and not the scale) after scratching, for candle grease sign. After scratched, psoriatic scales fall off and if revealing a shiny candle-like surface, it should be considered as positive candle grease sign.

Thank you Malcom Nobre

IL17/IL23 axis cytokines.

According to a recent paper published in "Nature" by Sarah Esther Chang et al. titled: "New-onset IgG autoantibodies in hospitalized patients with COVID-19", more than 50% of hospitalized Covid-19 patients have new-onset autoimmunity manifested by autoantibodies.

Nat Commun. 2021:14;12(1):5417.

doi: 10.1038/s41467-021-25509-3

There is increasing evidence worldwide that part of the late post-Covid syndrome includes a degree of new-onset autoimmunity.

We categorize psoriasis on the signs we observe and symptoms, the patient experience, of skin on knees, elbows, lumbosacral region, nails, joints, stretch marks, scalp, body folds and genitals.

Onset of psoriasis presented with with papules, scales leading to other clinical types. Untreated cases have erythema, thickening and scaly with clear margins.

We categorize psoriasis as follows : 1 Congenital psoriasis, 2 Primary psoriasis, 3 Infantile psoriasis, 4 Childhood psoriasis, 5 Papular psoriasis, 6 Guttate psoriasis, 7 Plaque psoriasis, 8 Linear psoriasis, 9 Exfoliative psoriasis, 10 Erythrodermic psoriasis, 11 Herpetiform psoriasis, 12Inverse psoriasis, 13 Scalp psoriasis, 14 Nail psoriasis, 15 Psoriatic arthritis, 16 Pustular psoriasis and

17 Palmoplantar psoriasis.

One important consideration is it there are may be multiple ligands for the same receptor, depending on the receptor of course. Blocking the receptor may therefore potentially inhibit the signalling from multiple ligands, rather than just one.

My coworker are developing skin OCT images. Please feel free to contact with me if you need more data.

Thank you so much Nabodita Sinha for your help.

Actually I want to know that the triggers like IFN-γ, TNF-α, IL-1β, IL-6, IL-17/Th17 and so on. So as there any different trigger activator for each psoriasis types? because about 90% is Plaque psoriasis, so it has a different triggering cytokines for it's activation than other types? please clear me about it.

Thank you

If not severe (Limited plaque psoriasis i.e. < 20% BSA or PASI<10,) prefer Topical agents.

If the involvement is more extensive (>20% BSA or PASI>10), some of the systemic/other agents which (according the literature) are not hepatotoxic are:

Feel free to add inputs if anything important was missed.

(1) Zerilli T, Ocheretyaner E. Apremilast (Otezla): A New Oral Treatment for Adults With Psoriasis and Psoriatic Arthritis. P T. 2015;40(8):495-500

(2) Vujic I, Herman R, Sanlorenzo M, et al. Apremilast in psoriasis - a prospective real-world study. J Eur Acad Dermatol Venereol. 2018;32(2):254-259. doi:10.1111/jdv.14598

Following

Sandhu K et al. in a study revealed the median time for marked improvement with methotrexate and cyclosporine was 5.3 weeks and 6.8 weeks respectively. Patients on methotrexate were found to have more rapid and complete clearance than those on cyclosporine. Both drugs were well tolerated. Side effects in both the treatment groups were minor, transient, and manageable. They concluded at doses with comparable safety profiles, methotrexate resulted in more rapid clearance of patients with severe psoriasis. Pl. have a look at the following link:

Please go through the following RG link.

Please also go through the following RG links.

The environmental risk factors in the causation of psoriasis include smoking, alcohol consumption, diet, overweight and physical inactivity, infection, drugs, and stressful life events.

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I suggest reading this article-

Dinan TG, Cryan JF.The Microbiome-Gut-Brain Axis in Health and Disease. Gastroenterol Clin North Am. 2017 Mar;46(1):77-89. doi: 10.1016/j.gtc.2016.09.007. Epub 2017 Jan 4

Mahonia aquifolium commonly known as Oregon grape is a safe and effective plant for treatment of psoriasis.

Yes

Tamer A Gheita, Thank You dear Prof

Imiquimod (e.g. Aldara ointment/cream - see https://www.drugs.com/international/imiquimod.html)

Madame, actually we know TNF-alpha inhibitors make a latent tubercolosis infection blow up as well as omalizumab is associated to an increased incidence of arterial thrombotic events as reported by US Food and Drug Administration (FDA), after having collected the adverse events since January 2004 to January 2011 (see: Ali AK, Hartzema AG. Assessing the association between omalizumab and arterio-thrombotic events through spontaneous adverse event reporting. J Allergy Asthma 2012, 5: 1–9. Efalizumab was withdraw from market because causing drug induced aseptic meningitis and polyneuropathies, but it is too early to establish know other delayed side effects of biologics

You can see this article https://www.researchgate.net/project/Evaluation-of-Vascular-Endothelial-Growth-Factor-VEGF-Hematological-and-Antioxidants-Parameters-in-Psoriatic-Patients-Treated-with-Methotrexate-in-Babylon

Dear Ayush please share me your protocol and which type of psoriasis you are working, psoriasis are various types like Plaque psoriasis, guttate, inverse, pustular etc. Lots of therapy are there but for plaque psoriasis I will recommended you two medicinal plant's like Argemone mexicana and aloe vera. First you make protocol and focus plant extraction write down phytochemical property's then discuss with me. My mail I'd - rk981487@gmail.com.

I will 100% help you.

Thanks and best regards

From point of view it could be Gardner-Diamond Syndrome, fixed drug rash or morphea. Not probably Lupus.

Look to my last reply!

Thomas

Dear Samira,

Attached link may help you.

Still needs more trials though. But I think it's a good start to find molecular evidence behind this;)

Creative Bioarray provides in vitro psoriasis model for research.

Medicinal Plants to Calm and Treat Psoriasis Disease

March 2017

DOI: 10.5772/67062

In book: Aromatic and Medicinal Plants - Back to Nature

Azadeh IzadyariAzadeh IzadyariAzim Akbarzadeh Khiavi

Did you try asking if it available as a galenic formulation at hospital and local pharmacies? Otherwise contact Meda pharm directly, they might be interested in the study and thus provide you with the cream .

Dear Michael after reading your answer i did look up to the internet and started reaading bout flouride in water.

I am now able to get some insight about the big problem the humans are facing.

Lets hope that the council for water management will take up the issue in a more seroius manner.

It also has made a difference to my understnading of the disease patterns of autoimmunity.

Thank you for the insights.

Good Morning Sir,

I am from Trichy, Tamilnadu.

Till date we treated 1715 cases of psoriasis with Wrightia tinctoria herbal extract laying emphasis on keeping healthy life style, healthy diet, healthy fluids. The following have adverse affect on healing of psoriasis lesions.

Professeur honoraire Faculté Libre de Médecine de Lille.

La manifestation clinique comme la disparition du psoriasis dépendent de si nombreux facteurs, qu'on simplifie l'étude de son étiologie en évoquant "l'environnement", "la prédisposition" les "HLA...", quel qu'en soit la clinique, puisqu'il peut être cutané et/ou arthropatique, sa définition anatomo-pathologique étant l'abcès de Munro et Sabouraud.

Il en est de même pour l'eczéma, ou "les eczémas" qui ont pour caractère commun la spongiose, alors qu'il est lui aussi en équation avec une pathologie "interne", l'asthme...

Hi Rajasekar,

You can use STRING or GeneMania database to extract the interaction in desired format (tab delimited or csv).

The cytoscape itself has plugins like StringApp & GeneMania. Network can be created directly by giving input as list of genes

Good morning Dr. I think this thesis was very important for your work so it shows son correlations of psoriasis pathogenesis parameters that proved its contribution in psoriasis severity.

Thanks Mukhtar, but please do not associate the term pathogenesis with psoriasis. In ur comment above.

Wait until she is no remission with psoriasi. There is no need to performe abdominoplasty under MTX. Better wait and push the surgery for a while. Otherwise pause mtx two weeks before and after.

Thanks Aldona Pietrzak

No response

Dear Sir,

I have not yet performed the cytokine estimation for skin samples obtained from the diseased animals so I am unable to share the protocol. I am planning to conduct the cytokine estimation in sequential studies. I will be in touch with you.

Thanks.

Dear Ranthilaka, I may provide you with accessory nipples,eczema, psoriasis, clear cell acanthoma, BCC et cetera. Please notify me how connect with you. Sincerely. Carlo.

Dear all,

In our clinical practice, after proper bio-purification regimens, we found promising results of Bhasma based prescriptions, e.g. Mall Sindura, Hartala etc along with suitable herbal adjuvants in Psoriasis. Nevertheless, appropriate diet & life style must be followed by patient, else recurrence is often the common failure found in therapy.

The below mentioned report on Researches conducted at Gujarat Ayurved University, Jamnagar may add some knowledge in regard to its Ayurvedic management (achievements or failures of trials).

Regards

Dr Rohit

I am already studying effect of diffrent plant extracts in psoriasis. Would be interested for inteacting & may be collaborative work in due course.

Hi Amit,

There is a plethora of enzymes known to be involved in skin diseases including psoriasis, that's why I asked whether you had a specific type or family in mind. A major group of enzymes are the ADAM metalloproteinases, cell surface expressed enzymes which regulate activity and/or expression of other cell surfaced proteins including cytokine receptors (e.g. IL-6 receptor), adhesion molecules (e.g. L-selectin) or even cytokines by a process sometimes referred to as 'shedding', i.e. proteinase-mediated cleavage od protein domains from the cell surface. One of the most important examples in the context of inflammation is the conversion of membrane-bound (inactive) TNF-alpha into its soluble (active, proinflammatory) form by the ADAM17 proteinase, also known as TACE. TACE and several other ADAMs have been shown to be upregulated in lesion of psoriatic skin, resulting in enhanced inflammation. Selective therapeutic targeting, however, is challenging due to the high homology between the family members and also due to other functions for cell homeostasis. I attached a paper for your interest.

 I am working extensively on the imiquimod model with different protocols to induce psoriasis. I must mention that to check efficacy of a antipsoriatic drug, systemically or topically, 62.3mg per mice is enough. But this is highly schedule (pretretreatment followed with imiquimod or imiquimod followed with drug therapy) and dose dependant. For topical study, 62.3 mg is fine, since imiquimod is such a potent inducer of immune system, this much dose is enough to get to know the difference in treated group (testing compund) and imiquimod control group

While for severe psoriatic phenotype, 81.5 mg is also used, but this is good only if you need to study long term effects.

However, in both cases, you cant get to trace the cytokine levels. As this is an acute model and activation of cytokine is transient. Thus if your study emphasis on cytokine levels, day 3 or maximum day 4 is good timepoint to detect cytokines. At later timepoint you cant get detectable levels.

Hope this will be helpful.

This article may be helpful for you: Preclinical models of psoriasis. Danilenko DM. 

Vet Pathol. 2008 Jul;45(4):563-75

Thanks @Jon Holmes

You might want to refer to:

Wordsworth S, Thompson S. , An annotated cost questionnaire for patients: results of piloting, HERU Discussion Paper, 2001, Discussion Paper 03/01,

... Chapter 6 provides some useful guidance on measuring productivity loss in both chronic and acute conditions. Full description here: http://www.dirum.org/instruments/details/28#

DIRUM (Database of Instruments for Resource Use Measurement) also have details of certain instruments for 'skin'

High IgE and eosinophilia point towards allegic phenomenon. Has the patient applied some creams like framycetin, silver sulphdizine etc? Oral cyclosprin can be strted as 5 mg/kg in psoriatic erythroderma in 2 divided doses /day and taper by 1 mg/kg depending upon clinical response over 2-4 weeks. Of course, monitor blood pressure and Renal function parameters.

The best allopathic therapy with promissing results and distantly relapsing is Methotrexate 10-20mg / weekly stratum doses. The adjuvant of Folic acid 5mg should be given evry day except on the day of taking Methotrexate. It can be combined with phototherapy also. 

Dear Amerigo,

I had some patients that needed a long term CyA treatment, because they do respond to a short term one but immediately they relapsed. Dose was usually 5 mg/kg QD. Of course it is needed to control blood pressure and lab analysis, particularly creatinine clearance, cholesterol, triglycerides  etc . If one year treatment was not enough to control and avoid immediate recurrences, I asked opinion of nephrologist before to continue and evaluated the risk/benefice of another therapy. I had no problems in my private patients, not so many, I treated as I mention. When they had a pathological background I preferred to refer them to our department where we treated them with help of other specialists. There is an updated short version guidelines of systemic treatment of psoriasis in the JEADV 2015; 29, 2277-94.

Warmest regards from your old friend Jose.

Dear Satyaprasad,

I think you are asking for the frequency of coexistence of true rheumatoid arthritis with psoriasis, rather than psoriatic arthropathy? There may be literature on this but the problem is that ascertaining the existence of true RA in the presence of psoriasis is not straightforward. Rheumatoid factors and ACPA occur in a small percentage of normals so could occur alongside psoriatic arthropathy. 

The only time I have been convinced that I knew that an arthritis was true RA in the presence of psoriasis was in a case with typical rheumatoid nodulosis and RF. I only saw the one case in thirty odd years.

In practical terms relating to hydroxychloroquine, I think you are entitled to go on probabilities. If an inflammatory arthritis is associated with RF and or ACPA and does not have DIP involvement then if you feel hydroxychloroquine is a reasonable choice for RA (I was never very convinced) then it is probably still reasonable if the patient also has psoriasis. Without autoantibodies or nodules the chances must be that you are dealing with psoriatic arthropathy and I know of no theoretical or practical evidence for hydroxychloroquine being useful there.

Paulo, read  carefully the Nature Med´s paper:

IL-23 induces spondyloarthropathy by acting on ROR-γt+ CD3+CD4-CD8- entheseal resident T cells.

 

Nat Med. 2012 Jul 1;18(7):1069-76. doi: 10.1038/nm.2817.

Dear Glatz

It was found that seventy-five per cent  of psoriatics had disease onset before the age of 46 years, males and females are equally affected by psoriasis. Considerable clinical evidence exists for the role of stress in onset and exacerbation of psoriasis. In a recent UK study, over 60% of a sample of psoriasis patients believed stress. Gupta  reported that several psychocutaneous characteristics, including more exacerbations and worse disease, correlated with stress reactivity. The early onset of psoriasis in women, with a peak around puberty, changes during pregnancy and provocation

of psoriasis by high-dose oestrogen therapy potentially indicates a role for hormonal factors in the disease.

Thanks. In my experience of internist, I noticed by chance that psoriasis of my depressed patients disappeared with the other signs, psychic and somatic as well, owing to the algorithm of treatment I had developed. 

Our article published in peer-reviewed Journal "Communicative & Integrative Biology". A few major points discussed in the paper:

(1) Brain is not the source of consciousness.

(2) Consciousness is ubiquitous in all living organisms, starting from bacteria to human beings.

(3) The individual cells in the multicellular organisms are also individually cognitive entities.

(4) Proposals like “artificial life”, “artificial intelligence”, “sentient machines” and so on are only fairytales because no designer can produce an artifact with the properties like internal teleology (Naturzweck) and formative force (bildende Kraft).

(5) The material origin of life and objective evolution are only misconceptions that biologists must overcome.

It is still questionable whether oral psoriasis exists or not. I have seen psoriasis on lips, male and female genitals, but usually in conjunction with nearby skin changes. However, since malignancy and other conditions, like for example HIV, are excluded, acitretin seems the most siutable option for your patient. It would be interesting to know which histopathology clues  were determining for the diagnosis of psoriasis in this case.

Dear Venkata;

There is overwhelming evidence that psoriasis has an important genetic component. Lomholt’s classic epidemiological study of psoriasis in the Faroe Islands (1963), in which he examined more than 10 000 inhabitants, made the key observation that the incidence of psoriasis was much greater amongst first- and second-degree relatives of patients than unaffected control subjects. A further large-scale study performed in Sweden supported these data, showing the prevalence of psoriasis to be 7.8% in first-degree relatives, compared with a prevalence of 3.14% in matched controls and 1.97% in the overall population . Based on population data, several investigators have calculated the risk for a child to develop psoriasis. In a German study, the risk was 14% if one parent was affected, 41% if both parents affected and 6% if one sibling affected, compared to 2% when no parent or sibling was affected. Henseler and Christophers demonstrated that the bimodal peak in disease onset (see above) could be taken as evidence for the existence of two pathogenetically distinct forms of the disease, similar to the model for diabetes mellitus. Thus, type 1 is hereditary, strongly HLA associated (particularly HLA-Cw6), early onset and more likely to be severe. Type 2 is sporadic, HLA unrelated, of late onset and usually mild.

FERNANDES NC. Erythroderma : a clinico- laboratorial and histopathological study of 170 cases .An Bras Dermatol .2008 ; 83 ( 6 ):526-32 .The main cause of erythroderma was psoriasis; three simultaneous skin biopsies can enhance the accuracy of the histopathologic diagnosis .Reaction TO INTERNAL DRUGS in 37 cases (21,77%).

It sounds convincing that MTHFR polymorphism a genetic marker for Cadiovascular disease in psoriasis. A review on MTHFR is enclosed.

Yes, the combined therapy  has better efficacy, expecially in periferic arthritis and cutaneous involvement, and not only due to a reduction in anti-drug antibodies vs Anti TNF drugs.

I think you could try, after surgical excision of the SCC, acitretin or methotrexate.

The risks of serious adverse events with biologics use in patients with severe psoriasis are lower than risks patients take on a regular basis such as heart attack, cancers, stroke, and accident. Additionally the risk of demylinateing diseases is less in patients using biologics compared to non biologics users.   However the risks of lymphoma and tuberculosis are slightly greater in patients using biologics than patients that do not use them.  Biologics have remarkable efficacy in patients with severe psoriasis and should continue to be used in the appropriate setting.

As a future patient who will use Ustekinumab, I do hope both doctors are right about the impressive clinical efficacy of this treatment: indeed, in my case no TNF alpha blocker worked to stop my psoriatic arthritis. 

There is little evidence that  definitively links diet with psoriatic disease. Healthy diet, rduce obesity, anti-oxident can help to reduce stresses, that could help.

elderly females with PPP will do better with phototherapy using Narrow band UVB.

Topical steroid with salicylic combination.

It may be difficult to consider methotrexate, but fatty liver should not be a problem, if The LFT is within normal limits and it may be tried for a short duration.

but yes Phototherapy helps. 

Satyaprasad: it. is not necessary a complete renal study before the treatment. As we use 2.5 to  3  mg/ kg, this dose is generally very well supported by the kidney.

to my knowledge this remains an answered but very interesting question . As chronic inflammation can induce endothelial damages , and some cytokines can enhance atheroma formation, at the opposite , antiinflammatory action of some biologc therapy for psoriasis could have a favorable effect , but it is only speculation at the moment and must be proved ,

In my very long personal clinical experience I have never seen coexistence of PLC and psoriasis. However PLC may sometimes look like psoriasis guttata and this would be possibly misinterpreted as an association or overlap. It is always possible that two different diseases could be present in the same subject but, before to conclude that PLC and psoriasis are present in the same individual, it is important to note that both could mimic the other.

Thank you Dr Jon, In this case the mother has not been given any steroid as systemic treatment nor cyclosporin. Psoriasis has affected all her limbs, abdominal area. there is erythema over the skin of abdomen.all her parameters ar normal. she has had 2 abortions hence this case has been considered precious.

My concern is of the following days post delivery.

1. if the delivery is normal then c section may be avoided.

2. precious baby hence probability of c section is high.

3. nsaids post delivery pose a risk to psoriasis.

4.extensive invovement of skin leads to topical steroids being absorbed.

5.methotrexate and phototherapy may be tried post delivery after advising against mothers milk.

6. very few studies are avalable for the management of psoriasis and pregnancy.

Inguinal lymph nodes are skin draining lymph nodes. Cervical lymph nodes are also skin draining lymph nodes. Inguinal lymph nodes receive lymph from lower extremities and cervical lymph nodes receive lymph from facial and upper portions of neck. Axilar lymph nodes receive lymph from upper extremities. There are other lymph nodes. If you look at anatomy book. The flow of lymph and places where lymph nodes located can be easily found. In animals, you can inject ink or FITC and can follow the flow of lymph and lymph nodes that receive ink or FITC.

Hello Mr. Ammar Bader

Please go thorugh the following links and the attached pdf's for details on animal models and work undertaken on in vivo assessment of psoriasis: