Psoriasis: A Comprehensive Review on the Etiopathogenesis And Recent Advances in Long-Term Management of Patients with Plaque Psoriasis

Psoriasis is a long-term inflammatory skin and joint condition that is autoimmune and non-communicable. Psoriasis is derived from the Greek words “psora,” which meaning itching, and “iasis,” which denotes a disease.One The prevalence of the condition is 2% worldwide, with affluent nations having a greater frequency of roughly 4.6%.2. “¹” Young adults are usually affected with psoriasis. Psoriasis often affects a small number of body parts. However, major affected regions are engaged in severe situations. The patches tend to heal and reappear over the course of a person’s lifetime. ²

Causes of Psoriasis:

Although the reason is unknown, scientists believe it to be caused by a number of circumstances. When the immune system is disrupted, new cells proliferate quickly. New skin cells typically replace old ones. In psoriasis, new cells begin to grow within 3–4 days, as opposed to 10–30 days. Silvery grey scales form as the old cells are replaced by new ones. ³ Although it is found to skip generations, psoriasis is typically prevalent in families. For instance, the grandchild’s parent may not be impacted, but the grandmother and grandchild may. ? An outbreak of psoriasis can be brought on by surgery, cuts or scrapes, strep infections, emotional stress, medications, such as lithium and other mood stabilizers, blood pressure drugs, NSAIDs, and antibiotics. Genes are little segments of DNA that provide cells instructions. They control the colour of the eyes and hair, food preferences, and other body processes. Certain genes are only active during specific hours of the day. Genes that regulate the immune system’s messages are jumbled in psoriasis patients. The genes cause inflammation by activating the skin cells rather than shielding the body from external antigens. According to research, psoriasis is caused by abnormalities in about 25 genes. ¹¹

1) Genetic predisposition

2) Immune system dysfunction

3) Environmental factors (Stress, Cold, weather, infection s)

4) Lifestyles factors (smoking, obesity, lack of exercise)

5) Autoimmune disorder (e.g rheumatoid arthritis)

6) Heart disease

7) Thyroid disorders.

8) Diabetes

9) Vitamin D deficiency

Symptoms: The symptoms vary depending on the type of psoriasis. Plaque psoriasis is the most prevalent variety of psoriasis, characterized by red plaques that are frequently covered with silver-colored scales. ¹? The plaques might occasionally split and bleed, and they are itchy and uncomfortable. Plaques proliferate and, in extreme situations, combine to cover substantial areas of the body. The main characteristics of toenail and fingernail diseases include discoloration and pitting. Furthermore, nails may break down or separate from the nail bed. On the head’s surface, crusts and plaques have been observed. ¹?People with psoriasis may develop psoriatic arthritis, a form of arthritis. It results in edema and joint pain.

Complications: Patients who have psoriasis are far more likely to develop the other conditions listed. Psoriatic arthritis symptoms include joint pain, stiffness, and edema. Where plaques have healed, there are differences in skin color (hypopigmentation following inflammation and hyperpigmentation). Eye disorders such as blepharitis, conjunctivitis, and uveitis. Diabetes mellitus type 2 Unusual weight gain The primary cause of cardiovascular disease was elevated blood pressure. Additional autoimmune conditions like sclerosis, IBD, primarily Crohn’s disease, and celiac disease psychological disorders,

Classification of Psoriasis

1) Plaque psoriasis (Psoriasis vulgaris)

2) Guttate psoriasis :Small, round stops

3) Inverse psoriasis:smooth, red patches in folds.

4) Pustular Psoriasis:Pus -filled bumps

5) Erythrodermic psoriasis:Widespread redness

6) Psoartic Arthritis: Joint inflammation

1) Plaque Psoriasis:

A chronic autoimmune skin conditions characterized by red, abnormal cell growth. The skin disorder known as plaque psoriasis is characterized by dry, elevated, red spots that are covered in silvery-white scales. This kind of psoriasis is the most prevalent. Plague Psoriasis is skin condition and chronic autoimmune disease and disorders.

Symptoms: Raised areas of skin that are itchy or painful Although patches can develop anywhere on the body, they are most frequently found on the lower back, scalp, knees, and elbows. In extreme situations, the skin surrounding joints may bleed and crack. Your skin tone can affect the color of the patches.

Causes: Reasons An immune system that interprets healthy cells as alien invaders is the cause of plaque psoriasis. Beta blockers, NSAIDs, lithium, and antimalarial medications are among the medications that might cause flare-ups. Additionally, thinner skin, stress, and a compromised immune system can trigger or exacerbate flare-ups.

Treatment: Although there isn’t a cure for plaque psoriasis, there are numerous ways to manage it. Topical therapies, light therapy, laser therapy, corticosteroid injections, and biologic medications are among the available treatments. Changes in lifestyle, such bathing every day, quitting smoking, and recognizing and avoiding personal triggers, can also be beneficial.
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    Fig- 1 Plaque Psoriasis

2) Guttate Psoriasis: A type of psoriasis characterized by small, scaly spots, typically affects trunk arms, and legs.  A skin disorder called guttate psoriasis results in tiny, teardrop-shaped, pink or red patches on the skin. Scales are silvery, flaky skin that may cover the marks. Skin irritation and itching are other symptoms.Gutte psoarias is chronic disease and disorders.

Tretment:

Topical treatments: Creams, lotions, and ointments that contain cortisone or other corticosteroids, coal tar, vitamin D, or vitamin A

Oral treatments: Vitamin A (retinoids) or other prescription medications

Phototherapy: A medical procedure that exposes the skin to ultraviolet light

Antibiotics: For recent infections, especially those caused by group A beta-hemolytic streptococci

Immunosuppressants: For severe cases, cyclosporine or methotrexate can suppress the immune response
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 3)Inverse psoriasis:

Inverse psoriasis, also know as flexural psoriasis, is a type of psoriasis characterized by smooth, ted and inflamed, patches, located on skin folds. Inverse psoriasis, also known as flexural psoriasis, is a painful autoimmune condition that causes inflammation in skin folds where skin rubs together. It's characterized by smooth, red, shiny lesions that can appear moist and itchy. Unlike plaque psoriasis, inverse psoriasis usually doesn't have scales. It can appear in the groin, armpits, under the breasts, and other skin folds.

Symptoms:

Inverse psoriasis, also known as flexural psoriasis, is a painful autoimmune condition that causes inflammation in skin folds where skin rubs together. It's characterized by smooth, red, shiny lesions that can appear moist and itchy. Unlike plaque psoriasis, inverse psoriasis usually doesn't have scales. It can appear in the groin, armpits, under the breasts, and other skin folds.

Causes:

Inverse psoriasis is caused by an immune system irregularity that can be triggered by a number of factors. These factors include:

Skin injuries: Cuts, scrapes, or surgery can trigger inverse psoriasis.

Friction: Skin folds rubbing together can aggravate the rash.

Sweating: Excessive sweating can contribute to the immune reaction.

Medications: Certain prescription medications, like lithium and beta-blockers, can trigger inverse psoriasis.

Infections: Infections like streptococcal infections can trigger inverse psoriasis.

Stress: Emotional stress can trigger inverse psoriasis.

Tobacco or alcohol use: Smoking or drinking a lot of alcohol can trigger inverse psoriasis.

Treatment:

Corticosteroid creams or ointments: Can reduce inflammation

Calcipotriene skin ointment: A form of vitamin D that can reduce discoloration

Pimecrolimus skin cream or tacrolimus ointment: Can help treat inverse psoriasis, though they are typically used to treat eczema

Coal tar: Can help correct the defect in keratinocytes that causes psoriasis
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4) Pustular Psoriasis:White or yellowish pus-filled pimples and red, swollen skin are the hallmarks of pustular psoriasis, a rare and severe kind of  psoarisis. Both widespread and localised pustular psoriasis are possible. Generalised pustular psoriasis (GPP) is the most severe type and can spread to many parts of the body.By examining the skin lesions, a dermatologist can typically diagnose pustular psoriasis. In order to confirm the diagnosis and rule out other illnesses, they could additionally conduct testing.

Symptoms:

Symptoms of pustular psoriasis include: Pustules: White or yellow lumps packed with pus. The soles of the feet, the palms of the hands, and other parts of the body may be affected. Redness: On lighter skin tones in particular, the skin may seem red or purple. Scales: When pustules dry out, they leave behind scales. Itching and pain: The skin may be both itchy and painful. Fever, chills, exhaustion, headache, nausea, diarrhoea, joint pain, muscle weakness, and a fast heartbeat are examples of systemic symptoms. Skin shedding: When the pustules rupture, the skin may start to peel off.

Treatment:

Topical medications corticosteroids, non-steroidal drugs, calcipotriene, tacrolimus, and coal tar.

Phototherapy Light therapy and Psoralen plus ultraviolet A.

Oral medications acitretin, cyclosporine, methotrexate, infliximab, and isotretinoin.

Biologics adalimumab and etanercept.

Other treatments antipyretics and anti-inflammatory medications.
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5) Erythrodermic Psoriasis:The signs and symptoms of erythrodermic psoriasis, a rare and severe kind of psoriasis, include skin peeling, scaling, and widespread redness and inflammation. You may rapidly and effectively rework and restate your content with the help of QuillBot's paraphraser, which takes your phrases and makes adjustments!

Symptoms:

Skin discolouration: More than 75% of the body's skin becomes red, like a bad sunburn. Shedding of the skin: Large sheets of skin peel. Pain and itching: The skin is extremely irritated and could burn. Swelling: Swelling results from the body retaining fluid. Chills and fever: The body may experience chills and a fever. Lethargy: The body could feel sluggish. Body temperature fluctuations are possible, particularly on hot or cold days. Nail loss: Some persons may experience toenail and fingernail loss.

Causes:

Drugs: Beginning or ceasing to use specific drugs, including interleukin II, lithium, immunosuppressants, corticosteroids, and antimalarials Diseases or infections: Serious disease, infection, or drug allergic response Sunburn: Extreme sunburn Use of alcohol: Overindulgence in alcohol Stress: tense situations in life History of psoriasis: The most vulnerable are those with poorly managed plaque psoriasis. Skin damage: Skin injuries such cuts, scrapes, insect bites, or extreme sunburn

Treatment:

Topical and oral medications

Corticosteroids: Steroid creams or ointments that can help with itching

Retinoids: Topical ointments or oral retinoids that can help with symptoms

Nonsteroidal anti-inflammatory drugs (NSAIDs): Can help with pain

Immunosuppressants: Like cyclosporine or methotrexate, these can help calm an overactive immune system
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6) Psoartic Arthritis: A chronic autoimmune disease, Psoartic arthritis combines a) inflammation of the skin from psoriasis and b) inflammation of the joints from arthritis. Although there is no cure for psoriatic arthritis, treatments can help patients reduce their symptoms, including joint pains and stiffness, skin psoriasis. In psoartic arthritis information in the joints Psoartic arthritis is a chronic conditions disease and disorder.

Symptoms:

Discolouration or redness near your affected joints, Swelling in your fingers and toes, Joint pain.

Treatment:

Treatment of psoriatic arthritis (PsA) aims to reduce inflammation, relieve symptoms, and prevent joint damage. Here's a comprehensive overview:

Medications:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs): Relieve pain and inflammation.

2. Disease-modifying antirheumatic drugs (DMARDs): Slow disease progression and reduce inflammation.

3. Biologics: Target specific proteins involved in inflammation, such as TNF-alpha inhibitors.

4. Phosphodiesterase 4 (PDE4) inhibitors: Reduce inflammation and slow disease progression.

5. Janus kinase (JAK) inhibitors: Block inflammatory pathways.
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