Psoriasis Explained Clearly - Including Types and Treatment

Comprehensive overview of psoriasis covering causes, types, symptoms, associated risks, and treatments.

Key Takeaways

Psoriasis is an immune-mediated chronic skin disease with genetic and environmental triggers.
Multiple clinical subtypes exist, each requiring tailored management approaches.
Psoriasis increases risk for cardiovascular and metabolic diseases, necessitating comprehensive patient evaluation.
Topical therapies are first-line for mild disease; systemic treatments are reserved for moderate to severe cases.
Proper diagnosis and monitoring are essential for effective management and reducing complications.

What the video covers

Psoriasis is a chronic inflammatory skin condition characterized by red, scaly plaques caused by rapid keratinocyte proliferation and immune dysregulation.
Genetic susceptibility plays a major role, with psoriasis susceptibility loci identified near the major histocompatibility complex on chromosome 6.
Triggers include drugs (beta blockers, lithium), trauma, infections (streptococcal, HIV), stress, smoking, alcohol, and obesity.
Common psoriasis types include plaque, flexural (inverse), guttate, pustular, and erythrodermic psoriasis, each with distinct clinical features.
Psoriasis can involve nails and joints, with psoriatic arthritis affecting distal interphalangeal joints and nails showing pitting and discoloration.
Psoriasis is associated with increased risk of metabolic syndrome and cardiovascular disease due to chronic inflammation and shared pathways.
Diagnosis is clinical, supported by history and examination; biopsy is rarely needed. Severity is assessed by body surface area and scoring systems.
Treatment includes lifestyle modifications and a range of topical agents: emollients, anti-proliferatives, anti-inflammatories, and descaling agents.
Topical steroids are commonly used but require careful management to avoid side effects; steroid-sparing options include calcineurin inhibitors and retinoids.
Severe cases may require phototherapy or systemic therapies; scalp psoriasis is challenging due to hair interference with treatment application.

Chapters

What causes the rapid skin cell growth in psoriasis?

Psoriasis involves sustained inflammation that increases mitotic activity of keratinocytes, causing them to divide faster and form scaly plaques.

What are common triggers that can worsen psoriasis?

Triggers include certain drugs like beta blockers and lithium, infections such as streptococcal throat, trauma, stress, smoking, alcohol, and obesity.

How is psoriasis diagnosed and assessed for severity?

Diagnosis is primarily clinical based on history and skin examination; severity is assessed by body surface area involved and may use scoring systems like PASI.

Full Transcript — Download SRT & Markdown

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[Music] Psoriasis is a chronic inflammatory condition affecting primarily the skin, classically characterized by well-defined red scaly plaques. The name itself comes from Greek and means itching disease. In normal circumstances, cells in the outermost layer of the skin, the epidermis, will gradually replicate and migrate to the skin surface. These cells are keratinocytes that differentiate as they migrate through the layers of the epidermis from the stratum basal, where they are produced, to

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the stratum corneum that is made up mostly of dead keratinocytes and keratin. In psoriasis, however, sustained inflammation leads to increased mitotic activity of the keratinocytes, meaning they divide faster than normal, giving uncontrolled proliferation as well as dysfunctional differentiation. The result is the formation of the plaques characteristic of psoriasis, which feature epidermal hyperplasia, inflammatory infiltrates, and increased vascularity. This is thought to be the

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result of an immune-mediated process present across the dermis and epidermis that leads to a cascade of inflammatory mediators. Specifically, interleukin 13 and 17 have been found in increased levels in patients with psoriasis and are thought to play a significant role, as well as TNF alpha. Overall, it's therefore thought that external insults in genetically susceptible individuals trigger the immune reaction and development of psoriasis. Heritability is estimated to be between 60 and 90%, and a group of

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areas of the genome associated with psoriasis have been identified called psoriasis susceptibility loci. One is located close to the major histocompatibility complex on chromosome 6, with the HLA-Cw6 allele being closely correlated with psoriasis before the age of 40 and a positive history. Although the exact mechanism is not currently understood, triggering or aggravating factors associated with psoriasis include drugs, with beta blockers in 20% of people with psoriasis

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and lithium in 50%, as well as others like antimalarial drugs, non-steroidal anti-inflammatories, ACE inhibitors, and antibiotics like amoxicillin. Trauma or injury can also induce or worsen lesions, and this is known as the Koebner phenomenon. Infection is another, primarily streptococcal infections like strep throat, but HIV is also another example. Stress, smoking, alcohol, and obesity are also potential triggers or aggravators. It affects roughly 3% of the US population and affects males and

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females roughly equally. There are two peaks of typical onset between 15 and 25 years and between 50 and 60 years. Around 1 in 3 people with psoriasis also have an affected family member. There are several different subtypes, with plaque psoriasis being the most common in all ethnicities, making up around 90%. It features well-defined red scaly plaques, often with a white or silver color. If this is scraped away, it can reveal pinpoint bleeding where dilated dermal capillaries are exposed, called

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Auspitz sign. They can be present anywhere; however, the most commonly affected areas are the scalp and extensor surfaces of elbows and knees. Non-Caucasians tend to have more extensive involvement, and plaques can appear more purple in darker skin colors. Itching is present in 60 to 90% of patients and can vary from mild to severe, and over time, scratching can lead to lichenification and thickening of the skin. Pigment changes, either hypo- or hyperpigmentation, can be left behind as

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plaques clear. Flexural psoriasis, as the name suggests, is more commonly found in flexures and folds of skin such as the groin, armpits, or beneath the breasts and commonly has a moist, shiny appearance rather than silver scales. This is also called inverse psoriasis. Guttate psoriasis often follows a streptococcal upper respiratory tract infection, mostly in children and young adults, and features widespread fine scaly lesions that resemble water drops, which is where the

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name comes from. These are mostly on the trunk, arms, and legs. Pustular psoriasis features development of yellow or brown pustules beneath the skin, mostly on the hands and feet. However, it can be an acute generalized condition with flu-like symptoms, which is severe and requires hospital treatment as the ability to regulate temperature is lost. The pustules are sterile and non-infectious. Another type is erythrodermic psoriasis, characterized by generalized redness with fine scales affecting between 90 and

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100% of the body surface. This can be painful and, like generalized psoriasis, also feature flu-like symptoms and similarly is a medical emergency due to the loss of thermoregulation and risk of hypovolemia. In around one-third of cases of people with other forms of psoriasis, there can be nail or joint involvement. The joint involvement can be destructive and is most commonly in the distal interphalangeal joints of fingers and toes but can involve any joint and can vary in its symmetry. Nail psoriasis

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features pitting, thickening, and discoloration without separation from the nail plate and may appear like a fungal infection. There is an association between psoriasis and other diseases, with psoriasis, obesity, and type 2 diabetes being correlated, thought to be due to genetic influence and chronic inflammation, and this is independent of age, sex, and smoking history. The interleukin 23 T helper cell 17 pathway is relevant in psoriasis but is also relevant in atherosclerosis. Overall, these mean a

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higher risk of metabolic syndrome and cardiovascular disease, with psoriasis itself being considered an independent risk factor for cardiovascular disease. Diagnosis is a clinical one, meaning it can be diagnosed on the history and clinical exam alone. If there is uncertainty, a skin biopsy may be taken. It is generally considered mild if less than 10% of the body surface is involved, and scoring systems exist such as the psoriasis area and severity index, but these are generally used more in

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research. If diagnosed, then a cardiovascular risk workup should also be done that includes BMI, blood pressure, bloods such as HbA1c, lipids, liver function, and uric acid, and an ECG. In terms of treatment, there are general recommendations that include weight management, cessation of smoking and alcohol consumption limits, and a wide range of therapies exist depending on the type and severity of psoriasis. Topical agents can broadly be divided into four categories: emollient, anti-proliferative,

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anti-inflammatory, and descaling agents. Emollient and moisturizing agents enhance skin hydration and help correct the dryness seen in psoriasis. They also aid the barrier function of the skin and can soothe itching. Many preparations are available, ranging from heavier to lighter creams with more or less lipid content and so should be individualized to the patient's needs and preference. Anti-proliferative include vitamin D analogues like calcipotriol or calcitriol

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as well as coal tar. These induce normal keratinocytes. Anti-inflammatories are primarily topical steroids, with mild to potent agents being preferred in psoriasis. Generally, lower potencies are used on areas such as the face and genitals, as well as any area of skin in contact with skin such as the axilla or groin. Hydrocortisone is an example of a mild steroid, cetone butate, also known as umate, for moderate, and betamethasone for late or Betnovate for potent. They are ideally only used for up to 3 weeks before having a steroid break for 1 to

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two weeks in order to reduce the unwanted effects like skin atrophy and tachyphylaxis, where increasing doses are needed for the same effect. Steroid-sparing therapies include calcineurin inhibitors like tacrolimus available topically, roflumilast, which is a topical phosphodiesterase 4 inhibitor, and tazarotene as a topical retinoid. Combinations of anti-proliferative and anti-inflammatory agents are available too, such as Daivobet, that includes betamethasone dipropionate and calcipotriol. The

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fourth is descaling agents. These are keratolytic and help soften the scales, an example being salicylic acid. This is particularly useful on the scalp where the scale can be very thick. Phototherapy using

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and it is used more in extensive cases but its use is decreasing due to the availability of systemic therapies these systemic therapies can include agents such as methotraxate cyclosporine or micop phenolate mtil and there are biological therapies available in the form of monoclonal antibodies such as tnf inhibitors like aanp or infliximab il23 Inhibitors like TI dmab and IL 17 Inhibitors like seuk kinab generally topical agents are used in mild plaque or flexos psoriasis with

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phototherapy or systemic therapies being added in moderate or severe cases including erythrodermic pular and nail psoriasis or sertic arthritis scalp psoriasis is more difficult to treat because the hair can block topical agent application as well as shielding from UV light some ways this is worked around is by application of Agents with a toothbrush and use of a shower cap overnight gut a psoriasis usually responds well with treatment of the underlying infection if indicated and

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then topical or systemic therapy afterwards

Topics:psoriasischronic skin diseasepsoriasis typespsoriatic arthritistopical treatmentimmune-mediatedskin inflammationcardiovascular riskgenetics of psoriasisdermatology

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