Psoriasis
From Ganfyd
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Drugs that modulate this inflammation are used to treat it, ranging from steroids and tar based preparations through to [[PUVA]] therapy in less severe disease. | Drugs that modulate this inflammation are used to treat it, ranging from steroids and tar based preparations through to [[PUVA]] therapy in less severe disease. | ||
| - | More severe disease may justify the transition to immunosuppressive agents such as [[methotrexate]], and [[ciclosporin]]. Inhibitors of [[Tumour necrosis factor alpha|tumour necrosis factor α (TNF-α)]] such as the biologics [[infliximab]], [[etanercept]], and [[adalimumab]] have an ever increasing evidence base in both severe skin disease and psoriatic arthritis. Presently there is some evidence that in severe disease blockage of [[interleukin-12]] and [[interleukin-23]] together is more effective than TNF-α alone as [[ustekinumab]] can be superior to [[etanercept]]. | + | More severe disease may justify the transition to immunosuppressive agents such as [[methotrexate]], and [[ciclosporin]]. Inhibitors of [[Tumour necrosis factor alpha|tumour necrosis factor α (TNF-α)]] such as the biologics [[infliximab]], [[etanercept]], and [[adalimumab]] have an ever increasing evidence base in both severe skin disease and psoriatic arthritis. Presently there is some evidence that in severe disease blockage of [[interleukin-12]] and [[interleukin-23]] together is more effective than TNF-α alone as [[ustekinumab]] can be superior to [[etanercept]]. Agents that block [[interleukin-17A]] activation may be more specific and [[interleukin-22]] is also being examined as injection of this interleukin induces psoriasis. |
All systemic agents and PUVA however have safety issues ranging from organ toxicity to serious infections, birth defects, and malignancies. These issues need to be balanced which is made difficult by several factors such as lack of long term data with some agents and that psoriasis itself is associated with an increased risk of malignancy<ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=19344980 Patel RV, Clark LN, Lebwohl M, Weinberg JM. Treatments for psoriasis and the risk of malignancy. Journal of the American Academy of Dermatology. 2009 Jun; 60(6):1001-17.]<small>([http://dx.doi.org/10.1016/j.jaad.2008.12.031 Link to article] – subscription may be required.)</small></ref>. In early [[2009]], one of the newer clinically effective agents [[efalizumab]] was withdrawn because of an increased risk of [[progressive multifocal leukoencephalopathy]]. | All systemic agents and PUVA however have safety issues ranging from organ toxicity to serious infections, birth defects, and malignancies. These issues need to be balanced which is made difficult by several factors such as lack of long term data with some agents and that psoriasis itself is associated with an increased risk of malignancy<ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=19344980 Patel RV, Clark LN, Lebwohl M, Weinberg JM. Treatments for psoriasis and the risk of malignancy. Journal of the American Academy of Dermatology. 2009 Jun; 60(6):1001-17.]<small>([http://dx.doi.org/10.1016/j.jaad.2008.12.031 Link to article] – subscription may be required.)</small></ref>. In early [[2009]], one of the newer clinically effective agents [[efalizumab]] was withdrawn because of an increased risk of [[progressive multifocal leukoencephalopathy]]. | ||
Latest revision as of 22:26, 28 March 2012
Web Resources for Psoriasis
ICD 10 code: L40
Relevant Clinical Literature
UK Guidance
Other Wikis
Medpedia on Psoriasis (Less technical, good quality control)
Wikipedia on Psoriasis (Less technical, ? quality control)
- Until there is more information at ganfyd, those with access to the British Medical Journal might find a recent Clinical review article useful.[1]
A chronic, inflammatory skin disease characteristically presenting with erythematous scaling plaques over the extensor surfaces. It is thought to be due to immune dysregulation.
Treatment
Drugs that modulate this inflammation are used to treat it, ranging from steroids and tar based preparations through to PUVA therapy in less severe disease.
More severe disease may justify the transition to immunosuppressive agents such as methotrexate, and ciclosporin. Inhibitors of tumour necrosis factor α (TNF-α) such as the biologics infliximab, etanercept, and adalimumab have an ever increasing evidence base in both severe skin disease and psoriatic arthritis. Presently there is some evidence that in severe disease blockage of interleukin-12 and interleukin-23 together is more effective than TNF-α alone as ustekinumab can be superior to etanercept. Agents that block interleukin-17A activation may be more specific and interleukin-22 is also being examined as injection of this interleukin induces psoriasis.
All systemic agents and PUVA however have safety issues ranging from organ toxicity to serious infections, birth defects, and malignancies. These issues need to be balanced which is made difficult by several factors such as lack of long term data with some agents and that psoriasis itself is associated with an increased risk of malignancy[2]. In early 2009, one of the newer clinically effective agents efalizumab was withdrawn because of an increased risk of progressive multifocal leukoencephalopathy.
Histological Features
- Parakeratosis
- Munro microabscesses (neutrophils in the parakeratotic layer)
- Attenuation of the granular cell layer
- Acanthosis
- Elongation of the rete ridges
- Thinning of the subpapillary plate, i.e. some of the papillary dermis will be within reach of the epidermis in contrast to chronic eczema
- Prominent dermal capillaries with a dermal mixed inflammatory infiltrate
This article is a stub. Please feel free to expand it and make it more encyclopaedic.
References
- ↑ CH Smith, JNWN Barker. Psoriasis and its management. BMJ 2006;333:380-384 (19 August), doi:10.1136/bmj.333.7564.380. Full text available at BMJ website (subscription may be necessary).
- ↑ Patel RV, Clark LN, Lebwohl M, Weinberg JM. Treatments for psoriasis and the risk of malignancy. Journal of the American Academy of Dermatology. 2009 Jun; 60(6):1001-17.(Link to article – subscription may be required.)
