Etiology of Psoriasis, Signs and Symptoms - Research Paper Example

? Psoriasis Outline Introduction a) Definition: Psoriasis as a common inflammatory, noninfectious dermatitis, which is characterized by sharply defined erythematous plagues of different size characterized by silvery scale. b) Thesis: Psoriasis is a lifelong disease that attacks both males and females across all ages, with several activators and predisposing factors. 2. Overview Psoriasis affects between 1% and 3% of adults in various populations (Stein (2003) Both sexes are equally affected Women affected at an earlier age 3. Etiology of Psoriasis Highlights the causes and origination of psoriasis Genetics Pregnancy, medication, stress, and infections as potential activators 4. Signs and Symptoms a) Enumerates features of psoriasis b) Key characteristic: thick, silvery plagues on their elbows, knees, or erythroderma 5. Treatment of Psoriasis Slow-to-potency topical corticosteroids. Vitamin D derivatives 6. Prognosis of Psoriasis a) Symptoms can be managed through various therapies b) Difficult to predict the presence of prognosis in patients (Lowe, 1998) c) Increased death rates among psoriasis patient Risk Factors for Psoriasis a) Explores individuals at high risk of suffering from psoriasis b) Age, climate, family history of the disease, gender, ethnicity 7. Conclusion a) Provide a summary of the discussion and recommendations. 8. References Psoriasis Introduction Stein (2003) describes psoriasis as a common inflammatory, noninfectious dermatitis, which is characterized by sharply defined erythematous plagues of different size characterized by silvery scale. Because of maceration and rubbing, in the flexural areas, psoriasis tends to be erythematous and moist without prominent scale (Lowe, 1998). The dry flakes and scales of the skin are thought to originate from the faster proliferation of cells of the skin triggered by normal lymphocytes from the blood cells. This disease commonly affects the scalp, knees and elbows. Psoriasis is a lifelong disease that attacks both males and females across all ages, with several activators and predisposing factors. The purpose of this paper is to explore psoriasis’s etiology, signs and symptoms, treatments and prognosis. Overview Stein (2003) notes that psoriasis is estimated to affect between 1% and 3% of adults in various populations. He is quick to caution that the statistics should be viewed skeptically since the standard line shows that psoriasis is not common in darker skinned people and in less developed warmer countries. However, in these same regions, studies of epidemiology are less refined and other more pressing health issues. Stein notes that psoriasis can strike at any age, although it commonly affects adolescents or young adults (2003). Despite the fact that both sexes, are equally affected, women tend to be affected at an earlier age than their male counterparts. Etiology of Psoriasis Stein (2003) argues that the etiology of psoriasis is quite complex. Clearly there is a genetic component involved in the same respect. He notes that people whose parents and siblings have psoriasis have a higher chance of becoming affected themselves, depending on whether or not their first degree relatives are affected by the condition. For instance, when one parent has psoriasis, the risk of their child having psoriasis is about 25%. However, when both parents have psoriasis, the risk of the child is estimated at 60%-70%. Patients appear to inherit the capacity to develop psoriasis, a condition referred to as psoriatic diathesis (Stein, 2003). Then, a number of factors can push the person from the state of ‘latent psoriasis’ to a state of active psoriasis. Many are the number of potential triggers of psoriasis, the factors being both internal and external. In this regard, a study shows that pregnancy, medication, stress, and infections are potential activators of the condition. Beta-hemolytic streptococcal infections are the most notable in the list of infectious triggers. They may cause guttate or eruptive psoriasis, especially in children (Stein, 2003). Sunburn, trauma, overly aggressive tropical therapy, and other diseases of the skin may all lead to the appearance of skin changes characteristics limited to the area of trauma. Stein (2005) reveals that psoriasis can undergo deactivation. Occasionally, the most alarming forms of disease disappear spontaneously. For instance, climatic changes or pregnancy may lead to a whole resolution of clinical psoriasis. The causes of psoriasis at the molecular level have not yet been established. Many arguments have been posted relating to whether psoriasis is a primary disorder of epidermal growth with defective control mechanisms or an inflammatory dermal disease with secondary epidermal changes (Stein, 2003). Current evidence, however, leans toward deranged T cell regulation of dermal inflammation with distressed cytokine patterns. This concept is supported by increased prevalence of psoriasis among HIV/AIDS patients. However, it is worth noting that a unifying explanation of the pathophysiology still does not exist. Signs and Symptoms Psoriasis can affect almost every region of the body and has different clinical appearances. Patients affected with the disease have thick, silvery plagues on their elbows, knees, or suffer from erythroderma, the whole of their skin surface being affected (Lowe, 1998). Psoriasis appears in different forms. It may appear as small flattened bumps (spongiform pustule of kogoj), raised skin, large, thick plagues (microabscess of Munro), pink mildly dry skin, red patches or large flakes of dry skin (Mitchell and Penzer, 2000). There are quite a number of different types of psoriasis that may infect an individual. These include psoriasis vulgaris (the commonest type), inverse psoriasis (affecting the folds like navel, underarms, and buttocks, guttate psoriasis (small drop-like sports and pustular psoriasis (pus-filled yellowish, small blisters)). Those that affect the palms of the hand and soles of the leg are referred to as palmoplantar psoriasis (Lowe, 1998). Pulling of one of the small dry white flakes of the skin may result in tiny blood spots being developed on the skin. Medically this is a special diagnostic symptom in psoriasis known as Auspitz sign. Genital lesions, particularly on the head of the penis of males are also common. Psoriasis in most areas such as the areas between buttocks and navel (intergluteal folds) may appear as flat red patches. Many times, these appearances are confused with other skin conditions like yeast infections, fungal infections, bacterial infections, and skin irritation (Lowe, 1998). On the nails, it may appear as small pits (white spots on the nail or pinpoint depressions) or as large yellowish-brown severance on the bed of the nail commonly referred to us “oil spots”. Psoriasis of the nail can be confused with and diagnosed incorrectly as a fungal nail infection. On the scalp, psoriasis may appear as severe dandruff coupled with dry flakes and red areas of the kin. The fact that it resembles dandruff (seborrhea) makes the scalp psoriasis difficult to detect. This is because more than often, it is confused with dandruff (Mitchell and Penzer, 2000). Nevertheless, the treatments for both conditions are quite similar. Treatment of Psoriasis Stein (2003) argues that while there is a variety of topical and systemic measures, which can be employed to control psoriasis and even give complete clearing, the condition has no cure. The rule is recurrences when therapy is stopped without exception. There is no effective way of controlling psoriatic diathesis but a variety of T cell modulators offer hope for the future. Treatment in the perennial region is seen to be more difficult than treatment of other areas. The often fissured and eroded painful, erythematous plagues are slow to respond but quick to relapse (Weinberg, 2008). However, in these anatomic regions, most medical practitioners focus most on topical methods. Stein argues that the standard approach is slow-to-potency topical corticosteroids. However, alternatives such as the use of vitamin D derivatives with some restrictions- anthralin- may help. Regarding treatment and control of inverse psoriasis, Stein argues that the quickest method involves the use of corticosteroid cream or paste. Patients can be injected with intralesional corticosteroids (triamcinolone acetonide 10 mg/cc solution mixed with local anesthetic to 2.5-5.0 mg/cc) (Stein, 2003). Macerated perianal skin may end up showing corteroid side effects. It is worth noting that in case the treatment is stopped midway, inverse psoriasis may return with severe vengeance, which is often more difficult to cope with. As a result, fluorinated corticosteroid should only be used to induce a response for a short time (Mitchell and Penzer, 2000). Stein (2003) reveals that they can be used together with vitamin D derivatives tacalciol or calcipotriol which the patient can then continue with as a monotherapy with very mild side effects. Other possibilities are low concentration anthralin in zinc paste (0.01%-1.0%) concentration of anthralin and slowly increasing the duration of application. While doing all this, patients must be warned against the staining of bedding and clothing (Weinberg, 2008). Selective ultra violet phototherapy can also be an effective treatment method but is not easy to use in perianal regions (Stein, 2003). Stein suggests the use cream PUVA therapy with modifications for the treatment of this disease. To achieve acceptable results, the therapy must be individualized. In case anthralin or vitamin D creams cause irritant dermatitis, one is advised to interrupt the treatment and instead use a protective zinc paste or lotion for a period of one to two days (Weinberg, 2008). As a way of minimizing dryness and irritation in the perianal areas, one is advised to consider the use of sitz baths mixed with tar and oil. This has been found to keep these areas moist, and in the process reduces irritation. Fissures or erosions can be treated using a protective paste such as zinc oxide paste with 1%-3% clioquinol. In this case, protective nonadherent gauze trips can be positioned in between the buttocks as a way or reducing further maceration (Stein, 2003). Prognosis of Psoriasis Many medical practitioners argue that it is extremely difficult to predict the presence of prognosis in patients (Lowe, 1998). However, what people must know is that the disease is life-long occasioned by patients experiencing relapse and remissions throughout their lives. Despite being life-long, the symptoms can be managed through various therapies. These treatments too must be done for life. The drugs used in the treatment of psoriasis tend to put patients at a higher risk of developing certain ailments of the skin such as cancer of the skin and lymphoma (Lowe, 1998). There has also been a significant link between psoriasis in women and complications related to pregnancy. This disorder poses a lot of risk factors for cesarean delivery. Moreover, there is significant propensity of psoriasis patients to develop pulmonary hypertension. It is noted that despite the fact that psoriasis is not fatal, it is likely to enhance the risk of abuse of alcohol and drugs that may increased death rates among psoriasis patients. Even in the mildest form, the condition can cause burning, itching, bleeding and stinging. These signs may be very debilitating under severe cases (Lowe, 1998). Risk Factors for Psoriasis Age: Studies show that about 40 percent of people get affected with the condition before attaining the age of 20. However, psoriasis can affect even infants (Most often, plaque psoriasis). Climate: A number of studies reveal that the condition develops earlier and more frequently under cold climates. For instance, the study found out that psoriasis more often occurs among African-Americans and Caucasians living in colder climates than their counterparts living in Africa that is hotter (Lowe, 1998). Family History of the Disease: Close to 35 percent of those with psoriasis have at least one family member with the condition. This suggests that the disease in heritable. Ethnicity: In the United States, psoriasis in not common among Native Americans living in the South or North. Gender:-Many studies indicate that there are higher cases of psoriasis in men than in women. Conclusion Psoriasis is a common chronic recurrent inflammatory skin disease that can be disabling not merely due to skin involvement but also for its being a concomitant disease of the joint. While the skin lesions are easily recognizable by a trained eye, others like psoriatic arthritis can sometimes be very difficult to diagnose. As such, a broad base of knowledge of the clinical features and other diseases associated with psoriasis and psoriatic arthritis is vital so that the most suitable therapy can be chosen for the patients. As research into psoriasis’s etiology and development of targeted immunotherapeutic agents to treat the condition continues, medics and society at large will be able to advance the care of patients with the potentially distressing and disabling condition. For instance, research show that more that more than 7.5 million Americans, which accounts for 2.2% of the population, suffer from the psoriasis condition. This figure is so alarming and requires that stringent preventive measures be established so that the condition can be effectively managed. This is because the disorder is not curable and to a high extent inheritable. It is also crucial that more research be conducted on how the disease can be treated as this is the bottom line. Furthermore, the government should establish more hospitals across the country to specialize in the control of the disorder especially in colder areas where the disease has been found to be common. In case these measures are put in place, the disorder will be contained and this will see a reduction in the number of patients suffering from the disorder. References Lowe, N. J. (1998). Psoriasis: Patient’s Guide. London: Taylor & Francis. Mitchell, T., & Penzer, R. (2000). Psoriasis at your fingertips: The comprehensive and medically Accurate…London: Class Publishing Ltd. Stein, E. (2003). Anorectal and Colon Diseases: Textbook and Color Atlas of Proctology. New York: Springer. Weinberg, J. M. (2008). Treatment of Psoriasis. New York: Springer. Read More