PSORIASIS
Psoriasis is a multisystem inflammatory disease with predominantly skin and joint involvement. It has a bimodal age of onset (16 to 22 and 57 to 60 years) and affects both sexes equally. Pathogenesis is multifactorial, involving dysregulated inflammation and genetic associations. Beyond the physical dimensions of disease, psoriasis has an extensive emotional and psychosocial effect on patients; it can result in stigmatization, poor self-esteem, and increased stress, affecting social functioning and interpersonal relationships.
The diagnosis of psoriasis is primarily clinical. There are different clinical types of psoriasis (Table 1),1 the most common of which is chronic plaque psoriasis, affecting 80% to 90% of patients with psoriasis. The hallmark of classic plaque psoriasis is well-demarcated, symmetric, and erythematous plaques with overlying silvery scale (Figure 1). Plaques are typically located on the scalp, trunk, buttocks, and extremities but can occur anywhere on the body. Patients might demonstrate nail involvement, which can present without concomitant plaques (Figure 2). Active lesions might be itchy or painful. Psoriasis can also present as an isomorphic response, where new lesions develop on previously normal skin that has sustained trauma or injury. The severity of disease can be helpful in guiding management and is classified as mild, moderate, and severe.
Table 1.
CLINICAL MANIFESTATION | CLINICAL FINDINGS |
---|---|
Plaque psoriasis |
|
• Flexural |
|
• Nail |
|
• Scalp |
|
• Palmoplantar |
|
Other variants | |
• Guttate |
|
• Pustular |
|
• Erythroderma |
|
• Annular |
|
Data from the Canadian Psoriasis Guidelines Committee.
Topical therapy is the standard of care for treatment of mild to moderate disease. A large proportion of patients would benefit from topical therapy, which can be initiated at the primary care level. If topical agents do not elicit an adequate response or if they are not practical owing to the affected body surface area, these patients can be referred for assessment by a dermatologist, at which point systemic therapy with topical adjuncts might be more suitable. Presence of psoriatic arthritis might also call for systemic therapies in collaboration with a rheumatologist.
Reference:
Kim WB, Jerome D, Yeung J. Diagnosis and management of psoriasis. Can Fam Physician. 2017;63(4):278-285.