Psoriasis: Manifestations, Management Options, and Mimics
Psoriasis is a complex, chronic, multifactorial, inflammatory disease that involves hyperproliferation of the keratinocytes in the epidermis, with an increase in the epidermal cell turnover rate (see the image below). Environmental, genetic, and immunologic factors appear to play a role. The disease most commonly manifests on the skin of the elbows, knees, scalp, lumbosacral areas, intergluteal clefts, and glans penis. In up to 30% of patients, the joints are also affected. Signs and symptoms of psoriasis may include the following:
Worsening of a long-term erythematous scaly area
Sudden onset of many small areas of scaly redness
Recent streptococcal throat infection, viral infection, immunization, use of antimalarial drug, or trauma
Pain (especially in erythrodermic psoriasis and in some cases of traumatized plaques or in the joints affected by psoriatic arthritis)
Pruritus (especially in eruptive, guttate psoriasis)
@rohit Management of psoriasis may involve topical and systemic medication, phototherapy, stress reduction, climatotherapy, and various adjuncts such as sunshine, moisturizers, salicylic acid, and other keratolytics such as urea. Expert dermatologists from across the globe released a consensus report on treatment optimization and transitioning for moderate-to-severe plaque psoriasis. Recommendations of the 2013 consensus report include the following:
Methotrexate may be used for as long as it remains effective and well-tolerated.
Cyclosporine is generally used intermittently for inducing a clinical response with one or several courses over a 3–6 month period.
Transition from conventional systemic therapy to a biological agent may be done directly or with an overlap if transitioning is needed because of lack of efficacy, or with a treatment-free interval if transitioning is needed for safety reasons.
Combination therapy may be helpful.
Continuous therapy for patients receiving biologicals is recommended.