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Le psoriasis (du grec ruption galeuse, psore ayant aussi autrefois dsign la gale en France) est une maladie auto-immune de la peau d'origine inconnue et non contagieuse. Cette affection dermatologique touche 1 3% de la population mondiale.
Dans sa forme bnigne et typique, le psoriasis se caractrise par des lsions rouges et squameuses du cuir chevelu, des genoux et des coudes, associe une atteinte des ongles. Dans les cas graves, l'atteinte cutane peut tre gnralise (rythrodermie) et il peut exister des atteintes des articulations. Cette dermatose volue de faon chronique avec des pousses entrecoupes de priodes de rmissions de dure variable au cours desquelles les lsions sont minimes. Aucun traitement permettant la gurison n'est connu; le traitement propos permet uniquement de contrler l'volution de la maladie, en permettant la rgression transitoire plus ou moins complte des lsions. Le traitement est adapt en fonction de la gravit et du retentissement sur la qualit de vie des patients.
Les causes prcises en sont inconnues bien que, dans prs de 30% des cas, une prdisposition familiale existe, surtout si des facteurs externes viennent se rajouter. La maladie aurait des composantes gntiques, auto-immunes[1], microbiologique et environnementale ou alimentaire (l'arrt de la consommation de produits laitiers ou certaines autres denres reviennent souvent dans les tmoignages de personnes ayant russi s'en dbarrasser sans faire intervenir un traitement en parallle[rf.ncessaire]).
L'piderme se renouvelle trop rapidement, en seulement quatre six jours, au lieu des trois semaines habituelles ce qui engendre des inflammations localises. Les cellules pidermiques s'accumulent la surface de la peau et forment une couche de pellicules blanches appeles squames. Parfaitement inoffensives, celles-ci ont pourtant le dsavantage d'tre inesthtiques. La prsence de nombreux leucocytes dans le derme a suggr le rle du systme immunitaire.
Comme indiqu prcdemment, il existe pour un petit tiers des personnes atteintes une composante familiale au psoriasis (restent dterminer les autres facteurs entrant en jeu): prs de 30% des patients atteints ont un membre de leur famille ayant galement la mme maladie[2]. Un certain nombre de gnes ont t identifis comme marqueurs potentiels de risque, dont le PSORS. Le plus important semble tre le PSORS1 situ sur le chromosome 6 et qui serait responsable de prs du tiers des psoriasis familiaux[3]. Seize gnes (en 2012[4]) ont des mutations pouvant favoriser cette maladie.
Les pousses de psoriasis sont parfois lies au stress. Elles peuvent aussi avoir pour origine un facteur infectieux (infection streptococcique, par exemple). Leur frquence est trs variable et, d'une manire gnrale, le facteur dclenchant de la pousse n'est pas identifiable. La consommation excessive d'alcool est un facteur d'aggravation du psoriasis.
Certains mdicaments exacerbent parfois le psoriasis mais leur arrt doit tre discut au cas par cas, celui-ci pouvant comporter d'autres risques, cardio-vasculaires en particulier. Ce sont essentiellement ceux de la classe des bta-bloquants. D'autres molcules ont t rapportes comme potentiellement aggravantes, avec un risque cependant moindre. Ce sont les sartans[5] et l'nalapril[rf.souhaite].
Au contraire, l'exposition solaire a un rle protecteur net. Durant la grossesse, une diminution des pousses avec une aggravation par contre la suite de celle-ci est gnralement observe. Le mcanisme invoqu est celui d'une immuno-modulation par les taux levs de progestrone et d'strognes qui entranent une stimulation de l'immunit dpendant des lymphocytes B mais une diminution de l'activit immunitaire des lymphocytes T. La progestrone est reconnue comme ayant un rle immuno-modulateur cl durant la grossesse[6].
Certaines formes peuvent se dvelopper la suite d'un traumatisme articulaire.
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Psoriasis - Wikipédia
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