Category Archives: Psoriasis

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Adriana Rendonet al. Int J Mol Sci. 2019.

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Research on psoriasis pathogenesis has largely increased knowledge on skin biology in general. In the past 15 years, breakthroughs in the understanding of the pathogenesis of psoriasis have been translated into targeted and highly effective therapies providing fundamental insights into the pathogenesis of chronic inflammatory diseases with a dominant IL-23/Th17 axis. This review discusses the mechanisms involved in the initiation and development of the disease, as well as the therapeutic options that have arisen from the dissection of the inflammatory psoriatic pathways. Our discussion begins by addressing the inflammatory pathways and key cell types initiating and perpetuating psoriatic inflammation. Next, we describe the role of genetics, associated epigenetic mechanisms, and the interaction of the skin flora in the pathophysiology of psoriasis. Finally, we include a comprehensive review of well-established widely available therapies and novel targeted drugs.

Keywords: chronic skin disease; inflammation; psoriasis.

The authors declare no conflict of interest.

Figure 1

Clinical manifestations of psoriasis. (

Figure 1

Clinical manifestations of psoriasis. ( A , B ) Psoriasis vulgaris presents with

Clinical manifestations of psoriasis. (A,B) Psoriasis vulgaris presents with erythematous scaly plaques on the trunk and extensor surfaces of the limbs. (C) Generalized pustular psoriasis. (D) Pustular psoriasis localized to the soles of the feet. This variant typically affects the palms of the hands as well; hence, psoriasis pustulosa palmoplantaris. (E,F) Inverse psoriasis affects the folds of the skin (i.e., axillary, intergluteal, inframammary, and genital involvement).

Figure 1

Clinical manifestations of psoriasis. (

Figure 1

Clinical manifestations of psoriasis. ( A , B ) Psoriasis vulgaris presents with

Clinical manifestations of psoriasis. (A,B) Psoriasis vulgaris presents with erythematous scaly plaques on the trunk and extensor surfaces of the limbs. (C) Generalized pustular psoriasis. (D) Pustular psoriasis localized to the soles of the feet. This variant typically affects the palms of the hands as well; hence, psoriasis pustulosa palmoplantaris. (E,F) Inverse psoriasis affects the folds of the skin (i.e., axillary, intergluteal, inframammary, and genital involvement).

Erythrodermic psoriasis.

Figure 3

Onycholysis and oil drop changes

Figure 3

Onycholysis and oil drop changes on psoriatic nail involvement.

Onycholysis and oil drop changes on psoriatic nail involvement.

Figure 4

Histopathology of psoriasis. ( A

Figure 4

Histopathology of psoriasis. ( A ) Psoriasis vulgaris characteristically shows acanthosis, parakeratosis, and

Histopathology of psoriasis. (A) Psoriasis vulgaris characteristically shows acanthosis, parakeratosis, and dermal inflammatory infiltrates. (B) In pustular psoriasis, acanthotic changes are accompanied by epidermal predominantly neutrophilic infiltrates, which cause pustule formation.

Figure 5

The pathogenesis of psoriasis.

Figure 5

The pathogenesis of psoriasis.

The pathogenesis of psoriasis.

Boehncke WH, Brembilla NC. Boehncke WH, et al. Clin Rev Allergy Immunol. 2018 Dec;55(3):295-311. doi: 10.1007/s12016-017-8634-3. Clin Rev Allergy Immunol. 2018. PMID: 28780731 Review.

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Andjar I, Esplugues JV, Garca-Martnez P. Andjar I, et al. Pharmaceuticals (Basel). 2022 Sep 3;15(9):1101. doi: 10.3390/ph15091101. Pharmaceuticals (Basel). 2022. PMID: 36145322 Free PMC article. Review.

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Psoriasis Pathogenesis and Treatment - PubMed

It sounds plausible: If psoriasis is causing dry, scaly patches on your skin, couldnt drinking more water hydrating from the inside out improve symptoms or prevent a flare?

Dermatologists arent buying it.

Yes, psoriatic skin has hydration issues. Because the skin barrier in psoriasis is abnormal, you can lose water through the skin, saysSteven Feldman, MD, PhD, a dermatologist who specializes in psoriasis treatment at Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina. Applying moisturizer to damp skin, he says, is important for hydrating psoriasis plaques.

But drinking water is a different kind of hydrating, Dr. Feldman says. There isnt any evidence that we know of that suggests drinking more water improves psoriasis.

By the way, there isnt much research to indicate that drinking extra water has any impact on skin hydration or appearance in individuals with healthy skin either, according to Mayo Clinic.

Certainly staying hydrated by drinking plenty of water is good for overall health, whether a person has psoriasis or not. Your cells, tissues, and organs need water to function properly its a key component in the regulation of body temperature and the removal of waste from the body, according to the American Academy of Family Physicians.

TheU.S. National Academies of Sciences, Engineering, and Medicine determined that women need about 11.5 cups of fluid a day and men need about 15.5 cups per day. That recommendation covers fluids obtained from water, other beverages, and food about 20 percent of daily fluid intake comes in the form of what you eat, not what you drink. If your urine is colorless or light yellow and you rarely feel thirsty, thats an indication that youre hydrating appropriately.

People with psoriasis can follow the same hydration guidelines as everyone else, says Feldman. They dont need to drink more water because of their condition, and there isnt any evidence that drinking more will improve psoriasis symptoms or prevent flares, he says.

RELATED: Hydration Calendar: How Much Water Do You Need to Drink a Day?

Topical ointments with vitamin D are sometimes used to treat psoriasis, but there isnt strong evidence to indicate that drinks fortified with vitamin D can help with psoriasis symptoms, according to theNational Psoriasis Foundation.

But people with psoriasis often have lower than normal levels of vitamin D, says the Mayo Clinic, a problem that can worsen as hours of daylight wane in the fall and winter. (Skin naturally produces vitamin D in response to sunlight.) Vitamin D is important to overall health for a host of reasons, including helping the body absorb calcium to build bone and maintaining immune function, says the National Institutes of Health.

If you do want to up your vitamin D intake through beverages, milk and orange juice fortified with vitamin D are good sources. Talk with your doctor before taking vitamin D supplements: Too much can be harmful.

Note: For people with psoriasis who are lactose intolerant or otherwise have trouble digesting dairy products, milk can be problematic because it can irritate the gut, worsening inflammation throughout the body. In some cases, people with psoriasis who cut out dairy see an improvement in their skin symptoms, according to Johns Hopkins Medicine.

Currently there isnt any evidence that antioxidants in black, green, or herbal teas will improve psoriasis symptoms, says Feldman.

Although laboratory studies suggest that antioxidants may be beneficial in lowering inflammation, the high amounts that a person would need to consume make it unlikely that antioxidants in ones diet would have any effect on psoriasis, according to a paper published in February 2021 in the journalAntioxidants.

Still, its worth remembering that people with psoriasis are at higher risk of heart disease and stroke. The antioxidants in tea can help reduce inflammation throughout the body, including the cardiovascular system, helping protect the heart and brain.

Drinking too much alcohol isnt a good idea it probably has a direct effect on psoriasis, says Feldman.

There isnt a lot of research on how drinking alcohol may impact psoriasis, but there is evidence to suggest that alcohol consumption may increase the risk of developing psoriasis and may worsen inflammation in people who already have the disease. This appears to be due at least in part to alcohols harmful effect on the gut microbiome.

Another concern is that high-calorie beverages like alcohol, juice, and sugary drinks like soda can contribute to weight gain. Evidence suggests that for people with psoriasis who are overweight or obese, treating the psoriasis and following a healthy and balanced diet that promotes weight loss could lead to fewer flare-ups and less severe disease, according to the American Academy of Dermatology.

Scientists have also linked overconsumption of sugar with chronic inflammation, which can make psoriasis worse.

Some people with psoriasis have a sensitivity to gluten, which is found in some types of alcohol, such as beer.Research suggests that for those who have the sensitivity, avoiding gluten can improve psoriasis symptoms, though it may not help much (if at all) in people without the sensitivity.

When it comes to hydration and psoriasis, you dont need to do anything special, says Feldman. Just make sure youre drinking enough water to support your overall health while limiting sweetened drinks or alcohol, he says.

Excerpt from:
Best and Worst Drinks for Psoriasis - Everyday Health

My skin is perfect, said no one ever. Real talk: By the time you hit adulthood, your skin has gone through growing pains of its own. Between the ages of 12 and 24, 85% of Americans have at least minor acne, according to the American Academy of Dermatology; another 10.7% will have eczema. Got dry skin? Youre among one in three people who deal with it every day, according to recent research.

In other words, weve all got skin issues. And just as no two people are alike, neither are the skin woes we face, meaning there is no one-treatment-fits-all plan. Each chronic skin condition has its own unique set of symptoms, causes and ways of being managed. Take a look at what the experts have to say about these 10 common skin disordersand how to keep your skin healthy now and in the future.

Leave it to the global pandemic to coin a new derm term: We seen a lot of maskne in the last two years, especially at the height of COVID, due to all the mask-wearing and how it affects the skin, saysDr. George Han, MD, PhD, an associate professor and director of research in the department of dermatology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Lenox Hill Hospital in New York City.

Pandemic or not, says Dr. Han, adult acne is on the rise. We have women who never had acne as kids coming in as new patients at 30 years old, he says, adding that the reason for this increase is not clear.

The condition occurs when hair follicles become clogged with oil and dead skin cells, leading to pimples, and to a lesser extent blackheads and whiteheads, according to the Mayo Clinic. Acne can occur on your face, chestand back, among other placesin the case of cystic acne, pimple-like bumps form under the skin surface.

We dont understand exactly why acne happens, however, we know that it is driven by hormones, diet and stress, saysDr. Joshua Zeichner, MD, an associate professor of dermatology and the director of cosmetic and clinical research at Mount Sinai Hospital in New York City.

Over-the-counter topical medications are the first line of defense with acne and can be effective in clearing your skin. Benzoyl peroxide is perhaps the most effective ingredient to treat angry pimples, Dr. Zeichner says. Look for formulations with 2.5% benzoyl peroxide, which studies show to be as effective as higher concentrations but with less skin irritation.

Meanwhile, topical retinoids act like pipe cleaners to keep the pores clear, Dr. Zeichner says. I use them in treating my adult acne patients because they also offer collagen-stimulating benefits to address aging skin. Products containing salicylic acid may also help, he says: This ingredient is a type of beta hydroxy acid that removes excess oil and dead cells from the surface of the skin to help dry out pimples.

If youve given these remedies a try and your acne stubbornly persists, its time to call in the reinforcements. If they are not doing the trick after one to two months, I recommend speaking to a dermatologist for professional recommendations and to consider an oral medication, says Dr. Zeichner. In adult women, we use hormonal therapies like birth control pills or spironolactone to address the hormonal impact on oil glands.

Related: Do Pimple Patches Actually Work?

If youre thinking, I didnt know dry skin was an actual condition, were with you. But theres the dish-soap-dried-out-my-hands dry skin, and then theres the clinical sort. Known as xerosis cutis, clinically dry skin can cause cracking, bleeding, itching and irritation. The condition frequently affects older people and is made worse by dry heat during winter months.

Dry skin can also be caused by another underlying condition, such as eczema or kidney disease, according to the American Academy of Dermatology (AAD). Certain medications can contribute to dry skin as well.

Treatment for dry skin starts with lifestyle changes. Follow these tips from the AAD:

In severe cases, your dermatologist might also prescribe a steroid for short-term use to calm any inflammation thats making itching or cracks in your skin worse.

Unless youve been living under a rock (pun intended), you know all about alopecia as it pertains to Jada Pinkett Smith, the Oscars and that infamous Chris Rock slap. In a nutshell, alopecia refers to hair loss. There are a few types of alopecia; alopecia areata is the most commonan autoimmune condition in which the immune system attacks hair follicles on the face, head and sometimes other areas of the body, causing hair to fall out.

Alopecia can occur in both men and women and people of any race and age, although it typically appears for the first time when people are in their 20s, 30s and 40s, per the National Institutes of Health. About 6.8 million Americans have alopecia areata, with a lifetime occurrence around 2%, according to the National Alopecia Areata Foundation.

Depending on your age, location of hair loss and extent of baldness, your doctor may talk with you about the following options to help stimulate hair growth, per the American Academy of Dermatology:

Other options include wigs, transplants or scalp prosthesis, or going the opposite route and shaving your head.

Related: Best Skincare Routine for Morning and Night

Even the word sounds itchyand with eczema, your skin usually is. We talk about eczema as the itch that rashespeople feel itchy and before their eyes, a rash starts to appear, says Dr. Han. That rash typically looks like tiny red bumps clustered together.

While the condition has no single cause, there is often a family history of asthma and allergies associated with the condition. (The condition itself is tied to genetics: If one of your parents has eczema, your risk of developing it jumps two- to three-fold, according to research in the Journal of Pediatrics.) Other triggers for the condition include smoking, stress, dry skin and hormonal fluctuations, among others.

Eczema is a condition where the skin barrier is not functioning as well as it should be, says Dr. Zeichner. In eczema, the microbiome, or collection of microorganisms that live on the skin surface, is disrupted. This leads to loss of hydration and inflammation in the skin.

Atopic dermatitis is the condition most people mean when they refer to eczemathe terms are used interchangeably. But there are several other types of the condition, according to the Cleveland Clinic, including contact dermatitis (caused by direct skin contact with an irritant); dyshidrotic eczema (blisters on hands and feet); hand eczema (symptoms are limited to your hands); neurodermatitis (patches on skin are thicker); nummular eczema (characterized by larger welts on your skin); and stasis dermatitis (caused by faulty veins that leak fluid).

The goal of treatment is to repair the skin barrier with moisturizers, says Dr. Zeichner. We also want to reduce inflammation in the skin with over-the-counter anti-inflammatories or topical or systemic medication by prescription. Treatments for eczema range from DIY therapies (warm baths, baking soda and thick moisturizers) to medical intervention. Your doctor may talk with you about calcineurin, Janus kinase and PDE4 inhibitors, or biologics, all of which work by blocking certain proteins in the body that turn on skin inflammation.

So that waseczema. The skin condition it is most commonly confused with is psoriasis. If you look at old medical textbooks, youll see that we used to distinguish between the two by saying that eczema means you have itchy skin and psoriasis doesnt itch, says Dr. Han. But in the past few decades that has been turned on its head and we now know psoriasis also itches.

In fact, he says, 80% to 90% of psoriasis patients cite itching as a primary symptom. So what makes psoriasis different than eczema? Mainly, how and where the disease appears on the body. The classic description of a psoriasis lesion is thick scaly skin on top of a plaque, says Dr. Han. It tends to be a red area thats relatively clearly cut off from the surrounding skin. Whereas with eczema, you have small red bumps in red patches on skin.

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While plaque psoriasis is the most common form of this condition, there are other types of psoriasis, including nail, scalp, guttate, inverse, pustular and erythrodermic psoriasis. In all cases, the psoriasis is caused by skin cell turnover that occurs too quickly. The process usually takes 30 days, but in people with psoriasis, cell turnover happens in three days, says Dr. Han. The dead skin cells pile up, leading to the conditions telltale plaques.

Treatments for psoriasis range from topical creams like retinoids to systemic medications, and which you use depends largely on the severity of your condition. In cases where your symptoms are very mild, you might even try home remedies for psoriasis, including moisturizers that contain salicylic acid to help exfoliate the plaques, essential oils (the benefits of these are questionable), mindfulness techniques and various foods to reduce skin inflammation. (Skip the processed foods, which make inflammation worse, according to research in the Journal of Investigative Dermatology.)

For moderate to severe psoriasis, your doctor will likely talk with you about drugs called biologics, which work by targeting the proteins in your body responsible for causing inflammation in your skin. Biologics are usually given as injections.

Related: Dermatologist-Approved Skincare Routine for Oily Skin

Rosacea can look a lot like acne but typically affects older patients as opposed to teens, says Alok Vij, M.D., a dermatologist at the Cleveland Clinic in Ohio. Rosacea can have a few components: broken blood vessels on the skin surface, pustules like acne but not blackheads and thickening of the sebaceous skin. (Picture W.C. Fields with thick skin on his nose, he suggests.)

So, how is rosacea treated? We start by classifying the severity of the disease, says Dr. Vij. If its mild, well use topical anti-inflammatory creams or antibiotics for pustular rosacea. Laser therapy may help reduce redness from blood vessels and there is some evidence that oral vitamin A therapy is helpful.

Rosacea treatment may take four weeks to see improvement because that's the length of a full skin cycle, he adds. In the meantime, many over-the-counter products and cosmetics can lessen the red appearance.

Unlike most of the common and chronic skin conditions that are marked by increased plaques, bumps or redness, the disorder vitiligo is characterized by whats missing: Namely, skin color. Vitiligo is an autoimmune condition in which your own antibodies attack cells called melanocytes in your body, says Nada Elbuluk, M.D., a clinical associate professor of dermatology at the Keck School of Medicine and director of the USC Skin of Color Center and Pigmentary Disorders Clinic at the University of Southern California in Los Angeles. These cells create melanin, which is what gives skin its color, so once they are affected, those areas of skin develop white patches.

Although scientists are still exploring the causes of vitiligo, the current thinking is that some people are genetically predisposed to the condition. There are two things that need to happen for vitiligo to occur, says Dr. Elbuluk. First, you have the genetics for it, and second, there is some sort of eventmaybe a sunburn or skin scrape or even stressthat triggers the onset of vitiligo.

The psychological impact of vitiligo can be severe: In a review of dozens of studies, a report in the American Journal of Clinical Dermatology found that 62% of people with vitiligo also suffer from depression while 68% struggle with anxiety. People with vitiligo start to self-isolate or feel uncomfortable in social situations, says Dr. Elbuluk. The emotional symptoms of the disease are very concerning.

Treatment for vitiligo varies depending on which parts and how much of the body is affected, and may include phototherapy, laser therapy, topical steroids, oral medication and surgery. Some people, though, may choose not to treat vitiligo at all. Celebrities like model Winnie Harlow have built their career celebrating their unique skin appearance.

If youve ever nicked yourself shaving, only to discover an inflamed red bump in the spot the following day, thats folliculitis. Sometimes referred to as fungal acne, the condition is marked by infected or inflamed bumps on the skin that can look like acne at first, according to the Cleveland Clinic. There are different types of folliculitis, named either for the type of bacteria that has caused the infection or the severity and location of the skin symptoms. (You can develop folliculitis anywhere and everywhere, including your butt, chestand chin.)

Folliculitis is a very common and benign condition that refers to little pimples that occur any place where there are hair follicles on your body, says Dr. Vij. You can get it on your face, thighs, back of armsjust about anywhere. Because symptoms (inflamed bumps) are typically mild, we tend to use fewer aggressive treatments, says Dr. Vij. These might include benzoyl peroxide washes and topical antibiotics, as well as warm compresses and anti-itch creams.

Related: Best Sunscreens for Sensitive Skin

Sweat much? If so, you might be among the one in 20 people in the U.S. who have hyperhidrosis, a skin condition characterized by excessive perspiration (the exact number of folks with hyperhidrosis is unknown and estimates range from one in 50 people to closer to one in 10, per the Cleveland Clinic.

We all sweat sometimesits how our body cools itself, after all. But in people with hyperhidrosis, not only is sweating excessive, it can happen at random times, for no apparent reason, when youre not even stressed. It is disruptive at best and a self-confidence crusher at its worst.

How can you tell the difference between a heavy sweater and one with a clinical disorder? The Cleveland Clinic list these symptoms of hyperhidrosis:

There are two types of hyperhidrosis: focal (also called primary) which results from a genetic mutation and generalized (also called secondary) which results from another condition or medication you may be taking.

Based on the severity of your sweating, your doctor may treat your hyperhidrosis with anything from clinical-grade antiperspirants to iontophoresisthis at-home device zaps your skin with a mild current to temporarily shut down your sweat glands, according to the American Academy of Dermatology. Other treatments include Botox injections, oral medication and even surgery to remove the sweat glands.

Hidradenitis is a condition where cysts, nodules and scars typically develop in areas like the underarms, groin and under the breasts, says Dr. Zeichner. We dont understand exactly why it happens, but we know that it is caused by blockages within sweat glands.

Risk factors for developing the condition (which can appear as bumps and blackheads on the skin surface) include family history, smoking and obesity.

Hidradenitis suppurativa is associated with other severe acne-like conditions, which are collectively known as the follicular occlusion tetrad, Dr. Zeichner says. Hidradenitis suppurativa goes through flares and remissions, but most lesions never completely clear, he adds. While medications can help keep symptoms under control, currently there is no cure.

Lifestyle modifications can help though. These include regular cleaning of the under-skin pimples with surgical-grade, antimicrobial cleansers; a healthy diet and exercise to maintain a proper body weight; and quitting smoking.

In mild cases, topical medications offer some help, says Dr. Zeichner. Cortisone injections to reduce inflammation are useful. Larger abscesses may be drained. In severe cases, plastic surgeons may remove the glands in the affected areas altogether and replace the skin with a graft.

As the disease progresses, systemic medications may be needed as well, including a biologic medication (Humira) that is FDA-approved to address the underlying inflammatory response that makes symptoms worse.

And there you have it: The main chronic skin conditions that can mess with your daily mojo. Theyre more common than most people realizeespecially when you add them all together. So if your skin is itching and you havent visited a patch of poison ivy lately, talk with your dermatologist about whats going on. If you do have one of these chronic skin disorders, treating it early will help you get back to your regularly scheduled life.

Next up: These Top TikTok Skincare Hacks Actually Work

Read more here:
These Are the 10 Most Common Chronic Skin Conditionsand the Most Important Facts to Know About Them - Parade Magazine

Holistic, collaborative, multidisciplinary, and integrated communication between physicians and women of childbearing age is lacking, according to a study published in Springer.1 Medical treatment and family planning, particularly among women of childbearing age with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), should be considered within this patient population. Patient-centered care including reproductive choices should be integrated as a part of routine clinical practice.

The proportion of women being treated with biologics is growing, investigators explained. However, data on treatment recommendation awareness among treating physicians and women who are considering pregnancy and family planning are limited.

An English-language, 55-question survey was developed to identify the current practices of physicians regarding the reproductive health needs of women with RA, PsA, and psoriasis in the Czech Republic, Slovakia, and Hungary. The questionnaire was designed to simultaneously elicit spontaneity of physicians while allowing for the processing of responses, mutual comparison, and overall assessment. The survey obtained information from 120 physicians, including 82 rheumatologists and 38 dermatologists.

Female patients of reproductive age (aged 18 to 45 years) with moderate-to-severe disease encompassed 10-30% of all respondents. Roughly two-thirds of physicians discussed family planning with their patients when making the diagnosis. Rheumatologists collaborated with other specialists more frequently when compared with dermatologists and gynecologist/obstetricians. Pregnancy effects were the top concern for female patients.

Approximately half of the rheumatologists revised treatment 6 months prior to when the patient planned on becoming pregnant (44% [n = 36/81]). However, dermatologists acted much sooner (26% [n = 10/38]), acting 2 to 3 years prior planned parenthood. While rheumatologists selected systemic glucocorticoids as firs-line treatment to counteract pregnancy flares, dermatologists preferred topical corticosteroids.

Although gender alone did not influence treatment choice in 11% of dermatologists and 39% of rheumatologists, all dermatologists and 96% of rheumatologists were influenced by the patients fertility and pregnancy. Disease severity and uncontrolled disease were the main risk factors linked to conception in this patient population. In fact, 53% of dermatologists and 79% of rheumatologists believed that poor disease control was associated with poor pregnancy outcomes. Of the most valuable sources of information as determined by physicians, congresses and interdisciplinary forums were the most highly rated. Patient education and collaboration were noted as key factors in reducing unplanned pregnancies.

A cross-border investigation, from the perspective of both rheumatologist and dermatologist, strengthened the study. However, investigators did not evaluate or categorize the individual physicians level of experience with biologics or reproductive health and instead based data on actual clinic experience. Investigators theorize that those who have had more exposure to this approach would be more willing to utilize it. The lack of formal survey validation, and the fact that the survey was provided in English, further limits the study.

To improve the reproductive health of sexually active women of childbearing age in Central Europe who have chronic inflammatory diseases (CID), rheumatologists and dermatologists must improve their education and work with other specialists, investigators concluded. More timely discussions with women of reproductive age and family planning are needed to educate them about the disease's effects on their childbearing potential and the selection of treatment options based on their reproductive goals. Best practices in patient-centered care must consider each patient's reproductive decisions in their treatment planning to give the best patient-centered care.

Reference:

Olejrov M, Macejov , Gkalpakiotis S, Prochzkov L, Tth Z, Prgr P. Reproductive Healthcare in Women with Rheumatoid Arthritis and Psoriatic Diseases in Routine Clinical Practice: Survey Results of Rheumatologists and Dermatologists [published online ahead of print, 2022 Sep 24]. Rheumatol Ther. 2022;10.1007/s40744-022-00488-z. doi:10.1007/s40744-022-00488-z

Read more:
Survey Addresses Concerns Regarding Reproductive Healthcare Communication in Women with RA, PsA - Rheumatology Network

Psoriasis is a chronic (long-lasting)diseasein which the immune system becomes overactive, causing skin cells to multiply too quickly. Patches of skin become scaly and inflamed, most often on the scalp, elbows, or knees, but other parts of the body can be affected as well. Scientists do not fully understand what causes psoriasis, but they know that it involves a mix of genetics and environmental factors.

The symptoms of psoriasis can sometimes go through cycles, flaring for a few weeks or months followed by periods when they subside or go into remission. There are many ways to treat psoriasis, and your treatment plan will depend on the type and severity of disease. Most forms of psoriasis are mild or moderate and can be successfully treated with creams or ointments. Managing common triggers, such as stress and skin injuries, can also help keep the symptoms under control.

Having psoriasis carries the risk of getting other serious conditions, including:

See the rest here:
Psoriasis Types, Symptoms & Causes | NIAMS

Treatments for psoriasis fall into four categories: topicals, phototherapy, systemics and complementary or integrative medicine, according to the NPF. The choice of therapy depends on the severity of the disease, says Dr. Green.

Topical treatments are creams applied directly to the affected area, slowing the rapid production of skin cells and reducing inflammation. The most common topical medications are topical steroids, which contain an anti-inflammatory ingredient to heal swelling and redness and usually require a prescription from your doctor. However, topical steroids cant be used in some areas because they may cause side effects like bruising, pigmentation and redness.

In 2022, the U.S. Food and Drug Administration (FDA) approved a new, nonsteroidal topical cream for adults for the first time in 25 years called tapinarof. Patients can use this treatment from head to toe without any limitations, which is great for those who have mild to moderate psoriasis, says Dr. Green.

The FDA has also approved several over-the-counter topical treatments for psoriasis, such as lotions, shampoos, tars and bath foams that often contain coal tar and salicylic acid.

Phototherapy is a type of light therapy that a dermatologist may prescribe if topical treatments are ineffective. This therapy involves regularly exposing the skin to ultraviolet (UV) light, particularly UVB light. UVB rays are found in natural sunlight and slow the growth of skin cells.

There are several types of phototherapy, and its most effective when patients receive therapy at least two to five times a week for several weeks, according to the American Academy of Dermatology Association (AAD). Phototherapy is not prescribed for patients with skin cancer or in the case of any condition or medication that makes them more sensitive to UV light.

Systemic treatments are prescription drugs taken orally or through an injection or infusion and are usually prescribed when topicals and phototherapy are unsuccessful. These drugs, known as biologics or biosimilars, work throughout the body to target specific molecules inside immune cells and correct the overactive immune response causing psoriasis flares.

Biologics and biosimilars include medicines that come from live organisms, including animal cells and microorganisms like yeast and bacteria. Both treatments are highly regulated by the FDA and deemed by the organization to be safe and effective.

The best way to prevent psoriasis flares is to follow your dermatologists treatment recommendations, moisturize well and avoid trauma to the skin. Lowering stress can also help, says Dr. Stevenson.

The AAD suggests practicing stress-relieving activities, such as yoga, meditation and attending support groups. Lifestyle changes like reducing alcohol consumption, quitting smoking, avoiding skin exposure to dry, cold weather, treating infections and avoiding cutting yourself while shaving can also help prevent flares. Dietary considerations, such as increasing fruits and vegetables and avoiding foods that are high in fat, sugars, sodium and meat as well as limiting processed foods, may play an important role in minimizing psoriasis symptoms, according to an article in Immunity.

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What Is Psoriasis And Can It Be Treated? - Forbes

A recent study found that treatment of moderate-to-severe plaque psoriasis with tildrakizumab was effective up to 36 weeks in a real-world setting.

While several effective biological therapies have been developed to treat plaque psoriasis, few have shown to be well-tolerated. When tildrakizumaba monoclonal antibodywas assessed in two phase 3 trials prior to this study, it was shown to be safe and effective.

This study, led by Alessio Gambardella, MD, and Gaetano Licata, MD, of the University of Campania Luigi Vanvitellis Department of Mental and Physical Health and Preventive Medicine, expanded upon these previous studies by allowing the treatment of patients with other comorbidities and varying other clinical characteristics.

In this retrospective study we evaluated the efficacy of tildrakizumab in 30 patients with moderate to severe plaque [psoriasis] up to 36 weeks in a real-world setting, Gambardella and colleagues wrote. The majority of patients were currently employed, had little time to travel to a hospital and therefore suitable for treatment every 12 weeks.

The investigators used a retrospective study of 30 total participants with moderate-to-severe plaque psoriasis (PsO). The study involved the participants being treated with 100 mg of tildrakizumab and then observed for 36 weeks in a real-world setting.

Most of the participants in the study were employed and, consequently, were only able to visit the hospital every 12 weeks. The primary exclusion criteria for the recruited participants was that they were required to have moderate-to-severe PsO, with body surface area involvement being 10%, a Physician's Global Assessment (PGA) score of 3, and a Psoriasis Area and Severity Index (PASI) score of 12.

Additionally, the participants had to have either failed to respond or have side effects or contraindications to a minimum of 2 conventional psoriasis treatments. The investigators treated the participants with 100 mg of tildrakizumab through subcutaneous injection at weeks 0, 4, and every 12 of the following weeks.

The investigators assessed the clinical efficacy of the treatment by using participants PASI scores at weeks 4, 12, 24, and 36. In addition, they used the PGA scores, Dermatology Life Quality Index (DLQI) scores, and Health-Related Quality of Life (HRQoL) scores.

The investigators found that participants PASI scores of less than 3 were reported following 12, 24, and 36 weeks in 86.7%, 100%, and 100% patients, respectively, treated with tildrakizumab.

They also found that PASI scores substantially decreased from 17.64.7 at baseline to 4.74.7 and 1.13.9 at 4 and 12 weeks, remaining less than 1 up to 36 weeks (P <0.001 versus baseline). Furthermore, PASI 75,90, and 100 responses were achieved in 100%, 96.7%, and 60% of participants respectively at 36 weeks.

The research team reported that DLQI also decreased significantly from baseline (13.82.9) to 3.61.6 by 4 weeks, 1.40.6 by 12 weeks, and 0 at weeks 24 and 36 (P<0.001 versus baseline).

Additionally, a multivariate regression demonstrated that tildrakizumab treatments effect on DLQI and PASI scores by 4 weeks was independent from the variables of gender, age, disease duration, BMI, previous biologic, or the existence of comorbidities.

Tildrakizumab was found to be effective and safe in moderate-to-severe plaque PsO in real-life clinical practice up to 36 weeks, they wrote. This benefit was independent of other predictor variables, therefore allowing it to be administered to patients with a range of clinical characteristics (including previous biological treatment) and the presence of comorbidities.

This study, Treatment of moderate-to-severe plaque psoriasis with tildrakizumab in the real-life setting, was published on Wiley Online Library.

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Plaque Psoriasis Treated With Tildrakizumab Shown to be Effective in Real-World Settings - MD Magazine

SOUTH SAN FRANCISCO, Calif.--(BUSINESS WIRE)--Alumis Inc., a precision immunology company that is reimagining the discovery, development and treatment of autoimmune disorders, today announced that the first patient has been dosed in Stride, a Phase 2 clinical trial of ESK-001 for the treatment of patients with moderate to severe plaque psoriasis. ESK-001 is a highly selective and potentially best in class allosteric tyrosine kinase 2 (TYK2) inhibitor.

Initiation of the Phase 2 trial is supported by data from Phase 1 studies in more than 100 healthy volunteers. ESK-001 demonstrated selective, full and sustained inhibition of TYK2, with no pharmacological inhibition of JAK1/2/3 and no observed JAK-related safety events to date. Across the Phase 1 program, ESK-001 was generally well-tolerated, with no serious adverse events observed.

The initiation of the Stride Phase 2 trial marks an important milestone for patients with immune-mediated diseases, as this is the first use of ESK-001 in an autoimmune disorder, said Martin Babler, chief executive officer of Alumis. ESK-001 has the potential to offer an oral therapy with superior efficacy compared to other available or investigational treatments for plaque psoriasis. Were highly encouraged by the data from our Phase 1 studies, in which administration of ESK-001 demonstrated high selectivity and the ability to achieve full TYK2 target inhibition. We are excited to advance the clinical development of this program and gain further understanding of the ultimate impact we may have for patients who are in need of more effective oral treatment options.

The Stride trial is a randomized, double-blind, placebo-controlled Phase 2 dose ranging trial that will evaluate the efficacy, safety, pharmacokinetics and pharmacodynamics of ESK-001 in patients with moderate to severe plaque psoriasis. The trial will enroll more than 200 patients across multiple doses of ESK-001 for 12 weeks. The primary endpoint of the trial is the proportion of patients with moderate to severe plaque psoriasis achieving greater than or equal to 75% reduction in PASI score (PASI 75) across doses of ESK-001 and placebo. PASI, or Psoriasis Area and Severity Index, is an instrument used to score, assess and grade the severity of psoriatic lesions and the patient's response to treatment.

Beyond psoriasis, Alumis is leveraging its precision immunology platform to explore ESK-001s potential application in other autoimmune indications. The company plans to initiate additional Phase 2 trials in the near future.

About ESK-001

ESK-001 is Alumis lead precision immunology candidate, designed to be a highly selective and potentially best in class tyrosine kinase 2 (TYK2) inhibitor with greater selectivity for TYK2 over JAK1 compared to currently available treatments or therapies in clinical development. In the companys Phase 1 studies, ESK-001 demonstrated selective, full and sustained inhibition of TYK2, with no pharmacological inhibition of JAK1/2/3 and no observed JAK-related safety events to date. ESK-001 was well-tolerated in these studies, with no serious adverse events observed.

About Alumis

Alumis is a precision immunology company looking to eliminate the all comer approach that is seen with todays treatments for people with autoimmune disease. Even with innovation of the last decade, many patients cycle through the approved therapies while continuing to look for the right therapy to alleviate the impact of their disease without life-impacting side effects. Alumis leverages a precision analytics platform, powered by Foresite Labs, coupled with a team of experts with deep experience in precision medicine drug discovery, development and immunology, in order to create medicines that change the lives of people with autoimmune disease. For more information, please visit alumis.com.

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Alumis Announces Initiation of Patient Dosing in Phase 2 Clinical Trial of ESK-001 for the Treatment of Plaque Psoriasis - Business Wire

Life with psoriatic arthritis can be difficult at times. Joint pain and stiffness can get in the way of performing everyday activities. Something as simple as getting dressed can become a challenge when experiencing a flare-up. Luckily, with the help of these 15 devices, accomplishing daily tasks will be much easier.

Opening jars and bottles can be difficult for the average person at times. But if you have joint pain from psoriatic arthritis, it becomes even more challenging. For this, you can try rubber or silicone grippers. A jar pop or church key opener to break the vacuum seal are also great options, according to John Indalecio, a hand therapist at Orthopedic One in Columbus, Ohio. After letting the air into the jar, its easy to open as if youve opened it before, he says. Electric jar openers will make your life much easier by doing the twisting for you without taxing your joints.

Finding it difficult to hold your phone? This is where attachments that allow you to hold the phone without gripping or pinching it come in handy. The Bunker Ring phone stand or a PopSocket are good options.

When getting dressed becomes a challenge, a dressing stick may offer you some assistance. Dressing sticks will help you hold open your pants or stabilize your shoes as you put them on. A dress zipper tool for reaching zippers up the back can also make it easier to reach or reduce the need for help, Indalecio says. If you need further assistance reaching your feet, try a hip kit.

RELATED: Bye Bye Back Aches! WFH Accessories You Need For A Better Back

Bending over can be an obstacle when you have psoriatic arthritis. These tools will help minimize how much bending you actually have to do when putting on your socks and shoes.

When looking for tools (silverware, hairbrushes, gardening tools, etc.), look for ones that have larger handles as opposed to smaller ones. Cant find a tool with a larger handle? Try foam tubing to build the handles on small-diameter objects to make them easier to hold, Indalecio suggests.

On days when you may need extra support, grab bars may help. Try placing them near staircase landings and in the bathroom where slipping may be a concern for you.

The standard hair dryer isnt designed with a psoriatic arthritis patient in mind. Fortunately, technology blessed us with hands-free dryers, which allow you to sit back and relax while the dryers do all the work. You no longer have to struggle to hold a dryer up.

For those that love to cook and spend a lot of time in the kitchen, a nonslip counter mat can help you prevent

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15 Items That Will Make Your Life With Psoriatic Arthritis Easier - BlackDoctor.Org

Psoriasis is an immune-mediated skin disease with a genetic predisposition. There is an involvement of the interaction of adaptive and innate immunity, which is the main pathological mechanism in this disease. Cytokines, which are secreted, mediatethe interaction of the T cells with the cells of dendrites, keratinocytes, and macrophages [1]. Biologists over the past decade have developed and approved blockers for interleukinIL-23, tumour necrotic factor , and IL-17 for psoriasis treatment [2]. This disease is an immunesystems-related disease of joints and also of skin, which is recurrent, chronic, and common. It has a considerable huge negative impact on various aspects of an affected patient's health, like emotional, psychosocial, and physical well-being [2].

One of the main determinants of expression of the disease is the carriage of the HLA-Cw6 and environmental triggers such as beta-haemolytic infection caused by Streptococcus in the early stage of psoriasis, like if it begins before 40 years of age [3]. The cells that are antigen-presentingare present in the skin and secrete the IL-12 and IL-23, which ultimately activate type 1 (Th1) and type 17 (Th17)T helper cells to produce a cellular type of immune response. The cutaneous findings which are observed in this disease are due to the development of a state of chronic inflammation, altered hyperproliferation of epidermis, apoptosis, differentiated mechanism, and neo-angiogenesis which is caused by different types of cytokines such as tumour necrosis factor (TNF) [4].

There can be dysfunction in the immune systems, particularly in autoimmune diseases, which are caused by specific triggers that vary among individuals. Whereas in psoriasis, it most commonly may include trauma of the skin, like bites of insects, scratches, and sunburn. Stress can also be considered as one of the triggers. An inflammatory response is accidentally generated in the activated immune systemin psoriasis. The immune system works against or attacks the healthy cells as if they resemble foreign invading harmful pathogens. Here, signalling molecules are produced in excess, as well as the helper variant of T type of lymphocytes or T kind of cells, which are the white cells of blood, that becomeirregularly active. The blood vessels present in the skinwidendue to the action of cytokine molecules. So thereafter, there will be an accumulation of keratinocytes and white blood cells, which will in turn make the outermost skin layer grow much quicker than the normal one. In the usual scenario, a person without psoriasis would take up to 3-4 weeks for cell maturation, migration to the skin surface, dividing, and also sloughing off, whereas in psoriasis, for the same events, it takes just 3-7 days. The outcome of this is that there is a thick skin buildup with flushed, scale, skin, and plaques.

Psoriasis begins in one-third of the overall cases in childhood itself and is of long duration. It is acommonly occurring inflammation-related disorder of the layer of skin that is immune-mediated [5]. For the exacerbation and onset of the disease, there are numerous factors: mutations in the gene 14 of the recruitment of the caspase domain of the family and the genetic factor which has the HLA-Cw6; environmental factors like medications, lifestyle; and infectious diseases [6].

Some triggers like injury to the skin or medications like lithium, quinidine, antimalarial drugs, infections, and stress, cause most kinds of psoriasis. Allergies, weather, and diet too can be the other triggers for this condition. There are about seven main kinds of psoriasis: plaque-type psoriasis; Guttatepsoriasis; inverse psoriasis; pustular psoriasis; erythrodermic psoriasis; nail psoriasis; and psoriatic arthritis.

While identifying this disease, we look for its symptoms, which can appear like rashes occurring in patches and lookdifferent as we see them in each individual. Some may appear as major eruptions all over the body or dandruff-like scaling. It could also be rashes with variation in the colours like shades of brown or pink or black skin or grey with purple or even with red along with silver scaling on the white skin, or cracked skin due to dryness that might bleed, or scaling small spots usually occurring in children, burning sensation, soreness, the appearance of episodic rashes that would aggravate for some weeks or months and then eventually subside.

As we mentioned earlier, among the various kinds of psoriasis, plaque is one. It causes raised patches of skin covering scales, itchiness, and dryness, and it is the most common kind of psoriasis. Scalp, knees area, elbow, and lower back are the frequent occurring sites. Depending on the colour of skin, there is variation in the colour of patches. Particularly on brown or black skins, there might be temporary changes due to postinflammatory hyperpigmentation in the appearance of colour as an outcome of the healing of the altered part of the layer of skin.

In the other kind, we see nail psoriasis which causes abnormally grown nails with discolouration and pitting affecting the fingernails and toenails. The nails could loosen up and get separated from the nail bed in this, also called onycholysis, and if it gets severe, then the nails may even crumble.

Further, there is also Guttate and inverse psoriasis, wherein the prior one mainly affects children and among adults and is mainly triggered by any infection caused due to Streptococcus,which is a bacterial infection. It is identified by scaling spots all over the trunk or arms, and legs, which are small drop-shaped. Inverse psoriasis is another kind in which there is an occurrence of inflamed skin which appears in smooth patchwork and worsens with sweating and friction, and it commonly acts on the folding of the skin of the area of the groinor buttocks and also of breasts. This kind of psoriasis is usually triggered by fungal infections.

The very least occurring kind of psoriasis is the erythrodermic type psoriasis which may either be chronic, which is of longer duration, or acute, which is of short duration. It appears like a peeling form of a rash that can itch or burn covering the entire body surface.

A rare kind which can be defined as blisters with pus is pustular psoriasis. It can appear in the small area of the sole and palm or like widespread patches. The most clearly demarcated are the generalized pustular, palmoplantar, and acrodermatitis continua of Hallopeau among pustular psoriasis which is a heterogenous entity of different organ disease subtypes clinically. These are different from psoriasis vulgaris in phenotype and genetic ways but these subtypes may resemble to plaque psoriasis, establishing the rationale for the inclusion in the psoriasis band. As shown by the recent identification of mutation of three different kinds of genes, of the skin's innate immune systems, the genetic background is thought to be monogenic which is unlikely in psoriasis, the genes are IL36RN, CARD14 and AP1S3 [7]. Paradoxical psoriasis form of dermatitis is usually triggered by subtypes of generalized pustularsand its various kinds like acute pustulosis, acrodermatitis, pustular of palmoplantar, and different kinds of pustular of mostly a TNF-blocker. Table 1 gives the types of psoriasis [8].

The pustular type of psoriasis may be present as the generalized type in the form of recurrent illness which is systemic, or as in palmoplantar type in the form of a locally centred disease mainly affecting the sole and palm, or in acrodermatitis in the nail beds or its digits. The consequences and severity should not be ignored or taken lightly, although these types of conditions are rare. With the capability of life-harming complications like a medical emergency of generalized pustular type of psoriasis when it appears like an acute episode like a flare. Debilitating conditions can be seen in the palmoplantar pustular type of psoriasis and in the acrodermatitis continua of Hallopeau. While in acrodermatitis there may be irreversible damage to the bone or nail, whereas in palmoplantar pustular psoriasis there is health-wise-related impaired life quality and morbidity psychiatrically [9].

Fever and malaise generally are accompanied by a systemic type of inflammatory, chronic disease, that is the generalized pustular type of psoriasis. Multiple pustules which are sterile occur all over the body surface along with diffused erythema and extremities swelled up, in generalized pustular psoriatic patients. There can behealth-threatening situations as generalized pustular often reoccur in the lifetime. Clinicians and researchers are being provided with major advances in the approach towards the pathomechanism of generalized pustular understanding with the help of the underlying genetic molecular basis of different cases with recent discoveries. Figure 1 give the types of pustular psoriasis [10].

The discovered anomalies include an unusual gain of the function of mutations in gene encoding around keratinocyte signalling molecule CARD14 and a loss-of-function mutation in the interleukin 36 receptor antagonist gene. Neutrophils and interleukin 36 (IL-36) are now recognised as key players in the pathogenesis of generalized pustular, with IL-36 signalling serving as a connecting link between the responses of innate and adaptive immune systems. Inflammation is now thought to be brought on by an aberrant innate immune response that is primarily genetically determined and results in an inflammatory kind of keratinization. Currently, generalized pustular is regarded as a representative of this newly discovered class of skin disorders known as autoinflammatory keratinization disease [11].

Retinoids, or methotrexate, or cyclosporine, also corticosteroids, or TNF-alpha inhibitors, topical therapy, and phototherapy are amongless well-established treatments. TNF-alpha inhibitors should be used in conjunction with methotrexate to prevent the development of antidrug antibodies [12].

Around 20% of patients referred to the early arthritis clinic have psoriatic arthritis, which is difficult to diagnose and treat. For the prevention of the function loss occurring long term and also to assure the best arthritis management and important comorbidities, early diagnosis is crucial. The differential diagnosis for a rheumatologist includes rheumatoid arthritis, also gout, including various inflammatorily arthritides. Once the condition has been identified, it is critical to thoroughly evaluate it, looking for signs of arthritis, or enthesitis, or dactylitis, or skin/nail disease, and also axial involvement [13].

Psoriatic arthritis is a chronic, autoimmune-mediated, inflammatory arthropathy that affects the joints and entheses, particularly those of the axial skeleton. It is associated with an increased risk of cardiovascular disease mortality [14].

Cytokine inhibitors, particularly those specific for tumour necrosis factor and, more recently, the interleukin 23-T-helper-17 cell pathway, have been very successful in the treatment of disease manifestations in a variety of tissues, even though targeting the interleukin 23-T-helper-17 cell pathway may be more effective in treating psoriasis than arthritis [14].In Western adults, it is prevalent at 2-4%, and psoriatic arthritis develops in 20-30% of psoriasis sufferers [15]. This illness affects several organ systems, including skin, nails, entheses, peripheral and axial joints, and nails. Osteoporosis, or uveitis, or subclinical intestinal inflammation, and also cardiovascular disease are all associated with psoriatic arthritis as comorbidities. Its heterogeneity has made diagnosis challenging. Here, we review its classification criteria in an updated manner. CASPAR, which stands for Classified Criteria for Psoriatic Arthritis, type of screening instruments are used to help in quick diagnosis, recent discoveries on aetiology, and new therapy modalities, which also include biological drugs [15].

Historically, non-steroidal anti-inflammatory drugs and the same old medicines that treat rheumatic diseases were used to treat psoriatic arthritis patients. Although their ability to halt the radiological development of joint disease is not established. Contrarily, anti-tumour necrotic factor medications such as certolizumab, or etanercept, or infliximab, or adalimumab, and also golimumab are considered in this aspect. Apremilast, an orally taken phosphodiesterase 4 inhibitor, tofacitinib, a Janus kinase inhibitor, and numerous new biologics that target the IL-23 and IL-17 pathways, such as secukinumab, or brodalumab, or ixekizumab, and also ustekinumab, are among the latest psoriatic arthritis medications [16].

Evidence suggests nutrition performs a significant aspect in the aetiology of psoriasis which is growing, among other psoriasis risk factors. In particular, diet, nutrition, and body weight may worsen or possibly start the disease's clinical signs [17]. There are a number of reasons that could account for the elevated frequency of cardiovascular events in the psoriasis population. The high prevalence of traditional cardiovascular risk factors and metabolic disorders are the main contributors to the significant cardiovascular burden in psoriasis patients. Similarly, the coexistence of systemic inflammation and metabolic disorders may raise the risk of cardiovascular disease in these people [18].

Psoriasis vulgaris is the most well-known and manageable human disease that is mediated by T lymphocytes and dendritic cells. Inflammatory myeloid dendritic cells release IL-23 and IL-12 to encourage IL-17-producing T cells, Th1 cells, and Th22 cells to produce significant amounts of the psoriatic cytokines IL-17, IFN (interferon), TNF, and IL-22 [19]. Patients with this genotype have been observed to have distinct clinical characteristics and acquire the disease at an earlier age, with a concordance of about 60% in monozygotic twins. HLA-Cw*0602 is a substantial risk factor for the beginning of the illness, and homozygous people are also at risk, according to recent linkage and higher resolution association studies.

Compared to heterozygotes, they have a disease risk that is around 2.5 times higher for this gene. According to published evidence, (cells of differentiation) CD8+ T cells may be a key effector in psoriasis. A notable characteristic of persistent psoriasis lesions is epidermal infiltration of oligoclonal CD8+ T cells, which are reacting to particular antigens, and likely also of CD4+ T cells in the dermis [20].

Local treatments, or phototherapies, and also systemic treatments like standard systemic therapy and biotherapy, are all currently available and, in the major part of the cases, are sufficient to control this skin condition. So as to improve these children's lifetime, subsequent management should concentrate on preserving therapeutic efficacy and preventing recurrence by minimising any of it [21].

Hydration of skin like frequent use of moisturisers and emollients, careful, and gentle skin cleaning, detection and avoidance oftriggers related to the phenomenon of Koebner like excoriation, maceration, and foci which are infectious are all important parts of treating psoriasis (Streptococcus pyogenes). Patients with psoriasis have shown that moisturisers considerably reduce their skin problems and enhance their quality of life. Due to the prevalence of dry skin, which increases the irritation of sick skin, they are an effective first-line treatment [22].

Newer topical treatments like calcipotriol and immunosuppressive medications like cyclosporin A and FK506 are significantly changing how psoriasis is treated [23]. Up until recently, corticosteroids, tars, anthralins, and keratolytics were the cornerstones of topical therapy. However, recently, topical retinoids, a novel anthralin preparation, and vitamin D analogues have increased doctors' treatment toolkits [24].

The topical management of psoriasis requires the use of emollients, moisturisers, and keratolytic medications. They serve as adjuvants to conventional therapies and aid in lowering the scale load of particular patients. Emollients and moisturisers primarily function to support proper hyperproliferation, or differentiation, and apoptosis; additionally, they have anti-inflammatory actions, for instance through physiologic lipids [25].

Upper respiratory tract infection is the most common reason for asthma in children. Treatment is determined based on the disease's severity and whether or not it has affected any joints. Corticosteroids and calcipotriene are examples of topical treatments. Systemic retinoids, ultraviolet radiation, and cyclosporine all reduce cutaneous psoriatic lesions. Both the cutaneous and joint symptoms of psoriasis respond well to methotrexate sodium and etanercept [26]. People with more severe, persistent, or extensive psoriasis can benefit from systemic medications, phototherapy, and other treatments. Although these treatments are more efficient than topical ones, they are also linked to serious cutaneous and systemic side effects [27].

UVB, that is ultraviolet B phototherapy, is a successful treatment for the widespread disease that allows for both quick management and long-term maintenance [28]. While cyclosporine is helpful, especially when used briefly in acute exacerbation situations, it should be substituted by other treatments for long-term maintenance [28].Lower concentrations and shorter durations of topical corticosteroids should be prescribed for treating children. Patients who are pregnant or nursing can benefit from topical corticosteroids in a safe and efficient manner. They are available in many different formulations, including shampoos, ointments, creams, lotions, gels, foams, and oils [29]. Although topical steroids are often used, there are only a few disorders that have been proved to benefit from their usage, such as psoriasis, vitiligo, eczema, atopic dermatitis, phimosis, acute radiation dermatitis, and lichen sclerosus [30].

The likelihood of psoriasis symptoms improving appears to be higher for foods and substances with systemic anti-inflammatory properties [31]. When combined with topical or systemic therapy, a low-calorie diet (LCD) improves the Dermatology Life Quality Index and Psoriasis Area and Severity Index. However, LCD was not successful in maintaining disease remission when patients stopped concurrent cyclosporine or methotrexate therapy [32]. Psoriasis patients usually have an imbalanced diet, with a higher consumption of fat and a lower intake of fish or dietary fibre, as compared to controls. Such dietary habits may have an impact on the frequency and intensity of psoriasis. Nutrition has an impact on the start, progression, and comorbidities of psoriasis [33].Body mass index and psoriasis severity have been linked in various studies, and obesity has been linked to a pro-inflammatory condition [34].

When it comes to the safety and effectiveness in patients having covid vaccine with immune-mediated inflammatory diseases (IMIDs), there is little reason to believe that these patients face any higher risk of negative side effects than healthy controls [35].Because of the elevated risk of infection, especially in high-risk areas, conventional immunosuppressive medications like methotrexate and cyclosporine, as well as anti-TNF drugs, should not be recommended. The side effect of hypertension, which has been linked to a higher likelihood of developing severe COVID-19 (coronavirus disease), may make using cyclosporine riskier. Given the lack of conclusive evidence to date that biologics increase the risk of COVID-19, these drugs should only be stopped when a patient displays COVID-19 symptoms [36].Due to the COVID-19 pandemic, clinicians treatingIMIDs, such as psoriasis, have encountered significant challenges. Patients with severe psoriasis are more likely to have obesity, hypertension, diabetes, and male sex as risk factors for severe COVID-19. The risk of severe infection is also known to increase with the use of several systemic psoriasis treatments. Therefore, it makes sense that in the early stages of the pandemic individuals receiving typical targeted systemic medication were believed to have a greater chance of getting a severe COVID-19 infection. In addition to risk-reducing behaviours like social distance suggested by the World Health Organization, people who were deemed to be more sensitive, such as those using immunosuppressants, were encouraged to adopt greater measures of social isolation [37]. The COVID-19 pandemic negatively affects the treatment of psoriasis and the provision of healthcare [38]. Patients with psoriasis who have had biological treatment or another sort of systemic therapy may develop a mild case of SARS-CoV-2(severe acute respiratory syndromecoronavirus 2) infection, while they may also briefly experience an aggravation of skin lesions [39].

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Types of Psoriasis and Their Effects on the Immune System - Cureus