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==Overview==
==Overview==
If left untreated, patients with psoriasis may progress to develop [[psoriatic arthritis]], [[joint]] erosions and [[conjunctivitis]]. Common complications of psoriasis include [[depression]], [[psoriatic arthritis]], [[Inflammatory bowel disease|chronic inflammatory bowel disease]], [[non-alcoholic fatty liver disease]], [[celiac disease]], [[sensorineural hearing loss]], [[osteopenia]] and [[osteoarthritis]]. Psoriasis is a life-long disease with multiple [[Relapse|relapses]] and [[Remission (medicine)|remissions]]. Symptoms can be controlled by medications.
If left untreated, patients with psoriasis may progress to develop [[psoriatic arthritis]], [[joint]] erosions, and [[conjunctivitis]]. Common complications of psoriasis include [[depression]], [[psoriatic arthritis]], [[Inflammatory bowel disease|chronic inflammatory bowel disease]], [[non-alcoholic fatty liver disease]], [[celiac disease]], [[sensorineural hearing loss]], [[osteopenia]], and [[osteoarthritis]]. Psoriasis is a life-long disease that involves multiple [[Relapse|relapses]] and [[Remission (medicine)|remissions]], though symptoms can be controlled with proper medication.


==Natural History==
==Natural History==
Natural history of psoriasis differs according to the clinical sub-type. The symptoms of psoriasis usually develop in the second decade of life, and start with symptoms such as [[skin lesions]] characterized by [[erythema]] and scales covering the lesions. The chronicity of psoriasis may lead to significant [[distress]] for the affected patient and leads to a decrease in quality of life.<ref name="pmid21550135">{{cite journal |vauthors=Rehal B, Modjtahedi BS, Morse LS, Schwab IR, Maibach HI |title=Ocular psoriasis |journal=J. Am. Acad. Dermatol. |volume=65 |issue=6 |pages=1202–12 |year=2011 |pmid=21550135 |doi=10.1016/j.jaad.2010.10.032 |url=}}</ref>
The natural history of psoriasis differs according to the clinical sub-type. The symptoms of psoriasis usually develop in the second decade of life, beginning with such symptoms as [[skin lesions]] characterized by [[erythema]] and scales covering the [[lesions]]. The chronicity of psoriasis may cause significant [[distress]] for the affected patient, which can lead to a decrease in the patient's quality of life.<ref name="pmid21550135">{{cite journal |vauthors=Rehal B, Modjtahedi BS, Morse LS, Schwab IR, Maibach HI |title=Ocular psoriasis |journal=J. Am. Acad. Dermatol. |volume=65 |issue=6 |pages=1202–12 |year=2011 |pmid=21550135 |doi=10.1016/j.jaad.2010.10.032 |url=}}</ref>


=== Plaque-Type Psoriasis ===
=== Plaque-Type Psoriasis ===
* [[Plaque]]-type psoriasis is a chronic condition with multiple [[Relapse|relapses]] and [[Remission (medicine)|remissions]] along the course of disease.
* [[Plaque]]-type psoriasis is a [[chronic]] condition involving multiple [[Relapse|relapses]] and [[Remission (medicine)|remissions]] along the course of the disease.
* Extra-[[cutaneous]] involvement is common and the most commonly affected sites include [[joints]] and eyes.
* Extra[[cutaneous]] involvement is common and the most commonly affected sites include [[joints]] and eyes.
* Typical presentation is that of [[plaques]] which persist on the same site for months to years, along with an asymmetric [[oligoarthritis]] with involvement of the [[Interphalangeal articulations of hand|distal (DIPs) and proximal (PIPs) interphalangeal joints of the hands]] and [[feet]]. Erosive joint disease usually develops years after involvement of joints.
* Typical presentation is that of [[plaques]] which persist on the same site for months to years, along with an asymmetric [[oligoarthritis]] with involvement of the [[Interphalangeal articulations of hand|distal (DIPs) and proximal (PIPs) interphalangeal joints of the hands]] and [[feet]]. Erosive joint disease usually develops years after joint involvement.


=== Guttate Psoriasis ===
=== Guttate Psoriasis ===
* Guttate psoriasis presents with spontaneous [[Remission (medicine)|remissions]] occurring over the course of weeks to months. In adults, the lesions of guttate psoriasis may become chronic and progress to plaque-type psoriasis.
* Guttate psoriasis presents with spontaneous [[Remission (medicine)|remissions]] occurring over the course of weeks to months. In adults, the [[lesions]] of guttate psoriasis may become [[chronic]] and progress to plaque-type psoriasis.
* It may be aggravated by extrinsic factors for example, smoking, excessive alcohol, pregnancy, [[HIV AIDS|HIV infection]] and stress.
* It may be aggravated by extrinsic factors such as smoking, excessive alcohol use, pregnancy, [[HIV AIDS|HIV infection]], and stress.


=== Pustular Psoriasis ===
=== Pustular Psoriasis ===
* Generalized pustular psoriasis is a severe form of psoriasis which is triggered by [[pregnancy]], rapid withdrawal of [[Corticosteroid|corticosteroids]], infections, and [[hypocalcemia]].<ref name="pmid19915261">{{cite journal |vauthors=Hazarika D |title=Generalized pustular psoriasis of pregnancy successfully treated with cyclosporine |journal=Indian J Dermatol Venereol Leprol |volume=75 |issue=6 |pages=638 |year=2009 |pmid=19915261 |doi=10.4103/0378-6323.57743 |url=}}</ref>
* Generalized pustular psoriasis is a severe form of psoriasis that can be triggered by:<ref name="pmid19915261">{{cite journal |vauthors=Hazarika D |title=Generalized pustular psoriasis of pregnancy successfully treated with cyclosporine |journal=Indian J Dermatol Venereol Leprol |volume=75 |issue=6 |pages=638 |year=2009 |pmid=19915261 |doi=10.4103/0378-6323.57743 |url=}}</ref>
**[[Pregnancy]]
**Rapid withdrawal of [[Corticosteroid|corticosteroids]]
**Infections
**[[Hypocalcemia]]
 
=== Psoriatic arthritis ===
Psoriatic arthritis goes through the following stages of progression during its course, defined by the change in clinical damage:<ref name="pmid15708927">{{cite journal |vauthors=Gladman DD, Antoni C, Mease P, Clegg DO, Nash P |title=Psoriatic arthritis: epidemiology, clinical features, course, and outcome |journal=Ann. Rheum. Dis. |volume=64 Suppl 2 |issue= |pages=ii14–7 |year=2005 |pmid=15708927 |pmc=1766874 |doi=10.1136/ard.2004.032482 |url=}}</ref>
* '''Stage 1:'''
** Reflects no damaged [[Joint|joints]]
* '''Stage 2:'''
** One to four damaged [[Joint|joints]]
* '''Stage 3:'''
** Five to nine damaged [[Joint|joints]]
* '''Stage 4:'''
** More than 10 [[Joint|joints]]


==Complications==
==Complications==
Individuals with psoriasis may develop the following complications:<ref name="pmid20415823">{{cite journal |vauthors=Gisondi P, Del Giglio M, Cozzi A, Girolomoni G |title=Psoriasis, the liver, and the gastrointestinal tract |journal=Dermatol Ther |volume=23 |issue=2 |pages=155–9 |year=2010 |pmid=20415823 |doi=10.1111/j.1529-8019.2010.01310.x |url=}}</ref><ref name="pmid19380659">{{cite journal |vauthors=Qureshi AA, Choi HK, Setty AR, Curhan GC |title=Psoriasis and the risk of diabetes and hypertension: a prospective study of US female nurses |journal=Arch Dermatol |volume=145 |issue=4 |pages=379–82 |year=2009 |pmid=19380659 |pmc=2849106 |doi=10.1001/archdermatol.2009.48 |url=}}</ref><ref name="pmid23197207">{{cite journal |vauthors=Fraga NA, Oliveira Mde F, Follador I, Rocha Bde O, Rêgo VR |title=Psoriasis and uveitis: a literature review |journal=An Bras Dermatol |volume=87 |issue=6 |pages=877–83 |year=2012 |pmid=23197207 |pmc=3699904 |doi= |url=}}</ref>
Individuals with psoriasis may develop the following complications:<ref name="pmid2048897">{{cite journal |vauthors=Roth PE, Grosshans E, Bergoend H |title=[Psoriasis: development and fatal complications] |language=French |journal=Ann Dermatol Venereol |volume=118 |issue=2 |pages=97–105 |year=1991 |pmid=2048897 |doi= |url=}}</ref>
* [[Depression]]
* High-output [[Congestive heart failure|cardiac failure]] in [[erythroderma]]<ref name="pmid14245176">{{cite journal |vauthors=FOX RH, SHUSTER S, WILLIAMS R, MARKS J, GOLDSMITH R, CONDON RE |title=CARDIOVASCULAR, METABOLIC, AND THERMOREGULATORY DISTURBANCES IN PATIENTS WITH ERYTHRODERMIC SKIN DISEASES |journal=Br Med J |volume=1 |issue=5435 |pages=619–22 |year=1965 |pmid=14245176 |pmc=2165960 |doi= |url= |issn=}}</ref>
* [[Psoriatic arthritis]]
* [[Infection|Infections]]
* [[Cachexic|Cachexy]]
* [[Amyloidosis]]


* [[Psoriatic arthritis]]
*Anti-TNF medications given during the management of psoriasis may lead to:
* [[Inflammatory bowel disease|Chronic inflammatory bowel disease]]
**[[Progressive multifocal leukoencephalopathy|Progressive multifocal leukoencephalopathy]]
* [[Non-alcoholic fatty liver disease]]
**[[Optic neuritis]]
* [[Celiac disease]]
**[[Transverse myelitis]]
* [[Sensorineural hearing loss]]
**[[Multiple sclerosis]]
* [[Osteopenia]] and [[osteoarthritis]]
**[[Infections]]
* [[Diabetes mellitus|Diabetes]]
* [[Hypertension]]
* [[Conjunctivitis]]
* [[Uveitis]]
* [[Metabolic syndrome]]
* Anti-TNF medications given during the management of psoriasis may lead to:
** [[Progressive multifocal leukoencephalopathy|Progressive multi-focal leukoencephalopathy]]
** [[Optic neuritis]]
** [[Transverse myelitis]]
** [[Multiple sclerosis]]
** [[Infections]]
* [[SAPHO syndrome]] ([[synovitis]], [[acne]], [[pustulosis]], [[hyperostosis]], and [[osteitis]])


==Prognosis==
==Prognosis==
* Psoriasis is a lifelong condition.<ref>{{cite journal|author=Jobling R|title=A patient's journey:Psoriasis|journal=Br Med J|year=2007|volume=334|pages=953&ndash;4|doi=10.1136/bmj.39184.615150.802}}</ref> There is currently no cure but various treatments can help to control the symptoms.  
* Psoriasis is a lifelong condition.<ref>{{cite journal|author=Jobling R|title=A patient's journey:Psoriasis|journal=Br Med J|year=2007|volume=334|pages=953&ndash;4|doi=10.1136/bmj.39184.615150.802}}</ref> There is currently no cure but various treatments can help to control the symptoms.  
* Many of the most effective agents used to treat severe psoriasis carry an increased risk of significant morbidity including [[skin cancer]]s, [[lymphoma]] and [[liver disease]]. However, the majority of people's experience of psoriasis is that of minor localized patches, particularly on the [[elbows]] and [[knees]], which can be treated with [[topical]] medication.  
* Many of the most effective agents used to treat severe psoriasis carry an increased risk of significant morbidity including [[skin cancer]]s, [[lymphoma]], and [[liver disease]]. However, the majority of people's experience of psoriasis is that of minor localized patches, particularly on the [[elbows]] and [[knees]], which can be treated with [[topical]] medication.  
* Psoriasis does get worse over time but it is not possible to predict who will go on to develop extensive psoriasis or those in whom the [[disease]] may appear to vanish. Individuals will often experience flares and remissions throughout their lives.   
* Psoriasis does get worse over time but it is not possible to predict who will go on to develop extensive psoriasis or those in whom the [[disease]] may appear to vanish. Individuals will often experience flares and remissions throughout their lives.   
* Controlling the signs and symptoms typically requires lifelong therapy.
* Controlling the signs and symptoms typically requires lifelong therapy.
* Psoriasis is linked to 2.5-fold increased risk for non-[[melanoma]] [[skin cancer]] in men and women, with no preponderance of any specific histologic subtype of cancer.<ref>{{cite journal |author=Olsen JH, Frentz G, Møller H |title=[Psoriasis and cancer] |language=Danish |journal=Ugeskr. Laeg. |volume=155 |issue=35 |pages=2687-91 |year=1993 |pmid=8212383 |doi=}}</ref> This, however could be linked to [[Antipsoriatics|antipsoriatic treatment]].
* Psoriasis is linked to 2.5-fold increased risk for non-[[melanoma]] [[skin cancer]] in men and women, with no preponderance of any specific histologic subtype of cancer.<ref>{{cite journal |author=Olsen JH, Frentz G, Møller H |title=[Psoriasis and cancer] |language=Danish |journal=Ugeskr. Laeg. |volume=155 |issue=35 |pages=2687-91 |year=1993 |pmid=8212383 |doi=}}</ref>  
 
=== '''Indications for referral to secondary or intermediary care for psoriasis''' ===
The Primary Care Dermatology Society and the British Association of Dermatologists suggests that the following groups of patients may require secondary care:<ref name="pmid16916825">{{cite journal |vauthors=Smith CH, Barker JN |title=Psoriasis and its management |journal=BMJ |volume=333 |issue=7564 |pages=380–4 |year=2006 |pmid=16916825 |pmc=1550454 |doi=10.1136/bmj.333.7564.380 |url=}}</ref>
* Diagnostic uncertainty
* Request for further counseling or education, including demonstration of topical treatment
* Failure to respond to appropriately used topical therapy for three months
* Psoriasis at sites that are difficult to treat ([[scalp]], face, palms, soles, genitals) if unresponsive to initial therapy
* [[Adverse drug reaction|Adverse reactions]] to [[Topical application|topical therapies]]
* Need for [[systemic therapy]] and [[phototherapy]]
* Disability preventing work or excessive time off work
* Acute unstable psoriasis
* [[erythroderma|Erythrodermic]] or generalized pustular psoriasis (emergency referral indicated)


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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{{WS}}


[[Category:Primary care]]
[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Needs overview]]
[[Category:Needs content]]
[[Category:Disease]]
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{{WS}}

Latest revision as of 23:52, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

If left untreated, patients with psoriasis may progress to develop psoriatic arthritis, joint erosions, and conjunctivitis. Common complications of psoriasis include depression, psoriatic arthritis, chronic inflammatory bowel disease, non-alcoholic fatty liver disease, celiac disease, sensorineural hearing loss, osteopenia, and osteoarthritis. Psoriasis is a life-long disease that involves multiple relapses and remissions, though symptoms can be controlled with proper medication.

Natural History

The natural history of psoriasis differs according to the clinical sub-type. The symptoms of psoriasis usually develop in the second decade of life, beginning with such symptoms as skin lesions characterized by erythema and scales covering the lesions. The chronicity of psoriasis may cause significant distress for the affected patient, which can lead to a decrease in the patient's quality of life.[1]

Plaque-Type Psoriasis

Guttate Psoriasis

  • Guttate psoriasis presents with spontaneous remissions occurring over the course of weeks to months. In adults, the lesions of guttate psoriasis may become chronic and progress to plaque-type psoriasis.
  • It may be aggravated by extrinsic factors such as smoking, excessive alcohol use, pregnancy, HIV infection, and stress.

Pustular Psoriasis

Psoriatic arthritis

Psoriatic arthritis goes through the following stages of progression during its course, defined by the change in clinical damage:[3]

  • Stage 1:
  • Stage 2:
  • Stage 3:
  • Stage 4:

Complications

Individuals with psoriasis may develop the following complications:[4]

Prognosis

  • Psoriasis is a lifelong condition.[6] There is currently no cure but various treatments can help to control the symptoms.
  • Many of the most effective agents used to treat severe psoriasis carry an increased risk of significant morbidity including skin cancers, lymphoma, and liver disease. However, the majority of people's experience of psoriasis is that of minor localized patches, particularly on the elbows and knees, which can be treated with topical medication.
  • Psoriasis does get worse over time but it is not possible to predict who will go on to develop extensive psoriasis or those in whom the disease may appear to vanish. Individuals will often experience flares and remissions throughout their lives.
  • Controlling the signs and symptoms typically requires lifelong therapy.
  • Psoriasis is linked to 2.5-fold increased risk for non-melanoma skin cancer in men and women, with no preponderance of any specific histologic subtype of cancer.[7]

Indications for referral to secondary or intermediary care for psoriasis

The Primary Care Dermatology Society and the British Association of Dermatologists suggests that the following groups of patients may require secondary care:[8]

  • Diagnostic uncertainty
  • Request for further counseling or education, including demonstration of topical treatment
  • Failure to respond to appropriately used topical therapy for three months
  • Psoriasis at sites that are difficult to treat (scalp, face, palms, soles, genitals) if unresponsive to initial therapy
  • Adverse reactions to topical therapies
  • Need for systemic therapy and phototherapy
  • Disability preventing work or excessive time off work
  • Acute unstable psoriasis
  • Erythrodermic or generalized pustular psoriasis (emergency referral indicated)

References

  1. ↑ Rehal B, Modjtahedi BS, Morse LS, Schwab IR, Maibach HI (2011). "Ocular psoriasis". J. Am. Acad. Dermatol. 65 (6): 1202–12. doi:10.1016/j.jaad.2010.10.032. PMID 21550135.
  2. ↑ Hazarika D (2009). "Generalized pustular psoriasis of pregnancy successfully treated with cyclosporine". Indian J Dermatol Venereol Leprol. 75 (6): 638. doi:10.4103/0378-6323.57743. PMID 19915261.
  3. ↑ Gladman DD, Antoni C, Mease P, Clegg DO, Nash P (2005). "Psoriatic arthritis: epidemiology, clinical features, course, and outcome". Ann. Rheum. Dis. 64 Suppl 2: ii14–7. doi:10.1136/ard.2004.032482. PMC 1766874. PMID 15708927.
  4. ↑ Roth PE, Grosshans E, Bergoend H (1991). "[Psoriasis: development and fatal complications]". Ann Dermatol Venereol (in French). 118 (2): 97–105. PMID 2048897.
  5. ↑ FOX RH, SHUSTER S, WILLIAMS R, MARKS J, GOLDSMITH R, CONDON RE (1965). "CARDIOVASCULAR, METABOLIC, AND THERMOREGULATORY DISTURBANCES IN PATIENTS WITH ERYTHRODERMIC SKIN DISEASES". Br Med J. 1 (5435): 619–22. PMC 2165960. PMID 14245176.
  6. ↑ Jobling R (2007). "A patient's journey:Psoriasis". Br Med J. 334: 953&ndash, 4. doi:10.1136/bmj.39184.615150.802.
  7. ↑ Olsen JH, Frentz G, Møller H (1993). "[Psoriasis and cancer]". Ugeskr. Laeg. (in Danish). 155 (35): 2687–91. PMID 8212383.
  8. ↑ Smith CH, Barker JN (2006). "Psoriasis and its management". BMJ. 333 (7564): 380–4. doi:10.1136/bmj.333.7564.380. PMC 1550454. PMID 16916825.

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