Psoriasis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural History[1]
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.
Plaque-Type Psoriasis
- Plaque-type psoriasis is a chronic condition with multiple relapses and remissions along the course of disease.
- 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 distal (DIPs) and proximal (PIPs) interphalangeal joints of the hands and feet. Erosive joint disease usually develops years after involvement of joints.
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 for example, smoking, excessive alcohol, pregnancy, HIV infection and stress.
Pustular Psoriasis
- Generalized pustular psoriasis is a severe form of psoriasis which is triggered by pregnancy, rapid withdrawal of corticosteroids, infections, and hypocalcemia
Complications
Individuals with psoriasis may develop the following complications:[2][3]
- Depression
- Psoriatic arthritis
- Chronic inflammatory bowel disease
- Non-alcoholic fatty liver disease
- Celiac disease
- Sensorineural hearing loss
- Osteopenia and osteoarthritis
- Diabetes
- Hypertension
- Conjunctivitis
- Uveitis
- Metabolic syndrome
- Anti-TNF medications given during the management of psoriasis may lead to:
- Progressive multi-focal leukoencephlopathy
- Optic neuritis
- Transverse myelitis
- Multiple sclerosis
- Infections
- SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis)
Prognosis
Psoriasis is a lifelong condition.[4] 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.
According to one study,[5] psoriasis is linked to 2.5-fold increased risk for nonmelanoma skin cancer in men and women, with no preponderance of any specific histologic subtype of cancer. This, however could be linked to antipsoriatic treatment.
References
- ↑ 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.
- ↑ Gisondi P, Del Giglio M, Cozzi A, Girolomoni G (2010). "Psoriasis, the liver, and the gastrointestinal tract". Dermatol Ther. 23 (2): 155–9. doi:10.1111/j.1529-8019.2010.01310.x. PMID 20415823.
- ↑ Qureshi AA, Choi HK, Setty AR, Curhan GC (2009). "Psoriasis and the risk of diabetes and hypertension: a prospective study of US female nurses". Arch Dermatol. 145 (4): 379–82. doi:10.1001/archdermatol.2009.48. PMC 2849106. PMID 19380659.
- ↑ Jobling R (2007). "A patient's journey:Psoriasis". Br Med J. 334: 953&ndash, 4. doi:10.1136/bmj.39184.615150.802.
- ↑ Olsen JH, Frentz G, Møller H (1993). "[Psoriasis and cancer]". Ugeskr. Laeg. (in Danish). 155 (35): 2687–91. PMID 8212383.