Psoriasis as a Complex Chronic Inflammatory Disease - Essay Example

Psoriasis affiliation ive Data Patient initials: P.D Age: 23 years Gender: Female History of Present Illness: The patient presents with a history of rashes, which are thick, scaly, well-defined, erythematous plaques that are silvery in color. She further states that she has had rashes before, but they were not bad off. The patient reports that she had just returned from a twelve-day trip to southern Louisiana to work with the ecosystem as part of her education as an environmental engineer. During the trip, she had significant solar exposure although she wore sunscreen. Past medical history: The patients past medical history is noncontributory; however, she occasionally applies moisturizing skin lotion or witch hazel if it becomes too irritating Diagnosis: Psoriasis Disease process Introduction Psoriasis is a complex chronic inflammatory disease that involves hyperproliferation of the keratinocytes in the skin epidermis, leading to an elevation of the epidermal cell turnover. The main cause of psoriasis is not well understood, however, several scholars believe that psoriasis is caused by defects in the immune system, enzymes as well as other factors that regulate skin cell division. One of the processes involves abnormalities in the immune response that leads to inflammation and increased production of immature skin cells. Genes have been associated to have a significant role in the development of psoriasis, in that research has shown that a group of genes called PSORS 1-8 have been involved in psoriasis. Psoriasis commonly manifests on the skin of the elbow, scalp, and intergluteal clefts among other places (Lowes, Bowcock, & Krueger, 2007). Pathogenesis As stated earlier, the pathogenesis of psoriasis is not well understood, however, T cells, that appear to be capable of inducing keratinocytes proliferation has been linked to causing psoriasis. This has been supported by several histological examination and immunohistochemical staining of the psoriatic plaques, which have revealed large population of T cells in the lesions. A study has shown that a patient with 20% body surface area affected by psoriasis has a proximately eight billion blood circulating T cells. The increased T cells lead to deregulated inflammatory process with extensive production of various cytokines like tumor necrosis factor- α, interferon-gamma and interleukin 12. Several clinical features (raised reddish patches, itchiness and small red spots) of psoriasis are explained by the immense production of these chemical mediators. The key findings in the affected part of the skin include vascular engorgement due to dilatation of the superficial blood vessels as well as altered epidermal cell cycle (Coimbra et al., 2012). Diagnosis and disease severity A microscopic examination of the skin tissue taken from the affected patches is required to make a definite diagnosis of psoriasis from other dermatological disorders. In psoriasis, the analysis usually shows several dry skin cells without signs of inflammation or infection. Moreover, specific changes in the nail are often a reliable indicator of psoriasis. Psoriasis severity ranges from a flaky, inflamed patch to widespread pustular psoriasis. The disease is usually classified as mild, moderate to severe. Mild psoriasis affect less than 3% of the total body surface area, moderate psoriasis affects 3-10% of the skin and severe psoriasis covers more than 10% of the body surface area. In addition, severity of psoriasis can be measured by the disease effect on an individual’s quality of life (Raychaudhuri, Maverakis, & Raychaudhuri, 2014). Prognosis and co-morbidities Despite psoriasis being benign, it is usually a life-long illness with remissions and exacerbations and occasionally refractory to treatment. It progresses to arthritis in about ten percent of cases, additionally 17-55% of the patients experience remissions of varying degree. Mild psoriasis does not increase the risk of mortality rate; however, men with severe psoriasis die three years earlier compared to men without the disease. Similarly, women with severe psoriasis die 4.4 years earlier compared to women without the disease. Psoriasis poses a greater risk for major co-morbidities including kidney diseases, diabetes, cardiovascular diseases and chronic lung diseases. Psoriasis is mostly associated with metabolic syndrome, alcohol, smoking, and depression and nonmelanoma skin cancers (Weigle & Mcbane, 2013). General Management of psoriasis Management of psoriasis encompasses the use of several approaches and they include drugs, climatotherapy, light therapy and stress reduction. Several drugs that affect the skin cell production rate are usually used in psoriasis treatment alone or in combination with other methods. Other treatment methods include skin moisturizers and salicylic acid scale removal agents. Treatment for severe psoriasis involves the use of narrow-band ultraviolet B light, light retinoids, methotrexate, cyclosporine, and adalimumab. Coal Tar agents are also applied to the plaques, Vitamin D Analogs, antimetabolites, and immunomodulators are also utilized in psoriasis management (Jackson, 2012). Orders: medication 1. Triamcinolone topical cream 0.25% BID for one month 2. Coal tar 0.5% topical cream two times weekly for one month 3. Anthralin 1% topical cream OD for one month 4. Calcitrol ointment 0.0003% BD for a month 5. secukinumab 300mgs S.C weekly for four weeks Lab order 1. Full blood picture Consultant/referral 1. Dermatologist to review the skin condition and prescribe any further management 2. Dietician for education regarding proper diet on improving immune system Health Education 1. Avoid a direct skin hit by sunlight by wearing protective devices 2. Observe daily body hygiene by bathing twice in a day 3. To come back after two weeks for review Description of the prescribed medications Topical corticosteroids are used to minimize the formation of the plaques. The drugs have an anti-inflammatory effect and causes profound metabolic activities. Moreover, the drug modifies the body immune responses to different stimuli. Example betamethasone ointment and Triamcinolone acetonide Coal tar is antipruritic and an antibacterial drug that acts by inhibiting the deregulated epidermal proliferation as well as dermal infiltration. It is a drug that is very safe on the skin since it does not injure the skin even if widely used, moreover it enhances the usefulness of phototherapy during treatment. Example is coal tar 0.5-33% Keratolytic agents are used to remove the scales and make the skin smooth. Removal of the thick skin plaques allows the topical medications to reach the targeted tissues better. Most of the keratolytic agents contain salicylic acid. They are only applied on the areas that need the removal of the scales. Example is Anthralin Vitamin D analogs regulate skin cell production as well as development. Example is calcitriol 0.0003% ointment Interleukin inhibitors selectively bind to neutralize the proinflammatory cytokines interleukin 17A Health education and collaborations Despite the drug treatment, the patient should be taught some lifestyle changes to avoid the disease progressing to higher levels. In essence, the patient should try as much as possible to avoid a direct hit by sunlight, this is because sunlight causes drying of the skin thus increases severity of the disease. The patient should use sunscreens as well as wearing clothes that cover most parts of their body. Additionally, the patient should observe daily body hygiene, which can be achieved through bathing twice in a day. When Hygiene is not observed, the psoriatic plaques can become infected and suppurate. The patient shall be referred to a dermatologist for further management, in addition, the patient shall be referred to a dietician for nutritional counseling and prescription (Mrowietz U, Reich, 2009). Conclusion Psoriasis is a disease that affects the skin, which if not managed properly can complicate and leads to multiple organ damage. Management of the disease encompasses several approaches which include drug, phototherapy and lifestyle change. Vigorous management of the disease, while it is still mild is very imperative to avert it from progressing to severe state. Reference Coimbra, S., Figueiredo, A., Castro, E., Rocha-Pereira, P., & Santos-Silva, A. (2012). The roles of cells and cytokines in the pathogenesis of psoriasis. International Journal of Dermatology. Jackson, K. (2012). The assessment and management of psoriasis. Nursing Times, 109, 18–9. Lowes, M. A., Bowcock, A. M., & Krueger, J. G. (2007). Pathogenesis and therapy of psoriasis. Nature, 445, 866–873. Mrowietz U, Reich, K. (2009). Psoriasis: new insights into pathogenesis and treatment. Dtsch Arztebl Int, 106, 11–8, quiz 19. Raychaudhuri, S. K., Maverakis, E., & Raychaudhuri, S. P. (2014). Diagnosis and classification of psoriasis. Autoimmunity Reviews. Weigle, N., & Mcbane, S. (2013). Psoriasis. American Family Physician, 87, 626–633. Read More