From the Guidelines
Yes, psoriasis is considered an autoimmune disease. In this condition, the immune system mistakenly attacks healthy skin cells, causing them to multiply much faster than normal. This accelerated cell growth leads to the characteristic thick, red, scaly patches on the skin's surface. The immune dysfunction involves T cells, which normally protect the body against infection, but in psoriasis, these cells become overactive and trigger inflammatory responses in the skin. This immune dysregulation is influenced by both genetic and environmental factors.
Key Points
- Psoriasis is a chronic disease that waxes and wanes during a patient’s lifetime, is often modified by treatment initiation and cessation, and has few spontaneous remissions 1.
- The immune dysfunction in psoriasis involves T cells, including the TH17 subset of T-helper cells, which play a central role in the pathogenesis of the disease 1.
- Treatment approaches often target this immune dysfunction, with medications like methotrexate, cyclosporine, and biologics (such as adalimumab, etanercept, and ustekinumab) working to suppress specific parts of the immune response.
- While psoriasis cannot be cured, these treatments can effectively manage symptoms and provide long periods of clear skin for many patients.
- Understanding psoriasis as an autoimmune condition helps explain why systemic treatments that modulate immune function are often more effective for moderate to severe cases than topical treatments alone.
Recent Guidelines
The most recent guidelines for the management and treatment of psoriasis with biologics were published in 2019 by the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) 1. These guidelines emphasize the importance of considering the patient's quality of life, comorbidities, and potential side effects when selecting a treatment.
Treatment Options
Treatment options for psoriasis include:
- Topical medications
- Phototherapy
- Photochemotherapy
- Traditional systemic drugs
- Biologic agents, such as adalimumab, etanercept, and ustekinumab, which have received regulatory approval for psoriasis and/or psoriatic arthritis 1.
Quality of Life
Psoriasis can have a significant impact on a patient's quality of life, with many patients experiencing depression, anxiety, and social isolation. Effective treatment of psoriasis can improve not only the patient's skin symptoms but also their overall quality of life.
Morbidity and Mortality
Psoriasis is associated with an increased risk of morbidity and mortality, particularly due to cardiovascular disease and lymphoma 1. Effective management of psoriasis, including treatment of comorbidities and lifestyle modifications, can help reduce this risk.
Conclusion is not allowed, so the answer will be ended here.
From the Research
Definition of Psoriasis
- Psoriasis is a chronic, recurring inflammatory disease affecting the skin, joints, and nails, with a significant negative impact on the quality of life 2.
- It is an immune-mediated inflammatory disease, with a chronic relapsing-remitting course, which affects 2-3% of the worldwide population 3.
Autoimmune Nature of Psoriasis
- Psoriasis is considered an immune-mediated and inflammatory systemic disease, with a complex pathophysiology involving various inflammatory pathways 3.
- The disease is characterized by an abnormal immune response, which leads to the development of inflammatory lesions and other systemic complications 3.
Treatment of Psoriasis
- Various treatments are available for psoriasis, including phototherapy, systemic therapies, and biologics 4, 5, 6, 2.
- Phototherapy, such as narrowband ultraviolet B (NB-UVB) and psoralen plus ultraviolet A (PUVA), is a common treatment for psoriasis, and can be used alone or in combination with other therapies 4, 5, 6.
- Biologics have been shown to be effective in modifying the natural history of the disease, by reducing the inflammatory background and preventing systemic complications 3.