PSORIASIS - TYPES, CAUSES AND MEDICATION Edited by Hermenio Lima Psoriasis - Types, Causes and Medication http://dx.doi.org/10.5772/56549 Edited by Hermenio Lima Contributors Sibel Dogan, Nilgün Atakan, Hermenio C Lima, Robyn S. Fallen, Anupam Mitra, Laura Morrissey, Sebastiano Bucolo, Valerio Torre, Giuseppe Romano, Filippo Farri, Maura Filidoro, Claudio Caldarelli, Carmelo Quattrocchi, Hani A. Al- Shobaili, Muhammad Ghaus Qureshi, Farideh Zafari Zangeneh, Fatemeh Shooshtary, Delia Colombo Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2013 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. 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Publishing Process Manager Ana Pantar Technical Editor InTech DTP team Cover InTech Design team First published April, 2013 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Psoriasis - Types, Causes and Medication, Edited by Hermenio Lima p. cm. ISBN 978-953-51-1065-1 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface VII Section 1 Types of Psoriasis 1 Chapter 1 Psoriasis — Types, Causes and Medication 3 F.Z. Zangeneh and F.S. Shooshtary Chapter 2 Clinical Presentation of Psoriasis 39 Ananya Datta Mitra and Anupam Mitra Section 2 Causes of Psoriasis 55 Chapter 3 Psoriasis as a Chess Board — An Update of Psoriasis Pathophysiology 57 Robyn S Fallen, Anupam Mitra, Laura Morrisey and Hermenio Lima Chapter 4 Pathophysiology of Psoriasis: Current Concepts 91 Hani A. Al-Shobaili and Muhammad Ghaus Qureshi Chapter 5 Psoriasis: A Disease of Systemic Inflammation with Comorbidities 107 Sibel Dogan and Nilgün Atakan Section 3 Treatment of Psoriasis 119 Chapter 6 Treatment of Psoriasis with Topical Agents 121 Robyn S. Fallen, Anupam Mitra, Laura Morrissey Rogers and Hermenio Lima Chapter 7 Quality of Life in Psoriasis 141 Delia Colombo and Renata Perego Chapter 8 Effects of Tonsillectomy on Psoriasis and Tonsil Histology-Ultrastructure 159 Sebastiano Bucolo, Valerio Torre, Giuseppe Romano, Carmelo Quattrocchi, Filippo Farri, Maura Filidoro and Claudio Caldarelli ContentsVI Preface By virtue of the dynamic nature of the scientific process, the description of the type, pathogene‐ sis and treatment of a disease is always a work in progress. Each day new research shapes and refines our understanding of disease processes; an attempt to describe the current scientific un‐ derstanding provides merely a snapshot of a body of knowledge that is constantly changing. However, characterizing a disease using homeostatic and physiological terms allows the crea‐ tion of a framework to convey the most up-to-date theories while maintaining the potential for their evolution. The complex nature of any disease can similarly be unveiled through understanding the histori‐ cal context of our current understanding, examining prevailing hypotheses and extrapolating horizons for new research. To develop a framework for understanding of psoriasis and its evolu‐ tion, the first perception to be changed is the prevalent teleological view of pathogenesis. The general notion that psoriasis is one disease with one mechanism must be changed. This model full of logic and consequences does not apply in many other areas of medical and non-medical science. However, the belief that certain phenomena are best explained in terms of purpose rath‐ er than cause infest the medical scientific field. As such, it is necessary to move to a new ap‐ proach to describing the relationship among immune system, other systems and environment. For better development of this book about psoriasis, the main objective was to provide insights on the types, causes, and treatments of this prevalent humans disease. Any successful program of knowledge transference has to discuss the pivotal role of some of these aspects of immunopatho‐ physiology, how our understanding of its mechanism evolved, and how to block or revert the effect of a specific immunological disequilibrium. Through this, the aim is to explain some facts of modern science that might be useful for clinicians to understand the basis of psoriasis. Moreover, an important goal is to dispel some misinformation that might have a negative impact on the use of new immunomodulators and medications available. Treatment basis and therapeutic response experience strongly supports the use of immunomodulators as important modalities in the treat‐ ment of many diseases in all fields of medicine. Studies with these therapeutic agents, which act in different steps of the inflammatory cascade, have also shown significant efficacy in psoriasis. This approach might substantially improve the transference of disease knowledge for physicians and is intended to improve the quality of medical services that endorses training of excellence and assesses the qualifications of physicians, most of whom will be naïve to clinical dermatologi‐ cal practices. Enjoy the book. Hermenio Lima, MD PhD McMaster University, Canada Section 1 Types of Psoriasis [...]... UVB As UVA-1 is even less erythematogenic than broadband UVA much higher doses of UVA-1 can be tolerated by the patients UVA-1 phototherapy works mainly through induction of apoptosis of skin infiltrating T cells, T-cell depletion and induction of collagenase-1 expression in human dermal fibroblast [121] [122] 23 24 Psoriasis - Types, Causes and Medication Sunlight: Already several thousands of years... lesions may appear in the plaque (so-called psoriasis with pustules) Chronic plaque psoriasis is the most common variety of psoriasis, representing about 70% to 80% of psoriatic patients [11] Figure 1 Typical plaque of Psoriasis Vulgaris Figure 2 Annular psoriasis showing clearance in centre of plaque 5 6 Psoriasis - Types, Causes and Medication Under the heading of plaque psoriasis, it is proposed to include,... features of psoriasis, and skin failure, that is, inability to maintain homeostatic functions [26] Erythrodermic psoriasis characterized by severe scaling, itching, and pain that affects most of the body, erythrodermic psoriasis disrupts the 11 12 Psoriasis - Types, Causes and Medication body's chemical balance and can cause severe illness (Figure11) This particularly inflamma‐ tory form of psoriasis. .. may predispose to psoriasis Cathecolamines regulate the immune system at regional, local and systemic levels via adrenergic receptors expressed on immune cells [86] and interestingly, β-AR blockers may cause this inflammatory autoimmune skin disease [87] [88] 19 20 Psoriasis - Types, Causes and Medication 3.3.3 Psoriasis & immune system Psoriasis is a chronic inflammatory, immune-mediated skin disease,... underarms, navel, and buttocks), and pustular psoriasis (pus-filled, yellowish, small blisters) When the palms and the soles are involved, this is known as palmoplantar psoriasis 2.2 Psoriasis vulgaris (chronic stationary psoriasis, plaque-like psoriasis) The commonest type of psoriasis, accounting for 90% of all cases, is psoriasis vulgaris, in which papulosquamous plaques are well-delineated from... the local‐ ization, duration, and amplitude of cyclic nucleotide signaling within subcellular domains The PDE superfamily of enzymes is classified into 11 families, namely PDE1-PDE11, in mam‐ mals PDEs have different substrate specificities Some are cAMP-selective hydrolases (PDE4, 7 17 18 Psoriasis - Types, Causes and Medication and 8); others are cGMP-selective (PDE5, 6, and 9) A phosphodiesterase type... women) and is much more strongly associated with smoking than plaque psoriasis [25] Palomar-plantar pustulosis (PPP) generally appears between the ages of 20 and 60 PPP causes large pustules to form at the base of the thumb or on the sides of the heel In time, the pustules turn brown and peel The disease usually becomes much less active for a while after peeling Psoriasis — Types, Causes and Medication. .. plaque psoriasis [8] Henseler and Christophers are credited with identifying two ages of onset: type I occurring at or before the age of 40 years—this accounts for approximately 75% of patients; and typeII presenting after the age of 40 years, with a distinct peak at 55–60 years [9] Psoriasis — Types, Causes and Medication http://dx.doi.org/10.5772/54728 2.2.2 Plaque-type psoriasis: Chronic plaque psoriasis. .. indispensable and protective barrier The first protective barrier is provided by the skin, our largest organ It serves as the interface between the organism and the outside world and it serves many functions, such as the retention Psoriasis — Types, Causes and Medication http://dx.doi.org/10.5772/54728 of body fluids, maintenance of body temperature, and protection against UV-light, chemical influxes, wounds, and. .. size and thickness of plaques [8] 2.2.3 Site-specific variants of Psoriasis Vulgaris (PV) Site-specific variants of psoriasis vulgaris exist Flexural (inverse) psoriasis in intertriginous sites is shiny, red, and typically devoid of scales (figure 3); sebopsoriasis, which can be confused with seborrhoeic dermatitis, has greasy scales and occurs in eyebrows, nasolabial folds, and postauricular and presternal . PSORIASIS - TYPES, CAUSES AND MEDICATION Edited by Hermenio Lima Psoriasis - Types, Causes and Medication http://dx.doi.org/10.5772/56549 Edited. orders@intechopen.com Psoriasis - Types, Causes and Medication, Edited by Hermenio Lima p. cm. ISBN 97 8-9 5 3-5 1-1 06 5-1 free online editions of InTech Books and Journals