Pathophysiology and treatment of psoriasis

The pathogenesis and treatment of psoriasis are reviewed. Psoriasis is characterized by defects in the normal cycle of epidermal deve lopment that lead to epidermal hyperproliferation, altered maturation of sk in cells, and vascular changes and inflammation. The condition typically ma nifests as areas of thickened, flaky, silvery white and reddened skin that may hurt, itch, and bleed. Biochemical markers of psoriasis are changes in levels of keratins, keratinocyte transglutamase, migration inhibitory facto r-related protein, skin-derived antileukoproteinase, involucrin, small prot ein rich protein 2, filaggrin, and cytokines. Types of psoriasis that may b e clinically encountered include plaque psoriasis, and pustular psoriasis. Psoriasis is belived to be genetically linked but canalso be triggered by m echanical, ultravilet, and chemical injury; various infections; prescriptio n drug use; psychological stress; smoking; and other factors. Topical treat ment of psoriasis is usually the first line of therapy. Topical treatments consist of emollients and keratolytic agents, anthralin, coal tar, corticos teroids, vitamin D-3 analogues, topical retinoids, and topical psoralens pl us ultraviolet A (UVA) light. In patients who do not respond adequately to topical therapy, oral or injectable therapy, such as oral retinoids, methot rexate, cyclosporine, tacrolimus, and oral psoralens plus UVA light, may be warranted. Patients receiving systemic treatments should be carefully moni tored for adverse effects and drug-drug interactions. Drug therapy is the mainstay of the treatment of psoriasis. The potential a dverse effects and interactions necessitate vigilant monitoring.