PHARMACOTHERAPY PRINCIPLES AND PRACTICE CARE PLANS & CASES
Upon completion of this chapter, the reader will be able to:
Discuss the etiology and risk factors of psoriasis.
Describe the pathophysiology and clinical presentations of psoriasis.
Evaluate the assessment strategies of patients with the disease state.
Recommend nonpharmacological approaches for the treatment of psoriasis.
Develop appropriate treatment and care plan for psoriasis patients.
Recommend appropriate monitoring parameters for a patient with psoriasis.
Propose patient education and counseling information for patients and caregivers as part of the care plan.
KEY CONCEPT Psoriasis is a chronic inflammatory condition that exhibits a normal pattern of relapse and remission. There is currently no cure for the disease and treatment is aimed toward management of signs and symptoms associated with the condition.1 Remission may last years in some patients, whereas, in others, exacerbations may occur every few months. Things known to exacerbate the condition are stress, seasonal changes, environmental factors, life crises, and certain medications.2 The severity of the condition ranges from mild and moderate to severely disabling. Depression, alcohol-related problems, cardiovascular diseases, metabolic syndrome, and skin cancers are select comorbidities associated with the severe form of the disease.1 Thus, management of patients with psoriasis is long term and management modalities may change according to the severity of illness at the time. Treatment should be individualized to meet patient needs. The disease may precipitate emotional distress that requires empathy and a caring attitude.
EPIDEMIOLOGY AND ETIOLOGY
Psoriasis is a chronic common inflammatory skin disorder with a population prevalence of 2% to 3% worldwide. The prevalence is found in Americans and Canadians in a range of 4.6% to 4.7%. African, African American, and Asian populations have an estimated 0.4% to 0.7% prevalence of the disease.3 Male patients tend to die at least 3.5 years earlier and females 4.5 years earlier than nonpsoriasis patients normalized for differences in mortality by gender.3 The disease may present at any age, but peaks between age 15 and 30 and again from 50 to 60 years.3,4 Types of psoriasis manifest as plaque, flexural (aka inverse or intertriginous), erythrodermic, pustular, guttate, nail, and psoriatic arthritis (PsA). Eighty to ninety percent of psoriatic patients present with plaque psoriasis. Plaque psoriasis presents with red-pink lesions of varying sizes covered with silvery scales.2 Up to 42% of patients with psoriasis have been reported to also have PsA.1,5 PsA is mostly limited to joints, ligaments, and tendons, and manifests in the presence of psoriasis disease. Clinical presentations include pain, stiffness, swelling, and tenderness. PsA progresses from mild symptoms to the destruction of joints affecting quality of life for patients. Some patients may have deforming PsA without cutaneous involvement.1,5