Upon completion of the chapter, the reader will be able to:
Discuss the etiology of, and risk factors for, psoriasis.
Describe the pathophysiology and clinical presentations of psoriasis.
Delineate treatment goals for each patient.
Develop an appropriate treatment and care plan for psoriasis patients.
Recommend nonpharmacologic and pharmacologic treatments for psoriasis.
Recommend appropriate monitoring parameters for a patient diagnosed with psoriasis.
Provide patient education for patients and caregivers as part of the care plan.
Psoriasis is a chronic inflammatory condition that exhibits a cyclical pattern of relapse and remission. There is currently no cure for the disease and treatment is designed to manage signs and symptoms associated with the disease.1 Remission may last for years in some patients, whereas, in others, exacerbations may occur as frequently as every few months. Patient factors known to exacerbate the condition are stress, environmental factors including seasonal changes, and certain medications.2 Depression, alcohol-related problems, cardiovascular diseases, metabolic syndrome, irritable bowel disease (Crohn disease and ulcerative colitis), and skin cancers are select comorbidities associated with the severe form of psoriasis.1 The severity of the condition ranges from mild to severely disabling. Thus management of patients with psoriasis is lifelong and treatment approaches may change according to the severity of illness at the time. Treatment modalities should be individualized to meet patient needs. The disease may result in emotional distress that requires empathy, a caring attitude, and consideration when weighing treatment approaches.
EPIDEMIOLOGY AND ETIOLOGY
Psoriasis is a common chronic inflammatory skin disorder with a population prevalence of 2% to 3% worldwide. The prevalence found in the United States is approximately 2.1%, while African, African American, and Asian populations have an estimated 0.4% to 0.7% prevalence of the disease.3 This difference may be attributed to genetic variations of the disease. While the overall incidence rate does not differ between men and women, 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 new diagnoses peak between ages 15 and 30 and again from 50 to 60 years.3 Psoriasis can manifest as several different types including plaque, flexural (aka inverse or intertriginous), erythrodermic, pustular, guttate, nail, and psoriatic arthritis (PsA). Eighty to ninety percent of patients diagnosed with psoriasis present with plaque psoriasis. Plaque psoriasis presents with red-pink lesions of varying sizes covered with silvery-white scales (Figure 64–1).2 Up to 42% of patients with psoriasis have co-occurring PsA.1,4 PsA is limited to joints, ligaments, and tendons, and clinical presentation includes pain, stiffness, swelling, and/or tenderness in the affected area. PsA progresses from mild symptoms to the destruction of joints, negatively impacting quality of life for patients.