Psoriasis Prevalence Characteristics and Therapeutic Options

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Psoriasis is one of the most common dermatological diseases. Although there is a great variation in the prevalence of psoriasis in different countries due to environmental and genetic factors, it can be said that it affects roughly 2 - 3 % of the world's Caucasian population. About 20-25% of these people suffer from moderate-to-severe forms of the disease.

The majority of patients with plaque psoriasis (75 %) show first signs of disease manifestation before the age of 40 years, with a peak in the second decade of life. These patients usually have a family history of psoriasis, their disease is more severe, and it is characterized by frequent relapses. The most common form of psoriasis, with a prevalence of about 70 %, is plaque psoriasis or "psoriasis vulgaris". Plaque psoriasis is characterized by hyperkeratosis, parakeratosis and the presence of inflammatory lesions in the skin. There is a predilection for symmetrical involvement of the scalp, elbows, knees and lower back. It can occur, however, anywhere on the body. Other, less frequent, morphologies of psoriasis include guttate, inverse, pustular, and erythrodermic forms. They may occur individually, concomitantly or sequentially.

There is agreement today that immunological mechanisms play an important role in the pathogenesis of many chronic relapsing inflammatory skin diseases, such as psoriasis (Krueger 2002; Schoen and Boehncke 2005). Evidence of the pivotal role played by T cells in the pathology of psoriasis is accumulating.

• Activated T cells are found in psoriatic lesions.

• T cells have the ability to induce the altered kerati-nocyte growth and differentiation pattern typical of psoriasis. This has been demonstrated in a SCID mouse model by injecting autologous immunocy-tes into the dermis of mice that have received grafts of human skin. Plaques typical of those seen in psoriasis are observed when immunocytes from a patient with psoriasis are injected into a mouse possessing a graft of symptom-free skin from the same patient.

T-cell-targeted immune suppressive drugs, such as cyclosporine, and antibodies against the CD25 receptor and CD4, have been shown to improve psoriasis.

• In bone marrow transplantation, psoriasis can be transferred from a donor suffering from the disease to a healthy recipient. Also, psoriasis can be "cured" when bone marrow is transplanted from a healthy donor to a person with psoriasis.

• When symptomless skin from psoriasis patients was engrafted onto AGR129 mice, deficient in type I and type II interferon receptors and for the recombination activating gene 2, resident human T cells in the skin grafts underwent local proliferation, demonstrating the importance of resident immune cells in the development of psoriasis.

There is a whole battery of treatment options available today. The mild forms of psoriasis are usually treated with topical preparations, including vitamin D3 analogues, corticosteroids and retinoids. When the disease becomes severe, phototherapeutic regimens are applied. Finally, there is the option to use an oral immune suppressive drug, such as methotrexate, cyclo-sporin, oral retinoids, or fumaric acid esters, as mono-therapy or in combination. As the majority of patients develop their disease before the age of 40 years, many of those with moderate-to-severe psoriasis will require

5.3 Efalizumab: From Mode of Action to the Treatment of Psoriasis

5.3 Efalizumab: From Mode of Action to the Treatment of Psoriasis

Psoriatic Arthritis Pathogenesis
Fig. 5.3. Scheme of the immune pathogenesis of psoriasis and the proposed mechanisms of LFA-1 blockade by the CD11a antibody efalizumab. Points of action for efalizumab are indicated

decades of continuous systemic or phototherapy. Unfortunately, none of the available therapies can be used chronically, because of long-term safety and toxic-ity problems.

Recent advances in the understanding of T-cell interactions in the pathogenesis of psoriasis have led to the development of several biological substances, such as the targeted T-cell modulator efalizumab, for continuous immune therapy of this disease, without the safety problems of the traditional systemic preparations (Fig. 5.3).

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Natural Treatments For Psoriasis

Natural Treatments For Psoriasis

Do You Suffer From the Itching and Scaling of Psoriasis? Or the Chronic Agony of Psoriatic Arthritis? If so you are not ALONE! A whopping three percent of the world’s populations suffer from either condition! An incredible 56 million working hours are lost every year by psoriasis sufferers according to the National Psoriasis Foundation.

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