Farid Menaa1,2*
1-Department of Internal Medicine and Nanomedicine, California Innovation Corporation, San Diego, CA, USA
2-Departments of Dermatology, Oncology, Venereology and Allergo-Immunology, School of Medicine, Wuerzburg, Germany
*Corresponding Author: Farid Menaa, Departments of Dermatology, Oncology, Venereology and Allergo-Immunology, School of Medicine, Wuerzburg, Germany; Email: [email protected]
Published Date: 25-05-2020
Copyright© 2020 by Menaa F. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Editorial
Psoriasis is a common chronic inflammatory skin disorder characterized by red, flaky, crusty, scaly, itchy, thickened plaques (Fig. 1), which affects approximately 2% of the population worldwide [1-2]. Increasing evidences supports the recognition of psoriasis as a multisystem chronic inflammatory disorder with multiple associated comorbidities, including myocardial infarction, metabolic syndrome, diabetes (Type 2 diabetes) and/or Crohn’s disease [3-6].
Figure 1: Clinical cases of psoriasis. (A= Skin psoriasis, B= Nail psoriasis).
Sudden sensorineural hearing loss, known as a systemic vascular involvement in autoimmune disease, has also been reported associated with psoriasis [7-8]. Eventually, prevalence of migraine with aura in the psoriatic population was found significant, which may also represent a possible new comorbidity of the psoriatic disease [9]. Then, severe psoriasis must be considered as a life-threatening disorder since it significantly impacts patients’ health and life quality [2].
Treatment options mainly include topical administration/application of corticosteroids (e.g. prednisone, dexamethasone), retinoid (e.g. acitretin), anthralin (aka dithranol), calcineurin inhibitors (e.g. tacrolimus or pimecromilus ointments), Goeckerman therapy (e.g. ultraviolet B + crude coal tar), Psoralen Plus Ultraviolet A (PUVA), excimer laser (e.g. exciplex laser), vitamin D3 analogues (e.g. calcipotriene), salicylic acid, moisturizers [2]. Interestingly, recent studies using immunobiologics (e.g. ustekinumab, tofacitinib) have reported effectiveness [10-11]. Besides, dietary supplementation (e.g. fish oils, honey mixture with beeswax and olive oil) and phytotherapeutics (e.g. Aloe Vera gel, Calendula officinalis cream) could be effective adjuvant treatments [2].
Research Pearls on Psoriasis
- MicroRNA-mRNA network analysis and Gene Ontology (GO) annotation analysis, coupled with experimental data of clinical samples, shall permit to investigate the relationship between psoriasis and a subsequent comorbidity (e.g. T2D, hearing loss). In other words, a reliable network-based bioinformatics approach to identify microRNA target genes involved in both psoriasis and a given comorbidity shall enlighten future studies on the molecular pathogenesis of psoriasis.
- Phytotherapy combined to immunotherapies as pathogenic probes of T1-mediated immune disorders, may be relevant to manage at least certain forms of psoriasis. Nevertheless, because immunotherapy drugs are relatively new, the full range of their side effects remains to be elucidated and their use limited to moderate to severe cases.
Clinical Pearls on Psoriasis
- Psoriasis Area and Severity Index (PASI) is the most widely used tool for the measurement of severity of psoriasis. PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease). The PASI calculator can be found using: http://pasi.corti.li/
- Approximately 62.5% of patients with psoriasis who experience migraines experience migraine with aura, but further studies are needed to assess their interplay in developing cardiovascular diseases [9].
- Ustekinumab is more effective than adalimumab and etanercept for the treatment of psoriasis over 5 years [10-11].
- Unique sera proteomic signatures may distinguish between inflammatory skin diseases (e.g. atopic dermatitis, contact dermatitis, and psoriasis) despite similar epidermal barrier disruption and epithelial inflammation [12].
- Tofacitinib treatment improves nail psoriasis in patients with plaque psoriasis up to 52 weeks [13].
- The Toronto Psoriatic Arthritis Screen II is a specific screening tool for diagnosing psoriatic arthritis [14].
Reference
- Nestle FO, Kaplan DH, Barker J. Mechanisms of Disease: Psoriasis. New Eng J Med. 2009;3615:496-509.
- Khan BA, Menaa F, Reich A, Caldeira E, Bakhsh S. Potential phytotherapy of atopic dermatitis, acne, psoriasis, vitiligo. Ind J Trad Know. 2016;15:531-37.
- Shahwanv KT, Kimball AB. Psoriasis and cardiovascular disease. Med Clin North America. 2015;996:1227-42.
- Owczarczyk-Saczonek AB, Nowicki RJ. Prevalence of cardiovascular disease risk factors, and metabolic syndrome and its components in patients with psoriasis aged 30 to 49 years. Postȩpy Dermatologii I Alergologii. 2015;324:290-5.
- Boehncke S, Thaci D, Beschmann H, Ludwig RJ, Ackermann H, Badenhoop K, et al. Psoriasis patients show signs of insulin resistance. Bri J Dermatol. 2007;1576:1249-51.
- Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren WMM, et al. (2012) The fifth joint task force of the european society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts); Developed with the special contribution of the european association for cardiovascular prevention & rehabilitation (EACPR). Euro Heart J. 2012; 33(17):2126-35.
- Yen YC, Lin YS, Weng SF, Lai FJ. Risk of sudden sensorineural hearing loss in patients with psoriasis: a retrospective cohort study. American J Clin Dermatol. 2015;163:213-20.
- Amor-Dorado JC, Barreira-Fernandez MP, Pina T, Vazquez-Rodriguez TR, Llorca J, Gonzalez-Gay MA (2014). Investigations into audiovestibular manifestations in patients with psoriatic arthritis. J Rheumatol. 2014;41(10):2018-26.
- Capo A, Affaitati G, Giamberardino MA, Amerio P (2018). Psoriasis and migraine. J Euro Aca Dermatol. 2018;32:57‐61.
- Zweegers J, Groenewoud JMM, van den Reek JMPA. Comparison of the 1-year and 5-year effectiveness of adalimumab, etanercept and ustekinumab in patients with psoriasis in daily clinical practice: results from the prospective BioCAPTURE registry. Bri J Dermatol. 2017;176:1001‐9.
- Richter L, Vujic I, Sesti A, Monshi B, Sanlorenzo M, Posch C, et al. Etanercept, adalimumab, and ustekinumab in psoriasis: analysis of 209 treatment series in Austria. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2017;15(3):309-17.
- Merola JF, Elewski B, Tatulych S, Lan S, Tallman A, Kaur M. Efficacy of tofacitinib for the treatment of nail psoriasis: two 52-week, randomized, controlled phase 3 studies in patients with moderate-to-severe plaque psoriasis. J American Aca Dermatol. 2017;77(1):79-87.
- Wang J, Suárez‐Fariñas M, Estrada Y, Parker ML, Greenlees L, Stephens G, et al. Identification of unique proteomic signatures in allergic and non‐allergic skin disease. Clin & Experiment Allergy. 2017;47(11):1456-67.
- Duruöz MT, Toprak CŞ, Ulutatar F. Validation of the Toronto Psoriatic Arthritis Screen II (TOPAS II) questionnaire in a Turkish population. Rheumatol Int. 2018;38(2):255-9.
Article Type
Editorial
Publication History
Received Date: 14-05-2020
Accepted Date: 18-05-2020
Published Date: 25-05-2020
Copyright© 2020 by Menna F. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation: Menaa F. Recent Highlights and Expert Opinion on Psoriasis Management. J Dermatol Res. 2020;1(1):1-4.
Figure 1: Clinical cases of psoriasis. (A= Skin psoriasis, B= Nail psoriasis).
