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Therapeutic management of psoriasis

By Samuel Bundu-Kamara

Psoriasis is a psychologically and physically disabling, chronic, relapsing and inflammatory skin disease that affects 1–3 per cent of the world population.1

The disease manifests itself as areas of thickened, scaly, silvery-white and reddened skin due to the distinct pathological changes that generally characterise this disorder. These are inflammation, hyperproliferation of the epidermis, altered maturation of the epidermis and vascular alterations which add to the redness.2 Recent research has shown that these processes are mainly driven by activated T cells or antigen-presenting cells. These cells release various chemokines and cytokines to induce keratinocyte hyperproliferation, leading to abnormal differentiation.3

There are several different clinical subtypes of psoriasis: psoriasis vulgaris (chronic plaque), as well as the guttate, erythrodermic, pustular and palmoplantar forms of psoriasis. Patients may progress from one clinical subtype to another during the course of their lifetime.2

At present, psoriasis has no cure, but patients will experience periods of exacerbation and remission.

Management options

Some patients with mild disease do not require any pharmacological intervention. Interventions with antipsoriatic treatments are normally started if the patient has problematic local symptoms such as itching, severe skin involvement or psychological problems. The goal of treatment is to control the extent and severity of the disease so that it has minimal impact on the patient’s quality of life.

In selecting a suitable agent, consideration should be given to the extent of the disease and the body areas involved. For chronic plaque psoriasis with involvement of less than 20 per cent of the body surface area, initial therapy is topical.

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Citation: Hospital Pharmacist URI: 10976354

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