Psoriasis history

Studies conducted in twins show a threefold increased risk of psoriasis in monozygotic twins versus fraternal twins.7 In addition, based on a study in 3,095 families with psoriasis, the calculated lifetime risk of developing psoriasis if no parent, one parent, or both parents have psoriasis was found to be 0.04, 0.28, and 0.65, respectively. If there was already one affected child in the family, the risks were increased to 0.24, 0.51, and 0.83, respectively.7,9 As many as 71% of patients with psoriasis during childhood have some positive family history.1 Similarly, psoriatic arthritis is heritable, with a prevalence 19 times higher in first-degree relatives of patients with psoriatic arthritis than in the general population.7... 

The medical history of a patient with psoriasis should include information about the onset and duration of lesions, family history of psoriasis, presence of exacerbating factors, previous history of antipsoriatic treatment (if any) along with efficacy and adverse effect data, exposure to chemicals and toxins, and allergies (food, drugs, and environmental). 

In vitro antiinflammatory effects have been documented, and the herb has a long history of being used externally for wound healing, psoriasis, and the reduction of skin irritation. Although there are a few small positive studies, the available evidence is not yet conclusive in regard to clinical use. 

A 22-year-old woman presents with a complaint of worsening psoriasis. She has a strong family history of the disease and has had lesions on her scalp and elbows for several years. She recently noted new lesions developing on her knees and the soles of her feet. She has been using topical over-the-counter hydrocortisone cream but admits that this treatment does not seem to help. What therapeutic options are available for the treatment of this chronic disease What risks are involved ... 

A thorough history for burning, stinging, and itching identifies sensory irritation and possible CUS. The history should include careful questioning of all topical products applied, as well as the time of onset in relation to exposure. Personal and family history of atopy should be actively sought, as should other skin conditions such as psoriasis and rosacea. A meticulous physical examination may identify other stigmata of atopic dermatitis, psoriasis, or other skin disease. 

Psoriasis is thought to be more likely if there is a history of it in a patient s family. However, there are also a range of other triggers implicated in the development of psoriasis. It is commonly associated with emotional stresses in a patient s life, and often associated with deficiencies in the immune system. Plaque psoriasis has also been associated with injury to the skin, including sunburn (although moderate exposure to the sun has been shown to be beneficial... 

Pustular drug eruptions due to penicillin (195), amoxicillin (196), ampicillin (197), bacampicillin (198), cefazo-hn (199,200), cefradine (201), cefalexin (202), cefaclor (203), or imipenem -I- cilastin (204) seem to form a distinct chnical entity that has to be differentiated from pustular psoriasis, which can be drug-induced as well (204). A history of drug exposure, rapid disappearance of the eruption after the drug is stopped, and eosinophils in the inflammatory infiltrate argue in favor of pustular drug eruptions. 

The first reports of psoriasis in cancer patients treated with high-dose interferon alfa were followed by a controversial debate (295,296). However, numerous cases have confirmed that interferon alfa can either induce typical psoriasis or worsen pre-existing psoriasis (SED-13,1095) (297), an observation that is compatible with interferon aHa-induced imbalance toward an increased Thl response. This was particularly exemplified by the reversibility of the lesions after withdrawal of treatment and the prompt recurrence of symptoms after interferon aha readministration. Exacerbation of psoriasis usuaUy occurred within the first month, whereas a minimum of 2-3 months of treatment was required in patients without a past history of psoriasis (297). Psoriatic lesions at the sites of injection were suggested to be potential indicators for further generalization of psoriasis. In more severe cases, there was concomitant development of monoarticular or polyarticular joint symptoms (SED-13, 1095) (SEDA-21, 372). Pustular psoriasis with balanitis and erosive monoarthritis, suggesting incomplete Reiter s sjmdrome, was also reported in one patient with HLA-B27 (298). 

Skin tolerability in patients with a history of eczema, psoriasis, or other skin disorders has been studied in 1481 participants (33). The adverse effects reported were erythema, rash, pruritus, irritation, edema at the site of application, musculoskeletal pain related to the application site, dreaming, and other sleep disturbances. 

Systemic PUVA is approved for the treatment of psoriasis. It consists of oral ingestion of a potent photosensitizer such as methoxsalen (8-methoxypsoralen) at aconstant dose (0.6 to 0.8 mg/kg) and variable doses of UVA, depending on patient skin type and history of previous response to ultraviolet radiation (see Table 96-6 for skin type classifications ). Approximately 2 hours after ingesting psoralen, the patient is exposed to UVA light. Photochemotherapy is performed two or three times a week. In most patients, control and partial clearing occurs by the twenty-fifth treatment. 

In addition, 5-FU and methotrexate are used to treat certain forms of breast cancer, and methotrexate is the drug of choice for the treatment of choriocarcinoma in women. It is also effective in the treatment of psoriasis, a disease in which there is an over-proliferation of epidermal cells in the skin. Finally, it is worth recalling that azidothymidine (AZT) was first synthesised in 1964 as a potential anti-metabolite for cancer chemotherapy, but proved to be ineffective in this role. Its subsequent efficacy as an inhibitor of viral reverse transcriptase in the treatment of HIV infections has assured its place in the history of the 20th century. 

Mrs Shabnam is a 32-year-old patient who you are seeing for treatment following an injury. You take a medical history and note that she is taking an antianxiety dmg, diazepam. Mrs Shabnam has quite severe and extensive psoriasis. She tells you that the psoriasis causes her a lot of anxiety and that this is the reason why the doctor has put her on diazepam. She is waiting for an... 

Either history or evidence of eczema. Other exfoliative or extensive skin lesions (eg, atopic dermatitis, psoriasis, burns) may also place a person at increased risk for vaccination. 

A 63-year-old man with a history of psoriasis had a severe phototoxic reaction within 30 minutes of UVB phototherapy. The man had been taking six capsules of St. John s wort daily for an unspecified amount of time (Lane-Brown 2000). 

Rule out nail involvement produced by dermatoses, such as psoriasis, atopic dermatitis, onychomycosis and lichen planus, which may present with an isolated symptom and lead to a false-positive diagnosis (Bennet 1975) in the absence of a thorough history and laboratory tests. 

In an epidemiological study of 1253 psoriatic patients, Melski et al. (1983) found that one-third of the study population had a history of Koebner response at sites of physical trauma. These patients were also found to be associated with earlier onset of psoriasis in life and a tendency to flare despite various treatment options. Apart from the limitations of this study, the authors believed that there is indeed a subset of psoriatic patients, in which Koebner phenomenon may be an important marker. Thus, it is important to identify psoriatic patients and discourage them from engaging in jobs in which they will be subject to excessive trauma. 

Those with increased susceptibility or predisposition, i.e. atopies Patients with a history of contact dermatitis Patients with a history of other types of eczema, psoriasis, acne and others... 

Patients with a History of Other Types of Eczema, Psoriasis, Acne and Others... 

Gamier et al. [90] reported two cases of paraquat poisoning resulted from skin absorption. One patient died from respiratory failure 26 days after applying paraquat onto his whole body as a treatment for scabies. The other with a previous history of psoriasis developed extensive generalized pustular erythroderma and a moderate, transitory renal and respiratory impairment 13 days after exposure. 

Cutaneous reactions may also be provoked by infliximab. Three patients with rheumatoid arthritis, none of whom had a personal or family history of psoriasis, developed what was described as psoriasiform skin lesions 6-9 months after the initiation of infliximab therapy. Two of the... 

Active infections or open wonnds Active retinoid dermatitis Cardiac disease Continned UV light exposure Fitzpatrick skin types IV to VI Hepatic disease Herpes simplex infection History of certain skin diseases (i.e., rosacea, seborrheic dermatitis, atopic dermatitis, psoriasis, vitiligo)... 

Skin Eczema-like eruptions In a prospective cohort study in 92 patients treated with infliximab for a variety of disorders, with the exception of cutaneous psoriasis, 15 developed eczema [121 ]. In univariate analyses, a personal history of atopic symptoms was the only predictive factor (OR = 3.6) sex, age, principal diagnosis, dose and duration of infliximab, and concomitant use of other immunosuppressant had no effect. 

A 29-year-old woman with a history of cutaneous psoriasis and a malignant glioneuronal tumour and treated with bevacizumab for 2.5 years developed oral mucositis wifhin 36h of each infusion. Oral mucositis has not previously been reported with bevacizumab but it is suggested that the mAb can potentially exacerbate psoriatic disease [113 ]. 

Psoriasiform erythroderma Rare Family history of psoriasis At or near birth lifelong Generalized erythema, scaling Possible ectropion Histology and epidermal kinetics are like psoriasis... 

This is a disorder in which exfoliative erythroderma is present at birth or occurs during early childhood, and continues into adulthood. Gross and histologic features most closely resemble psoriasis (Figure 13.8). A family history of psoriasis may be present. 

There are five reported cases of infants who have multiple defects " Unilateral ectromelia, and central nervous system anomalies and a skin disorder similar to that described above in patients with generalized skin involvement, limited to one side of the body. There is also a family history of psoriasis. The unique feature in these cases is that all abnormalities are unilateral (Figure 13.9). The kinetics of epidermal cell proliferation in the psoriasis-like skin are similar to... 

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