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Psoriasis
is an immune-mediated skin disease. In some
people it also affects the joints. The prevalence
of psoriasis in Western populations is estimated
to be around 2-3%. It affects both sexes equally
and occurs at all ages. |
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Psoriasis
can be physically and psychosocially limiting.
Depending on the severity and location of psoriasis
outbreaks, individuals may also experience
physical discomfort and disability. Itching
and pain can interfere with self-care, walking,
and sleep. |
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Psoriasis skin variants
include plaque, pustular, guttate, erythrodermic
and flexural psoriasis. Psoriasis can also
involve or be limited to the scalp or nails.
Plaques on the hands and feet can limit daily
activities. Erythrodermic psoriasis may be
associated with swelling of the legs, fatigue
and even heart failure in severe cases. |
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Psoriatic arthritis
is most common in the joints of the fingers
and toes but may also affect the hips, knees
and spine (spondylitis). About 10-20% of
people who have skin psoriasis also have
psoriatic arthritis. |
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Topical therapies for
psoriasis include moisturizers, corticosteroid
creams and ointments, zinc shampoo, salicylic
acid lotions and shampoos, coal tar lotions
and shampoos, anthralin, a vitamin D analog
called calcipotriol and tazarotene cream,
a topical retinoid. |
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Ultraviolet
light therapy (UVB and UVA phototherapy)
requires 2 to 3 sessions per week for a
few months, followed by maintenance sessions
2 to 4 times per month to maintain clearance.
Phototherapy can be combined with topical
products (coal tar, calcipotriol, topical
corticosteroids or topical retinoids) or
systemic retinoids (acitretin) for faster
results. |
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Oral therapies for
psoriasis include methotrexate (taken weekly),
acitretin (taken daily), cyclosporine (taken
daily and used mainly as a “bridge
drug” to long-term therapies) and hydroxyurea
(used when other standard oral therapies
are not working or not tolerated). |
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Injectable
agents for psoriasis, also called
biologic therapies, include Enbrel (etanercept),
Raptiva (efalizumab) and Humira (adalimumab)
which are given by subcutaneous injection,
Remicade (infliximab, an intravenous infusion)
and Amevive (alefacept, an intramuscular
injection). The frequency of injection
or infusion depends on the drug and the
severity of the psoriasis. |
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With all systemic psoriasis
drugs (whether oral or injectable) tuberculosis
testing (PPD and chest X-ray) must be negative
before beginning therapy. Some therapies
also require other blood work and monitoring
prior to and during therapy. |
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