Understanding the Plaque Psoriasis
Plaque psoriasis is a type of psoriasis that occurs when the skin becomes covered in small, white, bumpy plaques. Plaque psoriasis can be difficult to treat, but there are treatments available. Keep reading to learn more about plaque psoriasis and how you can get treatment.
Plaque psoriasis also called psoriasis vulgaris is the most common manifestation of psoriasis in approximately 90% of psoriasis patients. This is a chronic and relapsing disorder.
Prevalence is higher among first and second-degree cousins and in twins.
The skin shows pink to deep red patches, and round plaques with silvery scales.
Where plaque psoriasis occurs?
Areas of involvement are eyebrows, scalp, knees, umbilicus, genitalia, and gluteal cleft. Also, plaque psoriasis is associated with the koebner phenomenon. When the induction of plaque psoriasis happens in the areas of existing injury or trauma such as scratches, insect bites, and scars it is called koebner’s phenomenon. This usually happens within 7 to 14 days after injury.
Nail findings are the crucial features of plaque psoriasis, which includes discolorations of the nails, nail dystrophy, hyperkeratosis, and onycholysis.
Lesions of plaque psoriasis start with red patches and tiny papules that eventually coalesce as scales and bigger papules. The lesion size in plaque psoriasis is larger than that of guttate psoriasis.
The pathological changes that happen in the skin are strong. The lesions, when assessed deeply, show acanthosis. That is the thickening of the epidermis. The capillaries get dilated in the dermis. Dermis also shows perivascular lymphocytes. Supra papillary plate becomes thin. An excessive keratosis and an increase in the number of neutrophils in the stratum corneum of the skin are visible. This leads to the formation of microabscesses and pustules.
The pathogenesis of psoriasis is vaguely understood which is why there hasn’t been a complete cure.
But, the role of T lymphocytes, dendritic cells, cytokines, and genetic analysis and their interactions most likely plays a role in the pathogenesis.
T-cells which are crucial factors in the immune system, produce cytokines, B-cell stimulation, and host defense. In the case of autoimmune disorders, the T cells become aberrant. There will be an unwanted activation of these dendritic cells, response of interleukins, the proliferation of T cells, etc., causing potential inflammatory effects.
The induction of gene factors ends up in the vasodilation and chemotaxis of neutrophils.
Excessive keratinocyte growth causes the skin cells to rapidly increase.
Types of Plaque Psoriasis
Plaque psoriasis is further subclassified into various forms based on the shape and scale of the plaques. Psoriasis geographical, Psoriasis gyrata, Rupoid lesions, Ostraceous plaques, Elephantine psoriasis, and Annular lesions.
Prolonged usage of nonsteroidal anti-inflammatory drugs, anti-malaria, oral contraceptive pills, and systemic corticosteroids is a trigger to this disease.
Research has shown higher risks of plaque psoriasis in persons with existing streptococcal infections.
Plaque Psoriasis Treatment
The treatment approach for plaque psoriasis is a stepwise paradigm. The steps are progressive. They start with a topical agent for mild conditions of the disease. A classic systemic medication or phototherapy utilizing PUVA comes necessary as the disease becomes intense to treat.
The introduction of these targeted biologic therapies such as inhibitors of IL-17A, IL-23, and the IL-17 receptors, or the additional targeted biologic therapies such as IL-20, IL-22, GM-CSF, topical or oral small molecules like protein kinase inhibitors, Toll-like receptors 7,8, and 9 or function as a STAT3 decoy.
Eventually, the future development of biomarkers that can predict the result of the therapies is anticipated for more effective results in the treatment of the disease.
Overall, understanding the causes of plaque psoriasis can be a complicated process. It could be the result of a combination of factors such as chronic inflammation, genetic predisposition, environmental triggers, or an abnormal immune response. Nonetheless, by familiarizing yourself with some of the suspected causes mentioned in this article, particularly how these causes may interact, you can equip yourself to better manage your condition and find relief from its associated symptoms.
Reference:
- Michael Kelly-Sell MD, Johann E. Gudjonsson MD, PhD, in Therapy for Severe Psoriasis, 2016
- https://www.sciencedirect.com/science/article/pii/B9780123864567035073
- https://www.sciencedirect.com/science/article/pii/B9780323447973000013
- https://www.sciencedirect.com/science/article/pii/B9780323035064102688