Psoriasis E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 494

Veröffentlichungsjahr: 2014

Beschreibung

Practical and user-friendly, this is the ideal guide to the diagnosis and treatment of psoriasis, helping you navigate a logical management pathway through a complex maze of possibilities.

Psoriasis is a cruel disease that can seriously affect the sufferer’s quality and length of life. It is also highly idiosyncratic, with features that vary greatly from patient to patient; this being mirrored in the highly variable response to treatment. It is increasingly recognized that psoriasis is not a discrete disease and that many patients suffer two or three comorbid conditions that can complicate the efforts of doctors treating patients.

Psoriasis: Diagnosis and Management will provide dermatologists of all levels with a practical, well-illustrated approach to fully understanding the disease, including clear, clinical guidance to enable best-practice and effective management of patients.

In full color throughout and excellently illustrated, key highlights include:

• easily understandable description of the psoriasis pathogenesis;
• a strong emphasis on the clinical features of psoriasis;
• careful consideration of comorbid conditions as part of the psoriatic spectrum to be managed;
• coverage of both traditional and contemporary management approaches;
• plenty of diagnostic algorithms and management protocols to aid the daily practical care of patients.

Brought to you by several of the world’s leading authorities on the subject, Psoriasis: Diagnosis and Management is an essential purchase for the dermatologist.

Leseprobe

CONTENTS

Cover

Title page

Copyright page

List of contributors

Preface

Part I: Epidemiology and economic aspects

Chapter 1: Epidemiology and economic aspects

Epidemiology

Social and economic impact

Further reading

Chapter 2: Cost-effective psoriasis management

Health economics in a nutshell

Cost-effectiveness and cost–utility analyses in psoriasis

Further reading

Part II: Etiology and pathogenesis

Chapter 3: Microscopic skin alterations

The human skin: a multilayered, dynamic barrier to the environment

The psoriatic skin: inflammation with epidermal and vascular remodeling

Further reading

Chapter 4: Pathogenesis of psoriasis

Sensitization phase: antigen processing and presentation

Sensitization phase: generation of effector and memory T-cells

Effector phase: infiltration of immune cells into the skin

Effector phase: immune cell activation in the skin

Effector phase: tissue-cell response

Further reading

Chapter 5: Genetics of psoriasis

Further reading

Part III: Clinical features/diagnostic procedure

Chapter 6: Plaque psoriasis

Plaque psoriasis

Plaque psoriasis in special localizations

Chapter 7: Gutatte psoriasis

Further reading

Chapter 8: Erythrodermic psoriasis

Further reading

Chapter 9: Pustular psoriasis

Generalized pustular psoriasis (GPP)

Generalized pustular psoriasis of pregnancy (GPPP)/Impetigo herpetiformis (IH)

Annular psoriasis [erythema annulare centrifugum-type (EACP)]

Psoriasis vulgaris with pustulation

Palmoplantar pustular psoriasis (PPP)

Acrodermatitis continua suppurativa (Hallopeau)

Further reading

Chapter 10: Nail psoriasis

Clinical picture and pathophysiology

Diagnostic procedure

Burden of disease

Further reading

Chapter 11: Psoriatic arthritis

Epidemiology

Clinical picture

Clinical classification of PsA

Diagnostic procedures

Laboratory findings

Imaging

Prognosis

Further reading

Chapter 12: Mucosal presentation of psoriasis

Further reading

Chapter 13: Psoriasis in different life situations

Psoriasis in children

Psoriasis in pregnancy

Psoriasis in the elderly

Further reading

Part IV: Evaluation of disease severity

Chapter 14: Evaluation of disease severity—clinical scores and questionnaires

Assessment of skin involvement

Assessment of nail psoriasis

Assessment of psoriasis arthritis (PsA)

Spine assessment

Assessment of enthesitis

Assessment of dactylitis

Imaging techniques

Visual analog scale (VAS)

Quality-of-Life (QOL) Questionnaires

Further reading

Appendix

Part V: Psoriasis and associated diseases

Chapter 15: Psoriasis and associated diseases

Cardiovascular disease and metabolic syndrome

Obesity

Atherogenic dyslipidemia

Hypertension

Inflammatory bowel disease

Other inflammatory diseases

Psychosocial aspects

Depression

Nicotine use

Alcohol

Conclusion

Further reading

Part VI: Therapeutic management

Chapter 16: Therapeutic aim of psoriasis therapy

Further reading

Chapter 17: Treatment of plaque psoriasis

Topical therapy of psoriasis

Phototherapy and photochemotherapy

Classical systemic treatments

Biologics

Chapter 18: Special therapeutic aspects

Psoriasis capitis

Intertriginous psoriasis

Guttate psoriasis

Erythrodermic psoriasis

Pustular psoriasis

Nail psoriasis

Further reading

Chapter 19: Combination treatments

Why combination treatment of psoriasis?

Beneficial combinations

Contraindicated combinations and combinations for restrictive use

How to use combination treatment in practice

Further reading

Chapter 20: Optimizing adherence to treatment

Further reading

Chapter 21: Psoriasis therapy in children

Topical treatment

UV-light-therapy and systemic treatment

Further reading

Chapter 22: Therapy of psoriasis during pregnancy

Management of psoriasis in pregnancy

Treatment options during pregnancy

Management of psoriasis postpartum/breastfeeding

Further reading

Chapter 23: Recent and future developments in targeted therapy

Current and emerging biologic therapies

Oral systemic treatments in development

Future topical therapies

Personalized medicine

Conclusion

Further reading

Index

End User License Agreement

List of Tables

Chapter 01

Table 1.1 Selected estimates of the prevalence of psoriasis.

Table 1.2 Summary of main recent epidemiologic studies on risk factors for incident psoriasis.

Chapter 02

Table 2.1 Main methods of analysis in health economics.

Table 2.2 Summary aspects of recent studies on cost-effectiveness in psoriasis.

Chapter 07

Table 7.1 Drugs with known activity to induce psoriasiform skin lesions or to provoke psoriasis.

Chapter 11

Table 11.1 Classification of psoriatic arthritis.

Table 11.2 Clinical characteristics of psoriatic arthritis and rheumatoid arthritis.

Table 11.3 Laboratory and X-ray of psoriatic arthritis and rheumatoid arthritis.

Chapter 13

Table 13.1 Selected interactions of traditional systemic therapies with a focus on the elderly.

Chapter 14

Table 14.A.1 Psoriasis Area and Severity Index.

Table 14.A.2 Scores for the signs of psoriasis.

Table 14.A.3 Area score based on body surface area.

Table 14.A.4 Dermatology Life Quality Index. Each question is scored on a 4-point Likert scale: Not at all/Not relevant = 0, A little = 1, A lot = 2 and Very much = 3. Scores of individual items (0–3) are added to yield a total score (0–30); higher scores mean greater impairment of patient's QoL.

Chapter 15

Table 15.1 ATP III Criteria for metabolic syndrome.

Table 15.2 JNC 7 classifications of blood pressure (BP).

Chapter 17

Table 17.1 Comparison of corticosteroid potency classifications in the US, UK, and Germany/Nordic countries.

Table 17.2 Starting doses for UVB phototherapy.

Table 17.3 Routine therapy plan for UVB phototherapy (broad spectrum and 311 nm).

Table 17.4 Starting dosages for photochemotherapy.

Table 17.5 Routine approach to photochemotherapy.

Table 17.6 Overview of important side effects of MTX.

Table 17.7 Important contraindications/restrictions on use of MTX.

Table 17.8 Lab controls during treatment with MTX.

Table 17.9 Overview of important side effects of cyclosporine.

Table 17.10 Important contraindications/restrictions on the use of cyclosporine.

Table 17.11 Lab controls during treatment with cyclosporine.

Table 17.12 Overview of important side effects of retinoids.

Table 17.13 Important contraindications/restrictions on use of retinoids.

Table 17.14 Lab controls during treatment with retinoids.

Table 17.15 Overview of important side effects of fumaric acid esters.

Table 17.16 Lab controls during treatment with fumaric acid esters.

Table 17.17 Preferential use of classical systemic therapies.

Table 17.18 Biologics.

Table 17.19 Recommendations for monitoring patients in case of therapy with biologics, modified after the German S3 guidelines for therapy of psoriasis vulgaris and the European S3 guidelines on the systemic treatment of psoriasis vulgaris.

Chapter 19

Table 19.1 Combination of treatments in psoriasis.

Chapter 21

Table 21.1 Selected topical treatments for pediatric psoriasis.

Chapter 22

Table 22.1 Examples of mild to very potent topical corticosteroids (adapted from Chi

et al.

2011).

Chapter 23

Table 23.1 Drugs currently in development for the treatment of psoriasis.

List of Illustrations

Chapter 03

Figure 3.1 Schematic depiction of normal skin structure.

Figure 3.2 Histological pictures with nuclear staining (fluorescent dye DAPI) of (left) non-lesional and (right) lesional skin of a psoriasis patient.

Figure 3.3 Immunohistochemical CD3+ T-cell staining of (left) non-lesional and (right) lesional skin of a psoriasis patient.

Chapter 04

Figure 4.1 Phases of the psoriasis pathogenesis. The pathogenesis of psoriasis proceeds in the context of the underlying genetic predisposition and life-style-related factors. Resembling an adaptive immune reaction, the pathogenesis can be subdivided into the sensitization and the effector phase. During the sensitization phase that is triggered by primary exogenous factors, antigen-presenting cells guide the generation of specific effector and memory Th17-, Th22-, and Th1-cells in secondary lymphatic organs. The effector phase is triggered by secondary exogenous triggers, which activate skin-resident immune cells. Their release of inflammatory proteins leads to the infiltration of generated T- and other immune cells into the skin where they activate each other and tissue cells. The continuous presence of inflammatory mediators induces a regeneration-like state of the tissue cells and, eventually, the skin structure alteration characteristic for the psoriatic lesion.

Figure 4.2 Requirements for effector and memory T-cell generation. For the development of effector and memory Th-cell subsets from naïve CD4+ cell precursors, different levels of interaction with the antigen-presenting cells are necessary. Facilitated by nonspecific stabilizing interactions with the APC through adhesion molecules (e.g. ICAM1–LFA-1, LFA-3–CD2), the naïve T-cell needs three APC signals: The specificity of interaction is based on the recognition of the APC's MHC II–Ag peptide by the TCR complex. Costimulatory signals (e.g. from the DC's CD86, CD80, and CD40) ensure full activation and prevent anergy of the T-cell. Specific polarizing cytokines secreted by the APC are essential for the proliferating T-cell to obtain its effector function, that is, to become polarized into a Th1-cell, Th2-cell, Th17-cell, Th22-cell, inducible regulatory T-cell (iTreg), or type 1 regulatory T-cell (Tr1).

Figure 4.3 Leukocyte skin infiltration. The passage of leukocytes from the blood vessels into the tissue occurs in five steps: rolling, triggering, adhesion, diapedesis, and migration. Leukocyte rolling along the blood-vessel wall reduces the flow velocity of the leukocytes and is mediated by the interaction between P- and E-selectin expressed by endothelial cells and selectin ligands such as CLA expressed by leukocytes. Chemokines produced by activated endothelial cells, macrophages, and keratinocytes, and bound to glycosaminoglycans on endothelial cells, activate the immune cells via their specific chemokine receptors and induce an increased affinity of their integrins to the endothelial integrin ligands (triggering). The integrin-dependent interaction with the endothelial cells (e.g. LFA-1–ICAM-1, ICAM-2) causes the tight adhesion to the blood vessel and the rapid arrest of the immune cells in the blood flow. The passage of immune cells through the endothelial wall, called diapedesis, is also dependent on integrins such as VLA-4 and LFA-1.

Figure 4.4 Schematic depiction of the effector phase of the psoriasis pathogenesis.

Chapter 05

Figure 5.1 Genes associated with psoriasis susceptibility and potential role of their products during the psoriasis pathogenesis.

Chapter 06

Figure 6.1 Plaque psoriasis with sharply demarcated borders, covered by silvery scales.

Figure 6.2 Different appearance of psoriatic plaques. (a) Psoriatic plaque with less scaling and light red color, possibly recently triggered. (b) Chronic psoriasis plaque with brownish coloration. (c) Psoriatic plaques in skin type IV: note that inflammatory signs sign as erythema are barely visible. (d) Woronow's ring during treatment, a zone that does not stain with any external color. (e) Large silvery scales, sometimes with black dots (foci of erythrocytes).

Figure 6.3 Characteristics of the psoriatic plaque. (a) Candle-wax phenomenon. After scratching the surface of a psoriatic plaque with a wooden spade, the horny layer loses its transparency. (b) Last cuticle. After removal of the scales, one looks at the stratum spinosum, with a glossy aspect and covered with serum droplets. (c) Auspitz phenomenon. After removal of the last cuticle, the capillary loops of the stratum papillare in the upper dermis start to bleed, causing tiny blood droplets (bloody dew).

Figure 6.4 Tiny early lesions in psoriasis: pinpoint lesions.

Figure 6.5 (a) Geographic psoriasis (Denmark?) created by coalescence of psoriatic plaques. (b) Circinate psoriasis.

Figure 6.6 Rupoid psoriasis with large amount of serum embedded between the corneocytes.

Figure 6.7 Different localization of psoriatic plaques. (a) Retroauricular plaques. (b) Lesions on the extensor sites of the arms. (c) Plaque on the extensor site of the leg. (d) Involvement of the ileosacral area. (e) Periumbilical plaque. (f) Lesion in the rima ani—note the lack of scaling.

Figure 6.8 Histopathology of fully developed psoriasis, featuring hyper- and parakeratosis, acanthosis, papillomatosis, and inflammatory infiltrate.

Figure 6.9 Differential diagnosis of plaque psoriasis. (a) Seborrheic dermatitis with some overlap to psoriasis (so-called seborrhiasis). (b) Yellowish color of seborrheic dermatitis. (c) Tinea corporis resembling annular psoriasis—note the accentuated border. (d) Nummular dermatitis with papulovesicles as primary lesions at the periphery. (e) Discoid lupus erythematodes with lesions in sun-exposed areas that later will show healing with atrophy. (f) Psoriasiform lesion in overlap collagenosis. (g) Mycosis fungoides, histologically and molecular biologically proven. (h) Pityriasis rotunda.

Figure 6.10 (a) Scalp psoriasis transgressing the border between hairy and nonhairy scalp. (b) Extensive scalp involvement. (c) Hair loss in extensive psoriatic scalp involvement. (d) Chronic scalp dermatitis causing tinea amiantacea. (e) Tinea capitis in a wrestler caused by

Trichophyton tonsurans

. (f) Scalp involvement of discoid lupus erythematosus with scarring.

Figure 6.11 (a) Submammary psoriasis. (b) Psoriasis in the genital and inguinal skin as well as the abdominal fold. (c) Axillary involvement. (d) Submammary candida infection with small peripheral satellite lesions, as well as fine scaling borders. (e) Langerhans cell histiocytosis. (f) Hailey–Hailey's disease with erosions, fine fissures, and macerated epidermis.

Figure 6.12 Inverse psoriasis.

Figure 6.13 Palmoplantar psoriasis and its differential diagnosis. (a) Psoriasis of the back of hands and fingers, together with nail psoriasis. (b) Palmar psoriasis extending to the forearm. (c) Small maculopapular psoriatic lesions in the palm. (d) Maculopapular lesions in secondary syphilis. (e) Subacute hand dermatitis with small erosions having evolved from papulovesicles. (f) Tinea manuum due to

Trichophyton rubrum

infection. (g) Palmar keratoderma in pityriasis rubra pilaris with typical salmon color.

Figure 6.14 Köbner phenomenon.

Chapter 07

Figure 7.1 Guttate psoriasis in a boy. Note the pronounced involvement of the face.

Figure 7.2 Guttate psoriasis. There is less scaling here than with plaque psoriasis.

Figure 7.3 Histopathology of guttate psoriasis. All features of psoriasis are expressed but less severe than in psoriasis vulgaris.

Figure 7.4 Pityriasis rosea with typical arrangement of lesions along skin tension lines.

Figure 7.5 Secondary syphilis with maculopapular exanthema.

Chapter 08

Figure 8.1 Erythrodermic psoriasis.

Chapter 09

Figure 9.1 (a) Generalized pustular psoriasis. (b) Generalized pustular psoriasis with erosions after shedding of dried pustules.

Figure 9.2 (a) Annular psoriasis with collarette-like scales. (b) Acrodermatitis continua suppurativa, showing peri- and subungal confluent pustules on erythemateous base and almost complete destruction of the nail plate.

Figure 9.3 Typical clinical pictures of palmoplantar pustular psoriasis.

Figure 9.4 Histological picture of palmoplantar psoriasis with sterile pustules (Kogoj) as well as hyper- and parakeratosis.

Chapter 10

Figure 10.1 Schematic illustration of the different nail parts. (a) Free edge of the nail plate. (b) Hyponychium. (c) Nail plate. (d) Lunula. (e) Proximal nail fold. (f) Dorsal matrix. (g) Intermediate/ventral matrix. (h) Nail bed.

Figure 10.2 Characteristic clinical symptoms of psoriatic nail disease. (a) Pits and onycholysis. (b) Massive pitting with subungual discoloration. (c) Longitudinal ridges, pits and transversal grooves on the middle and ring fingers. (d) Nail-bed discoloration with typical “oil drops” or “salmon patches,” and discrete red spots (increased transparency by thinning of nail plate). Fine splinter hemorrhages can be detected at the free nail edge. (e) Subungual hyperkeratosis with whitish crumbling material underneath the nail plate causing distal onycholysis. (f) Complete onychodystrophy of the nail.

Figure 10.3 Differential diagnoses of psoriatic nail disease. (a) Onychomycosis. (b) Trachyonychia. (c) Lichen ruber.

Figure 10.4 Co-occurrence of psoriatic arthritis (swollen joints), skin lesions, and nail affection.

Chapter 11

Figure 11.1 Joint count: (a) tender joints; (b) swollen joints.

Figure 11.2 Typical radiological findings.

Figure 11.3 Musculoskeletal sonography for arthritis: (a) synovitis; (b) tenosynovitis; (c) erosion.

Figure 11.4 Different FOI signal patterns in psoriasis arthritis. (a) High signal activity along a finger as a sign of synovitis of the second and third finger in PsA. (b) High signal activity in the skin as a sign of plaque psoriasis. (c) High signal activity in the nail/DIP region as a sign of enthesitis.

Chapter 12

Figure 12.1 Geographic tongue.

Figure 12.2 Psoriasis of intertriginous areas and external female genitalia.

Figure 12.3 Uveitis in a psoriatic arthritis patient. Courtesy of Professor Pleyer, Dept. of Opthalmology, Charité University Medicine, Berlin

Chapter 13

Figure 13.1 Disseminated red papules and small flat plaques on the trunk (guttate psoriasis).

Figure 13.2 (a) Characteristic erythemateous psoriasis plaques around the eye. (b) Typical scaly plaques on the forehead.

Figure 13.3 Sharply demarcated red plaques in the anogenital region, typical for inverse psoriasis.

Figure 13.4 Pronounced pitting of all nails.

Chapter 14

Figure 14.A.1 Assessment of BSA and disease characteristics: legs.

Figure 14.A.2 Assessment of BSA and disease characteristics: trunk.

Chapter 19

Figure 19.1 Erythrodermic psoriasis before treatment.

Figure 19.2 Eythrodermic psoriasis after 4 weeks' treatment with cyclosporine (5 mg/kg) and calcipotriol ointment on the right-hand side.

Chapter 22

Figure 22.1 Therapeutic management of psoriasis in pregnancy.

Figure 22.2 Therapeutic options of psoriasis in pregnancy. *Washout-periods: systemic retinoids 2 years; methotrexate 3–5 months, leflunomide either 2 years or washout with colestyramine.

Guide

Cover

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Psoriasis

Diagnosis and Management

EDITED BY

Wolfram Sterry, MD, PhD

Department of Dermatology and Allergy

University Hospital Charité

Berlin, Germany

Robert Sabat, MD, PhD

Head of Psoriasis Research and Treatment Center

Department of Dermatology and Allergy/Institute of Medical Immunology

University Hospital Charité

Berlin, Germany

Sandra Philipp, MD, PhD

Psoriasis Research and Treatment Center

Department of Dermatology and Allergy/Institute of Medical Immunology

University Hospital Charité

Berlin, Germany

This edition first published 2015, © 2015 by John Wiley & Sons, Ltd.

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Library of Congress Cataloging-in-Publication Data

Psoriasis (Sterry) Psoriasis : diagnosis and management / [edited by] Wolfram Sterry, Robert Sabat, Sandra Philipp.  p. ; cm. Includes bibliographical references and index.

 ISBN 978-0-470-65736-2 (cloth)I. Sterry, Wolfram, editor. II. Sabat, Robert, editor. III. Philipp, Sandra, editor. IV. Title. [DNLM: 1. Psoriasis–diagnosis. 2. Psoriasis–therapy. WR 205] RL321 616.5′26–dc23

 2014029373

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: CharitéCover design: meadencreative.com

List of contributors

Frank Bachmann, MD, PhDDepartment of Dermatology and Allergy, University Hospital Charité, Berlin, Germany

Marina Backhaus, MD, PhDDepartment of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany

Simone Cazzaniga, MD, PhDBergamo General Hospital, Bergamo, Italy

Kenneth B. Gordon, MD, PhDProfessor of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA

Erhard Hölzle, MD, PhDDepartment of Dermatology and Allergology, Klinikum Oldenburg, Oldenburg, Germany

Georgios Kokolakis, MD, PhDPsoriasis Research and Treatment Center, Department of Dermatology and Allergy/Institute of Medical Immunology, University Hospital Charité, Berlin, Germany

Knud Kragballe, MD, PhDDepartment of Dermatology, Arhus University Hospital, Arhus, Denmark

Peter C.M. van de Kerkhof, MD, PhDDepartment of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands

Alan Menter, MD, PhDDepartment of Dermatology, Baylor University Medical Center, Dallas, TX, USA

Luigi Naldi, MD, PhDBergamo General Hospital, Bergamo, Italy

Steven M. Nwe, MD, PhDDepartment of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA

Sandra Philipp, MD, PhDPsoriasis Research and Treatment Center, Department of Dermatology and Allergy/Institute of Medical Immunology, University Hospital Charité, Berlin, Germany

Giovanna Rao, MD, PhDBergamo General Hospital, Bergamo, Italy

Caitriona Ryan, MD, PhDDepartment of Dermatology, Baylor University Medical Center, Dallas, TX, USA

Hans-Joachim Röwert-Huber, MD, PhDDepartment of Dermatology and Allergy, University Hospital Charité, Berlin, Germany

Robert Sabat, MD, PhDPsoriasis Research and Treatment Center, Department of Dermatology and Allergy/Institute of Medical Immunology, University Hospital Charité, Berlin, Germany

Wolfram Sterry, MD, PhDProfessor, Department of Dermatology and Allergy, University Hospital Charité, Berlin, Germany

Ellen Witte, PhDPsoriasis Research and Treatment Center, Department of Dermatology and Allergy/Institute of Medical Immunology, University Hospital Charité, Berlin, Germany

Kerstin Wolk, PhDPsoriasis Research and Treatment Center, Department of Dermatology and Allergy/Institute of Medical Immunology, University Hospital Charité, Berlin, Germany