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Consider obtaining the following baseline laboratory studies in patients being initiated on systemic therapies (eg, immunologic inhibitors):

Medications used in the management of psoriasis include the following:

The American Academy of Dermatology (AAD) guidelines recommend treatment with methotrexate, cyclosporine, and acitretin, with consideration of contraindications and drug interactions. [5]

A 2013 international consensus report on treatment optimization and transitioning for moderate-to-severe plaque psoriasis include the following recommendations [6]:

Management of psoriasis may also involve the following nondrug therapies:

Ocular manifestations such as trichiasis and cicatricial ectropion usually require surgical treatment. Progression of corneal melting, inflammation, and vascularization may require lamellar or penetrating keratoplasty.

See Treatment and Medication for more detail.

Psoriasis is a chronic, noncontagious, multisystem, inflammatory disorder. Patients with psoriasis have a genetic predisposition for the illness, which most commonly manifests itself on the skin of the elbows, knees, scalp, lumbosacral areas, intergluteal clefts, and glans penis. The joints are also affected by psoriasis in up to 30% of patients with the disease. (See Pathophysiology and Etiology.)

Psoriasis has a tendency to wax and wane with flares related to systemic or environmental factors, including life stress events and infection. It impacts quality of life and potentially long-term survival. There should be a higher clinical suspicion for depression in the patient with psoriasis. (See Prognosis.)

Multiple types of psoriasis are identified, with plaque-type psoriasis, also known as discoid psoriasis, being the most common type. Plaque psoriasis usually presents with plaques on the scalp, trunk, and limbs (see the image below). These plaques appear as focal, raised, inflamed, edematous lesions covered with silvery-white “micaceous” scales. (See Clinical Presentation.)

Ocular signs occur in approximately 10% of psoriasis patients, and they are more common in men than in women. Patients with ocular findings almost always have psoriatic skin disease; however, it is rare for the eye to become involved before the skin. [7]

The diagnosis of psoriasis is clinical. (See Workup.) Management of psoriasis may involve topical or systemic medications, light therapy, stress reduction, climatotherapy, and various adjuncts such as sunshine, moisturizers, and salicylic acid. (See Treatment and Management.)

For more information, see the following:

Psoriasis is a complex, multifactorial disease that appears to be influenced by genetic and immune-mediated components. This is supported by the successful treatment of psoriasis with immune-mediating, biologic medications.

The pathogenesis of this disease is not completely understood. Multiple theories exist regarding triggers of the disease process including an infectious episode, traumatic insult, and stressful life event. In many patients, no obvious trigger exists at all. However, once triggered, there appears to be substantial leukocyte recruitment to the dermis and epidermis resulting in the characteristic psoriatic plaques.

Specifically, the epidermis is infiltrated by a large number of activated T cells, which appear to be capable of inducing keratinocyte proliferation. This is supported by histologic examination and immunohistochemical staining of psoriatic plaques revealing large populations of T cells within the psoriasis lesions. One report calculated that a patient with 20% body surface area affected with psoriasis lesions has around 8 billion blood circulating T cells compared with approximately 20 billion T cells located in the dermis and epidermis of psoriasis plaques. [8]

Ultimately, a ramped-up, deregulated inflammatory process ensues with a large production of various cytokines (eg, tumor necrosis factor-α [TNF-α], interferon-gamma, interleukin-12). Many of the clinical features of psoriasis are explained by the large production of such mediators. Interestingly, elevated levels of TNF-α specifically are found to correlate with flares of psoriasis.

One study adds further support that T-cell hyperactivity and the resulting proinflammatory mediators (in this case IL-17/23) play a major role in the pathogenesis of psoriasis. [9]

Key findings in the affected skin of patients with psoriasis include vascular engorgement due to superficial blood vessel dilation and altered epidermal cell cycle. Epidermal hyperplasia leads to an accelerated cell turnover rate (from 23 d to 3-5 d), leading to improper cell maturation.

Cells that normally lose their nuclei in the stratum granulosum retain their nuclei, a condition known as parakeratosis. In addition to parakeratosis, affected epidermal cells fail to release adequate levels of lipids, which normally cement adhesions of corneocytes. Subsequently, poorly adherent stratum corneum is formed leading to the flaking, scaly presentation of psoriasis lesions, the surface of which often resembles silver scales.

Conjunctival impression cytology demonstrated a higher incidence of squamous metaplasia, neutrophil clumping, and nuclear chromatin changes in patients with psoriasis. [10]

Psoriasis involves hyperproliferation of the keratinocytes in the epidermis, with an increase in the epidermal cell turnover rate. (See Pathophysiology.) The cause of the loss of control of keratinocyte turnover is unknown. However, environmental, genetic, and immunologic factors appear to play a role.

Many factors besides stress have also been observed to trigger exacerbations, including cold, trauma, infections (eg, streptococcal, staphylococcal, human immunodeficiency virus), alcohol, and drugs (eg, iodides, steroid withdrawal, aspirin, lithium, beta-blockers, botulinum A, antimalarials). One study showed an increased incidence of psoriasis in patients with chronic gingivitis. Satisfactory treatment of the gingivitis led to improved control of the psoriasis but did not influence longterm incidence, highlighting the multifactorial and genetic influences of this disease. [11]

Hot weather, sunlight, and pregnancy may be beneficial, although the latter is not universal. Perceived stress can exacerbate psoriasis. Some authors suggest that psoriasis is a stress-related disease and offer findings of increased concentrations of neurotransmitters in psoriatic plaques.

Patients with psoriasis have a genetic predisposition for the disease. The gene locus is determined. The triggering event may be unknown in most cases, but it is likely immunologic. The first lesion commonly appears after an upper respiratory tract infection.

Psoriasis is associated with certain human leukocyte antigen (HLA) alleles, the strongest being human leukocyte antigen Cw6 (HLA-Cw6). In some families, psoriasis is an autosomal dominant trait. Additional HLA antigens that have shown associations with psoriasis and psoriatic subtypes include HLA-B27, HLA-B13, HLA-B17, and HLA-DR7. [12]

A multicenter meta-analysis confirmed that deletion of 2 late cornified envelope (LCE) genes, LCE3C and LCE3B, is a common genetic factor for susceptibility to psoriasis in different populations. [13]

Obesity is another factor associated with psoriasis. Whether it is related to weight alone, genetic predisposition to obesity, or a combination of the 2 is not certain. Onset or worsening of psoriasis with weight gain and/or improvement with weight loss is observed.

Evidence suggests that psoriasis is an autoimmune disease. Studies show high levels of dermal and circulating TNF-α. Treatment with TNF-α inhibitors is often successful. Psoriatic lesions are associated with increased activity of T cells in the underlying skin.

Psoriasis is related to excess T-cell activity. Experimental models can be induced by stimulation with streptococcal superantigen, which cross-reacts with dermal collagen. This small peptide has been shown to cause increased activity among T cells in patients with psoriasis but not in control groups. Some of the newer drugs used to treat severe psoriasis directly modify the function of lymphocytes.

Also of significance is that 2.5% of those with HIV develop worsening psoriasis with decreasing CD4 counts. This is paradoxical, in that the leading hypothesis on the pathogenesis of psoriasis supports T-cell hyperactivity and treatments geared to reduce T-cell counts help reduce psoriasis severity. This finding is possibly explained by a decrease in CD4 T cells, which leads to overactivity of CD8 T cells, which drives the worsening psoriasis. The HIV genome may drive keratinocyte proliferation directly.

HIV associated with opportunistic infections may see increased frequency of superantigen exposure leading to similar cascades as above mentioned.

Guttate psoriasis often appears following certain immunologically active events, such as streptococcal pharyngitis, cessation of steroid therapy, and use of antimalarial drugs.

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»Med øget forskning og dermed bedre sygdomsforståelse, håber vi i fremtiden at kunne udvikle nye lægemidler, som inde i cellerne rammer bestemte kommunikationsveje af betydning for udviklingen af psoriasis,« siger Lars Iversen.

»Ved at udvikle lægemidler, som virker meget målrettet på præcis de mekanismer, som har betydning for sygdommen, håber vi at kunne undgå en række bivirkninger,« siger Lars Iversen.

Et andet projekt, som Lars Iversen arbejder med, er at afklare virkningsmekanismen af Fumaderm, som er et meget benyttet middel mod psoriasis i Tyskland. Fumaderm anvendes i dag udelukkende i Tyskland. Lægemidlet er ikke registreret i den øvrige del af verden, bl.a. fordi man ikke kender virkningsmekanismerne.

»Når vi finder ud af, hvordan Fumaderm virker, vil det utvivlsomt fremme godkendelsen i bl.a. Danmark. I Tyskland har de 20 års erfaring med Fumaderm, og der har hverken vist sig øget risiko for kræft og/eller øget risiko for infektioner, siger Lars Iversen.

Fremtiden byder altså på flere muligheder i forhold til behandling af psoriasispatienter.

A principal source of advice, support and information on psoriasis and psoriatic arthritis

A registered charity no: 1118192

As the term suggests, genital psoriasis is psoriasis in the genital area. Sometimes this can be the only area affected. The presentation will vary according to the site involved and may range from plaques on the external genitalia to fissures in between the buttocks. Usually, genital psoriasis does not resemble the thick, red, scaly plaques seen in other areas. It appears as bright red, shiny patches of skin, often with no scale on top. The reason for this is that the affected sites are usually covered, which helps the lesions to retain moisture and therefore appear redder and less scaly.

All age groups may be affected by genital psoriasis, including babies. Involvement of the genital area in this age group is often described as nappy psoriasis, which may appear very red and can be alarming to parents, who need reassuring that this is usually not a painful condition.

Affected sites

  • The pubic region - a common site of genital psoriasis, which can be treated in the same way as scalp psoriasis, but be aware that the skin in this area is likely to be more sensitive than on the scalp.
  • Upper thighs - psoriasis on the upper thighs is likely to appear as small round patches, which are red and scaly. Any psoriasis between the thighs can become more easily irritated by the friction caused by thighs rubbing together when you’re moving. Reducing the friction between your legs will relieve sweatiness and irritation. Liberal use of emollients will help with this particular problem.
  • Skin folds between thigh and groin - psoriasis in this area will normally appear nonscaly and reddish white in the creases between the thigh and groin, and may become sore with cracks forming. Overweight or sporting people may be susceptible to thrush in the skin folds, which can be mistaken for psoriasis. Like genital psoriasis, it can cause the same irritation from friction of the skin, so a correct diagnosis is essential for proper treatment.
  • Psoriasis of the vulva - commonly appears to be smooth, non-scaly and red. The liberal use of emollients will help reduce any irritation in this area, which would otherwise increase the risk of secondary bacterial or fungal infection. The typical sites of involvement are the creases at the top of the legs and the hair-bearing pubic region. The mucosal membranes at the entrance to the vagina are not involved.
  • In men - the appearance of psoriasis may consist of small red patches on the glans (tip of the penis) or shaft, and the affected skin may appear to be shiny. Scale is not usually present. Circumcised and uncircumcised penises can be affected.
  • The anus – psoriasis on the anus and surrounding areas will normally appear to be red, non-scaly and can become itchy, weepy and sore. Secondary infections, both bacterial and fungal, may occur due to skin splitting and can be uncomfortable or painful.
  • Buttocks – psoriasis in the buttock folds may appear as red and non-scaly or red with very heavy scaling. The skin in this area is not as fragile as that of the groin.

Psoriasis is an inflammatory condition that affects the genital region. There is no identifiable cause for the condition in this area and it is important to stress that it cannot be transmitted through sexual contact. There is no correlation with pregnancy or the menopause.

The fact that skin in the genital region tends to be covered up (sometimes referred to as occluded skin) means that any treatment is more easily and thoroughly absorbed, which makes it more effective. This more powerful effect means that potent topical steroids must be used under strict medical direction to avoid skin thinning and stretch mark formation. Perfumed products should also be avoided to reduce the risk of both irritant and allergic contact dermatitis, either of which will make the psoriasis even harder to treat.

Psoriasis in the genital region is very difficult to control. While it is easy to relieve the symptoms of itch and discomfort, treating the lesions effectively is more challenging. When treating genital psoriasis it is important to keep the affected areas moisturised. When using moisturisers, any irritation that occurs may be due to your sensitivity to some of the ingredients.

Below is a summary of topical treatments, some of which may be recommended for your particular

circumstances. Others are unsuitable for use in the genital area. If you develop genital psoriasis, you should discuss it with your doctor, who will be able to advise you on suitable treatments.

Emollients - are an important par t of the daily care of psoriasis on all parts of the body, including the genitalia. They help to make the skin more comfortable. There is also a range of topical treatments available - creams and ointments - that your doctor can prescribe.See our Emollients and Psoriasis leaflet.

Topical vitamin D creams and ointments – are effective in treating psoriasis and the newer types are less likely to cause irritation. However, some do have the potential to irritate sensitive areas such as the genitalia. Some doctors recommend cautious use of vitamin D analogue creams and ointments on genital skin.

Topical steroid creams - may be recommended for sensitive areas. However, care should be taken with their use as the potential for increased absorption may lead to side effects such as skin thinning. For this reason, low strength topical steroids are favoured for use in the genital area. It is also important that topical steroids are not used for long periods of time or without close supervision from your doctor. Prolonged use of high-potency steroids can also cause stretch marks and you may become resistant to these medications, making them less effective in the long term.

Treatment should never be stopped abruptly as this may trigger a rebound flare of your psoriasis.

Topical steroids may also be combined with antifungal and antibacterial agents because infections with yeasts and bacteria in warm, moist skin creases such as the groin are more common.

Dithranol and vitamin A - derivatives (retinoids) are not usually recommended for use in skin flexures because of their tendency to cause irritation.

Coal tar preparations - are not usually recommended in genital areas because they can cause irritation, especially to areas such as the penis, the scrotum, the vulva or cracked skin.

Calcineurin inhibitors - (tacrolimus and pimecrolimus) are effective in treating genital psoriasis and do not have the side effect of thinning the skin that limits the use of topical steroids. They do, however, often cause an uncomfortable burning sensation when applied and can reactivate sexual transmitted infections such as herpes and viral warts.

UV light treatment - is not usually recommended for genital psoriasis due to an increased risk of skin cancer in this area. Men with psoriasis undergoing UV light treatment are specifically advised to cover the genital area during treatment to reduce the risk of cancer. See our Psoriasis and phototherapy leaflet and Treatments for Psoriasis: An overview leaflets for more details.

Remember: it is also advisable to get any rash that appears on the genitals checked, as there are other conditions that can affect these areas. Never assume that because you have psoriasis all rashes that appear will be due to psoriasis.

If your partner is worried, you can show him or her leaflets on psoriasis, ask your doctor to explain the problem, or even attend a genitourinary clinic together for a joint check-up. Treatment at genitourinary medicine (GUM) clinics is free and confidential; you can also make an appointment yourself without a referral. At certain times, some clinics also operate as drop-in centres, where you can turn up without needing to make an appointment. You can find location, telephone number and clinic times by phoning your local hospital.

Skin diseases can be difficult to cope with and a skin disease that affects the genitals can be doubly so. You may find it embarrassing and stressful to discuss genital psoriasis with a doctor or nurse.

Try to remember there is nothing to be embarrassed about. Overcoming your natural reluctance to discuss these matters, and learning how to be up-front with your doctor and loved ones, can make coping with psoriasis much easier.

Honesty and openness are key factors in coming to terms with your situation. If your partner knows how genital psoriasis is affecting you, he or she will be better able to support you emotionally and physically. Equally, your doctor will be in a better position to help you. See Psychological aspects of psoriasis.

Remember, your healthcare professional wants to help you, so let them know how you are feeling, and don’t forget that professionals are used to seeing and dealing with such sensitive areas and issues as part of their daily work. They have seen it all before!

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Sykdommen kan også utarte seg i form av langsgående eller tverrgående striper på neglene, eller som gule flekker eller en lagdeling. Enkelte personer kan også oppleve at huden under neglene løsner. Ved denne typen psoriasis er det ikke uvanlig at man kan få skader på både tå- og fingerneglene, og det er meget viktig at man avstår fra å fjerne eller plukke på neglebåndene ettersom dette kan trigge tilstanden.

Tilstanden forårsaker blemmer med puss eller væske som etter hvert får en brunlig farge før de tørker ut. Blemmene oppstår normalt på hendene og føttene, og kommer som oftest i forbindelse med graviditet, sykdom eller bruk av enkelte medikamenter. Sykdommen refereres gjerne til som pustulosis palmo-plantaris i de tilfellene den forekommer i håndflatene eller på fotsålene.

Denne undergruppen representerer den alvorligste formen for sykdommen, og forekommer bare i noen meget sjeldne tilfeller. Tilstanden gjør at huden på store deler av kroppen blir rød, betent og flassende, og medfører ofte at rammede personer må legges inn på sykehuset for spesialbehandling.

Bruk av enkelte medisiner ser ut til å være den vanligste årsaken til at denne formen for psoriasis oppstår, og det er spesielt malariamedisiner med klorokin eller klorokinfosfat, eller kortikosteroid tabletter som har en utløsende effekt.

Dette er en psoriasis type som skiller seg fra de andre ved at den angriper leddene i kroppen og ikke huden. Tilstanden kategoriseres derfor som en revmatisk sykdom som gjør at leddene hovner opp og blir stive, betente og smertefulle.

Psoriasisartritt kan ofte sette seg i fingre, tær og ryggrad, men forekommer også i hofter, knær og albuer. Tilstanden oppstår gjerne hos personer som allerede er kraftig rammet av psoriasis utslett og neglepsoriasis.

For å forstå hvordan psoriasis oppstår, må man først vite hvordan huden er bygget opp. Man deler gjerne huden inn i tre lag, der det øverste laget kalles overhuden (epidermis), det mellomste laget kalles lørhuden (dermis) og det ytterste laget kalles underhuden (subcutis).

Samspillet mellom de forskjellige hudlagene er tett, selv om hvert lag også har sin egen unike funksjon. Det er imidlertid bare overhuden og lærhuden som blir påvirket når man har psoriasis. Underhuden, som kun består av fett og bindevev, har derimot ingen spesiell funksjon i forbindelse med tilstanden.

Overhuden utgjør ca. 10% av hudens totale tykkelse, og består av flere lag med plateepitel, der cellene ligger tett i tett. Cellene fornyer seg til stadighet ved at de underste cellene deler seg og skyver de øverste cellene oppover. Samtidig som dette skjer, vil de øverste cellene gjennomgå en modningsprosess der de produserer og fylles med keratin. Etter modningen vil cellene dø og omdannes til mangekantede flak som etter hvert slites av fra hudoverflaten slik at nye friske celler kan slippe til. Denne prosessen, som kalles forhorningsprosessen, tar 3-4 uker og sikrer at hudoverflaten alltid er ny og slitesterk.

Hos personer med psoriasis løper imidlertid forhorningsprosessen løpsk, slik at hudcellene fornyes på bare 3-4 dager, i motsetning til de 28 dagene som er normalt. Dette fører til at huden blir rød og fortykket, gjerne med hvite påleiringer, ettersom hudlagene produseres raskere enn hva huden er i stand til å bryte ned. Huden vil i den forbindelse ofte sprekke opp og avgi væske, bli sår og irritert og kan i tillegg flasse mye. I enkelte tilfeller kan også neglene sprekke, spesielt på føttene.

Lærhuden, som gir huden sin elastisitet og smidighet, består av mye bindevev, blodkar og nerver. Også denne delen av huden blir påvirket når man har psoriasis. De små blodkarene blir i den forbindelse utvidet som følge av økt blodgjennomstrømning, noe som fører til at hudoverflaten blir rød.

Psoriasis blir i økende grad omtalt som en "autoimmun" sykdom der kroppen reagerer mot seg selv. Dette innebærer at immunforsvaret feilaktig angriper og ødelegger friske celler og vev, noe som setter i gang en sykdomsprosess i kroppen.

Det første utbruddet oppstår gjerne i 15-30 årsalderen, og det er i den forbindelse vanlig at utbruddet starter med en halsinfeksjon. Etter noen dager etterfølges infeksjonen ofte av mindre og røde dråpeformede knuter i huden som tidligere nevnt kalles guttat psoriasis.

Utslettet som oppstår ved et førstegangsutbrudd er som oftest meget typisk, og en erfaren lege vil derfor være i stand til å diagnostisere tilstanden ved første blikk. I de tilfellene der det er vanskeligere å stille en visuell diagnose, kan legen også ta en vevsprøve for å være helt sikker.

Det finnes flere ting som kan påvirke utbrudd av psoriasis. Klima er for eksempel en faktor som både kan lindre og utløse tilstanden,der kaldt og tørt vær ofte vil forverre sykdommen, mens varme, sollys og fuktighet derimot kan lindre og redusere plagene.

En annen utløsende faktor er hudskader. Alle skader på huden eller neglene, slik som for eksempel sår- eller slagskader, kan nemlig gjøre at det danner seg psoriasis rundt det skadede området. Utslettet oppstår normalt i det skaden begynner å gro, noe som gjerne refereres til som Koebners fenomen.

Alkohol, stress og psykiske påkjenninger er andre faktorer som kan utløse et utbrudd, og som derfor bør unngås så langt det er mulig. Yoga og meditering er i den forbindelse to verktøy for stressmestring som har vist seg å være effektive for personer med psoriasis.

Enkelte medisiner slik som betablokkere, litium og klorokin kan også fremkalle eller forverre et psoriasis utslett. Det er derfor viktig at man forteller leger og helsepersonell at man har sykdommen før man eventuelt starter på et nytt medikament.

Utbrudd av psoriasis kan lindres ved hjelp av medisiner, lokalbehandlinger, fuktighetskremer og sol og lysbehandlinger. Nedenfor finner du en beskrivelse av disse forskjellige behandlingene:

Sol og saltvann kan ofte hjelpe mot sykdommen, noe som gjør at personer som er sterkt rammet gjerne tilbys såkalte behandlingsreiser. Behandlingsreisene er et alternativ til behandling på et sykehus i Norge, og tilbys stort sett mellom august og mai. Oppholdet innebærer normalt 3 uker i Spania, Tyrkia eller et annet solfylt sted med daglig soling, trening, samtaler og undervisning i hvordan man skal håndtere psoriasis. I løpet av denne tiden vil man også lære ulike stress reduserende teknikker og treningsmetoder.

Det er et krav at man må ha en uttalt form for psoriasis for å være berettiget til en behandlingsreise.

Det antas at ca. 80% av de som har psoriasis har en lett til moderat versjon av tilstanden. For denne gruppen er det normalt nok at man bruker kremer og salver for å holde sykdommen i sjakk. Kremene demper betennelse, rødhet og plager, og inneholder kortikosteroider eller D-vitaminlignende stoffer eller en kombinasjon av disse. Noen av de mest brukte preparatene i den forbindelse er:

Betnovate: Kommer i form av både salve og krem, og inneholder chinoform med betametasonvalerat. Den faller innenfor gruppen sterke kortikosteroider, og demper hudreaksjoner samtidig som den er effektiv mot psoriasis kløe. Medisinen inneholder også det antimikrobiele legemiddelet kliokinol, som hindrer at det setter seg sopp og bakterielle infeksjoner i utslettet.

Protopic: En salve som egentlig behandler eksem, men som også har vist seg å være meget effektiv mot psoriasis negler. Den gir normalt mindre bivirkninger enn kortisonkremer og salver med D-vitamin, og kan derfor med fordel prøves dersom man ikke har oppnådd resultater med slike preparater.

Daivobet salve: Tilgjengelig også som krem, og inneholder en kombinasjon av D-vitaminstoffet kalcipotriol og kortikosteroidet betametason. Den virker raskt mot kløe og betennelser, og brukes ofte i behandlingen av stabil psoriasis. Medisinen kan brukes både på kroppen og i hodebunnen.

En viktig del av behandlingen for personer med mye eksem eller psoriasis innebærer spesialbygde solarier som avgir UVB-lys. Disse solariene er forskjellige fra vanlige UVA-solarier ved at de kun avgir kortbølget ultrafiolett lys, noe som har en meget gunstig effekt på utslett. UVA-solarier derimot, avgir stort langbølget ultrafiolett lys, som har liten virkning på psoriasis og utslett.

For de personene som er sterkt rammet av sykdommen og som ikke har hatt noen nytte av lokalbehandlende salver og kremer, kan man forsøke medikamenter eller cellegift som har en immundempende funksjon. Velkjente legemidler i den forbindelse er Neotigason, Sandimmun og Methotrexat.

Immundempende behandlinger har gjerne en meget effektiv virkning mot psoriasis, men de er også kjent for å fremkalle en rekke bivirkninger.

Världshälsoorganisationen WHO har nyligen uppgraderat psoriasis till en allvarlig, kronisk sjukdom. Detta innebär ett helt nytt sätt att se på sjukdomen.

Psoriasis är inte längre enbart en kosmetiskt störande hudsjukdom utan en sjukdom med potentiellt allvarliga konsekvenser i form av systemisk samsjuklighet. Studier visar att psoriasissjuka löper ökad risk för att drabbas av metabola komplikationer i form av övervikt, högt blodtryck, hjärt- och kärlkomplikationer och diabetes. Detta gäller framför allt vid svår psoraisis och betyder att dessa patienter behöver behandla inte bara huden men hela kroppen och få hjälp med att förändra sin livsstil. Psoriasispatienter bör uppmuntras till att motionera, gå ner i vikt och sluta röka.

Psoriasis är en immunmedierad, inflammatorisk ärftlig sjukdom. Orsaken till psoriasis är inte känd men den aktuella hypotesen är att det är en obalans i samspelet mellan immunsystemet som initierar och driver inflammation i huden och påverkar själva hudcellerna.

Redan i Gamla Testamentet finns beskrivningar av symtom och hudutslag som kan ha varit psoriasis. Sjukdomen klassificerades under många århundraden tillsammans med spetälska. Först i mitten på 1800-talet beskrevs psoriasis som en egen sjukdom i alla dess former.

Psoriasis förekommer över hela världen, men är ovanlig hos vissa ursprungsbefolkningar (indianer, inuiter och aboriginer). Hos den vita befolkningen är prevalensen upp till tre procent. I Afrika finns en väst-östlig gradient med ökad förkomst i, Östafrika. I Västafrika och Asien är prevalensen lägre, mellan en halv till en procent.

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