Best Home Remedies to Cure Psoriasis

Psoriasis Revolution

Psoriasis Revolution is a natural program that has been well researched by the experienced medical nutritionist and a psoriasis sufferer Dan Crawford. It is designed to guide users on how they can completely cure psoriasis and eliminate red, silvery scales, patchy itchy skin, haemorrhage and also boost the immune system, essentially a life-time solution. Psoriasis is not only a long-term solution, but also provides instant remedy to psoriasis. For example, the program can lower the burning sensation and itchiness within 24 hours. Although results will vary from one person to another, many users have reported significant results within 1 to 2 months of its use. Dan is a popular medical nutritionists, wellness adviser, research worker and a person who has suffered psoriasis for 27 years. Dan spent more than 12 years, 47,000 hours doing clinical analysis and a lot of money doing trial and error methods to develop a program that can truly cure any type of psoriasis at any level of severity. More here...

Psoriasis Revolution Overview

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Iipsoriasis A Introduction

Psoriasis is a chronic inflammatory skin disease of unknown etiology that affects between 1 and 3 of the population. There is increased proliferation of the epidermis with infiltration of inflammatory cells within the dermis and epidermis, coupled with dilation of the upper dermal capillaries. Psoriasis tends to run in families and may be associated with certain HLA phenotypes individuals with first-degree relatives with psoriasis are more likely to develop the disease themselves. Abnormalities of arachidonic acid metabolism have been demonstrated within psoriatic plaques, and it is possible that arachidonic acid and its metabolites may be intimately involved in the psoriatic process. An increase in the levels of prostaglandins (PGs) may cause vasodilation and erythema, and leukotrienes, such as acid (LT-B4) and acid (12-HETE), as well as interleukin (IL)-8, and the complement product C5a des arg may cause neutrophil accumulation (1-4). Raised levels of calmodulin, a cellular receptor...

Treatment of Scalp Psoriasis

Scalp psoriasis, similar to psoriasis elsewhere, will respond to a similar range of topical therapy although the presence of hair makes treatment more difficult. Application is messy. For thick plaques on the scalp topical therapies include oil of cade, ung. cocois,'' and combinations of coal tar and salicylic acid (such as 6 coal tar and 3 salicylic acid), all of which are effective at removing scale and settling inflammation. These preparations may be applied to the scalp and left on overnight before being washed out in the morning with a tar-based shampoo. Patients should be warned to use old pillowcases or towels, or to wear a showercap to protect bedding. Other more cosmetically acceptable preparations include calcipotriene scalp solution (Dovonex), 0.025 fluocinolone acetonide gel (Synalar gel), and 0.1 betamethasone valerate (Betnovate scalp application). Various tar-based shampoos can be used to reduce mild inflammation and scaling.

Lichen Planus And Psoriasis

Clonal T-cell populations have been found in inflammatory skin diseases such as lichen planus and psoriasis. Preferential usage of V beta 3 and or V beta 13.1 genes by the lesional CD8+ T cells has been found in psoriatic lesions (5). Various clones of T cells have been isolated from mucosal lichen planus (6). Preferential use of V alpha 2 and V beta 3 of TCR was found on lymphocytes in mucosal lichen planus, whereas T-cells in Candida-induced lesions did not show a restricted TCR pattern (7). These data reflect the dominance of certain clones in the infiltrating T cells of lichen planus and psoriasis.

Psoriasis and Lupus Erythematosus

The coincidence of LE and psoriasis seems to be rare. Based on their prevalence in the population, the coexistence of psoriasis with all forms of lupus seems to be less than expected. Dubois (Dubois 1974) reported that 0.6 of 520 patients with systemic LE (SLE) had concurrent psoriasis. Tumarkin et al. (Tumarkin et al. 1971) described 637 patients with discoid LE (DLE), and only 1 had coexistent psoriasis. In 1927, O'Leary (O'Leary 1927) described one of the first cases of coexistent psoriasis and LE. Throughout the years, several explanations concerning this coexistence have been developed. Schaumann (Schaumann 1928) postulated that the combination of LE and psoriasis - disorders with different affinity to the ground on which they appear - must be sought in the etiologic factors determining their pathogenesis. Louste et al. (Louste et al. 1939) focused on the endocrine deficiency. Charpy et al. (Charpy et al. 1952) proposed that both disorders (in combination with arteriitis and...

Conditions That May Simulate Psoriasis Vulgaris

Eruptive PV in its early stages can be indistinguishable from early PR. This diagnosis must always be considered in a patient with a positive family history for PV. In general, PV will progress unless treated, and as the lesions mature they develop the deeper color and loose silvery scale typical of that disease. Eruptive PV should always be considered with fixed PR. Usually PV lacks a herald plaque and the classic Christmas tree pattern. At this stage, the biopsy findings are generally inconclusive. A short period of observation will usually spare the victim the discomfort, scar, and expense of biopsy. As with SD, the presence of nail pitting favors a diagnosis of psoriasis. Discoid and subacute lupus erythematosus (LE) can occasionally resemble PV in onset, distribution, and lesional morphology. Lupus lesions usually have a deeper hue with telangectasias. Scarring, which is absent in psoriasis, tends to occur early in discoid LE. Arthralgias and systemic symptoms may be present,...

Psoriasis

Psoriasis is a persistent skin disorder that produces red, itchy, dry patches of skin with silvery scales. The disorder often begins in childhood and comes and goes throughout a person's life. The areas most commonly affected are the scalp, elbows, arms and legs, knees, groin and genitals, fingernails and toenails, and lower back. There are several different types of psoriasis, distinguished by the shape and pattern of the scales. The most common type begins as small, red patches that grow larger and form scales. The cause of psoriasis is unknown, but it may be linked to an abnormality in the function of white blood cells that somehow triggers inflammation in the skin and causes it to shed too quickly. The condition seems to run in families. Four million to 5 million people in the United States have psoriasis. Factors that can trigger the condition include bacterial or viral infections, certain drugs, dry and cold weather, sunburn, skin injury, drinking alcohol, and stress. Doctors...

Evaluation of Eyelid Lesions

Fluid Filled Cyst Eyelid

Configuration represents the shape of the lesion as it is seen from above. Common types of configurations include nummular (coin sized and shaped), gyrate, annular (ring-like border with some degree of clearing in the center), and linear lesions. Most lesions have a circular configuration. A few lesions are oval, notably those of pityriasis rosea, and many others are irregular in shape. Examples of irregular shapes include gyrate and serpigenous lesions, which generally occur due to the melding of adjacent lesions that are enlarging in a centrifugal manner until they reach the point of confluence. Such lesions are frequently found, for example in psoriasis and urticaria. On the other hand, irregular lesions with angular or linear shapes generally occur as a result of external trauma such as scratching or are due to the direct inoculation of antigen (ocular medications) or virus (linear warts). Linear lesions (the shape, not the arrangement of a group of lesions) are special types that...

Epidermal Repair Mechanisms A The Effects of Hydration

It is well recognized that natural moisturizing factor (NMF) can make up to 10 of the corneocyte dry weight and, as humectants, these materials can sorb water extensively. There appears to be an absence of NMF in severe, dry flaking skin in both psoriasis and ichthyosis vulgaris. Rawlings et al. (88) have pointed out that the amino acids to which filaggrin is proteolyzed are themselves precursors for the natural moisturizing factor. Glutamine is converted to the potent humectant, pyrrolidone carboxylic acid, a major component of NMF, whereas histidine is converted to uro-canic acid. Interestingly, filaggrin is converted to NMF only when the water activity is between 0.70 and 0.95, filaggrin being stable at higher water activities and pro-teolysis being impeded by low water activity. Hence, under occlusive conditions the stratum corneum NMF level decreases to close to zero, and all corneocytes contain filaggrin. The result of this homeostatic mechanism is that the skin has prevented...

Clinical Application Questions

A 32-year-old man comes to your office complaining of a thick crusted flaking scalp dermatitis of 6 weeks' duration. You suspect psoriasis vulgaris. 2. What are the primary lesions of psoriasis vulgaris 3. What are the secondary lesions of psoriasis vulgaris 4. What distribution of lesions on the head would support your suspected diagnosis of psoriasis vulgaris 5. Where else on the patient's body should you look for evidence of psoriasis vulgaris

Calcipotriol [Calcipotriene

Calcipotriol known in the United States as calcipotriene is a vitamin D analogue that has benefit in psoriasis. Vitamin D analogues reverse the increased proliferation and other changes seen in psoriatic skin, and this may be through intracellular vitamin D receptors known to be present in epidermal keratinocytes, Langerhans cells, T lymphocytes, and macrophages (7). Vitamin D analogues may also affect the inflammatory cell infiltrate. Calcipotriene (ointment or cream) has the advantage of being cosmetically more acceptable to patients than tar or anthralin (dithranol) preparations, but may cause irritant dermatitis in some patients. Patients are limited to a maximum of 100 g week because there is a potential risk of hypercalcemia and hypercalciuria.

Conditions That May Simulate Lichen Planus

These have been reported with a large number of medications. Thiazide diuretics, gold, antimalarials, -blocking agents, vitamins, and NSAIDs are among those most commonly cited. This differential must be carefully evaluated in every case of LP. Some reactions are clinically identical to idiopathic LP however, subtle findings on routine biopsy may help to distinguish them. Immunopathology is not helpful. LP-like drug reactions resolve slowly and require a good deal of support and confidence on the part of the treating practitioner. Clinical features that help to distinguish the two include a photodistribution and a psoriasis-like appearance common with the drug-induced form.

Microdistribution None

Scabies must be considered in the differential diagnosis of any generalized pruritic skin disorder especially with a history of nocturnal itching that interrupts sleep. Atopic dermatitis, generalized drug reactions, and widespread impetigo all show common features. A high index of suspicion that leads to a search for primary lesions is important to maintain. Crusted scabies can simulate eczema, psoriasis, or on rare occasions, an ery-throderma.

Fresh Discoid Lupus Erythematosus Lesions

In psoriasis vulgaris, again, individual psoriatic plaques may be similar to DLE, especially fresh lesions and those of the photosensitive type. Psoriatic plaques are round and well demarcated their scales, however, are large, silvery, and easily detachable. They do not lead to hair loss or epidermal atrophy. At the clinical overview, psoriasis differs from DLE by its exanthematic distribution and its totally different predilection sites. Also, psoriatic plaques of the face are rare. As antimalarials can aggravate psoriasis, psoriasis should be ruled out before treatment of DLE is started.

Hypertrophic Discoid Lupus Erythematosus

Hypertrophic DLE usually presents as a solitary, raised, indurated, hyperkeratotic lesion, most often of the face or the extensor surfaces of the extremities. It is not a very characteristic type of lesion, and the diagnosis is often made histologically. Clinical differential diagnoses include hypertrophic lichen planus (usually multiple lesions, location on the extremities, often accompanied by classic lichen planus, extremely itchy), hypertrophic psoriasis (usually exanthematic), nodular prurigo (which is also intensively pruritic), with multiple lesions in a characteristic distribution (trunk and shoulders only those regions are involved that can be reached by the scratching finger). Particularly in elderly people, squamous cell carcinoma and kera-toacanthoma must be considered.

Dermatologic Physical Exam

A loose white scale develops in some cases, and the lesions may simulate a papulosquamous disease. There is no follicular accentuation as in DLE, and the carpet-tack sign is negative. As the lesions evolve, they exhibit telangiectatic vessels and a dusky color not seen with pityriasis rosea or psoriasis. When the lesions regress they may leave mild epidermal atrophy, telangectasia, and hypopigmentation, but they do not scar. Annular lesions usually enlarge peripherally with a border that has erythema and loose white scale. The central areas show gray-white hypopigmentation. These lesions tend to coalesce to form polycyclic and gyrate patterns (see Chapter 2).

Dermal DCs Definition

In 1986, Headington (Headington 1986) described the dermal dendrocyte as DCs of the human dermis. These DDCs appear nowadays as an ill-defined, probably hetero-genous, dendritically shaped cell type within the dermal compartment exhibiting a considerable degree of immunophenotypic and functional heterogeneity. Some aspects of DDCs have been studied, for example, in psoriasis (Nestle et al. 1994), but no general or unifying concept of DDC biology has been established. The role of DDCs in the pathogenesis of inflammatory skin diseases is currently unclear.

Elevated Eosinophil and Basophil Counts

Reactive Bronchial Cells

Bacterial and viral infections are both unlikely ever to lead to eosinophilia except in a few patients with scarlet fever, mononucleosis, or infectious lymphocytosis. The second most common group of causes of eosinophilia are allergic conditions these include asthma, hay fever, and various dermatoses (urticaria, psoriasis). This second group also includes drug-induced hypersensitivity with its almost infinitely multifarious triggers, among which various antibiotics, gold preparations, hydantoin derivatives, phenothiazines, and dextrans appear to be the most prevalent. Eosinophilia is also seen in autoimmune diseases, especially in scleroderma and panarteritis. All neoplasias can lead to paraneoplastic eosinophilia, and in Hodgkin's disease it appears to play a special role in the pathology, although it is nevertheless not always present.

Studies in MS and Other Conditions

Meditation has been investigated in a number of other medical conditions. It may improve psoriasis (a skin condition), reduce blood pressure, and improve heart function in people with heart disease. Meditation also has produced some beneficial results in various forms of addiction.

Macrodistribution

Psoriasis Points

Classic Scalp, pressure points over extensor surface of joints, presacral and upper gluteal clefts, glans penis. Psoriasis may occur on any skin surface (see Fig. 8). Figure 8 Macrodistribution of psoriasis vulgaris. Figure 8 Macrodistribution of psoriasis vulgaris. 2. Inverse Creases and folds. An uncommon intertriginous form is referred to as inverse psoriasis. 3. Skin biopsy As noted above, PV can simulate several other inflammatory der-matitides. Unfortunately, the histology of SD can also show similar changes. For this reason, biopsy of PV is not always a definitive procedure and should not be undertaken routinely. If the disease is atypical, extensive, or refractory to treatment, the patient should be referred to a dermatologist to decide whether this expense is cost-effective. Biopsy readily distinguishes psoriasis from subacute lupus erythematosus. However, distinguishing PV from other diseases, especially cutaneous T-cell lymphoma, is tricky and requires special competence...

Clinical manifestation

Ink spot lentigo reticulated pattern, resembling spot of ink limited to sun-exposed areas single ink-spot lentigo among an extensive number of solar lentigines PUVA lentigo persistent, pale brown macule appearing 6 months or longer after the start of PUVA therapy for psoriasis resembling solar lentigo, but often with more irregular borders which may mimic ephelides occurrence closely associated with greater cumulative doses of PUVA

Differential Diagnosis at Particular Sites Discoid Lupus Erythematosus of the Scalp

Scutula Favus

DLE of the scalp (Fig. 11.2A) typically arises as one or a few roundish erythematous plaques identical to DLE lesions elsewhere on the skin. When atrophy develops, they gradually transform into patches of scarring alopecia that may be surrounded by rims of scaly erythema. In the early phase, it must be distinguished from psoriasis and seborrheic dermatitis (see previously herein). In advanced stages, DLE may

Conditions That May Simulate Tinea

The noninfectious dermatidities seborrhea and psoriasis can both cause inflammation and scaling of the scalp, but do not cause patchy hair shedding. Both are more diffuse than TCa. When any inflammatory scalp condition does not respond promptly to treatment, a KOH exam and fungal culture of epilated hairs are indicated. Patches of nummular eczema, early lesions of psoriasis, patches of impetigo, pityriasis alba in its early inflammatory phase, and the herald patch of pityriasis rosea can all be confused with TC. When other diagnostic features of these conditions are absent, a simple KOH exam should distinguish them. Psoriasis, lichen planus, monilia of the nails, and other nondermatophyte fungal and yeast organisms that invade nail tissue must be distinguished from onychomycosis of the nails. Psoriasis may be clinically very similar. Fine linear pitting of psoriasis is not a feature of TU. Another helpful sign is the oil-spot change on the nail bed seen in psoriasis.

Indications and Dosage

The efficacy of systemic retinoid therapy in a variety of dermatologic diseases, such as acne, psoriasis (pustular and erythrodermic types), and disorders of keratiniza-tion (ichthyoses, symmetric progressive erythrokeratoderma, Darier disease, pityriasis rubra pilaris, and palmoplantar hyperkeratosis), is well known. There are also reports of successful treatment of other dermatologic conditions, including disorders of epidermal differentiation (epidermodysplasia verruciformis, confluent and reticulated papillomatosis, and axillar granular parakeratosis) and inflammatory and immunodermatoses (atrophoderma vermiculatum, lichen planus, sarcoidosis, and granuloma annulare). Various synthetic retinoids have also been tried in the treatment of patients with different forms of cutaneous LE (CLE), and there are numerous reports of good responses to etretinate, acitretin, and isotretinoin (Duna and Cash 1995, Furner 1990b). Etretinate has been shown to be effective in the treatment of DLE,...

Differential diagnosis

Atopic dermatitis dermatitis herpeti-formis pityriasis lichenoides lichen pla-nus insect bite reaction contact dermatitis psoriasis ecthyma impetigo xerotic eczema transient acantholytic dermatosis linear IgA bullous dermatosis seborrheic dermatitis erythroderma from other causes such as Sezary syndrome and pemphigus foliaceus Langerhans cell histiocy-tosis fiberglass dermatitis dyshidrotic eczema pityriasis rosea animal scabies pediculosis delusions of parasitosis metabolic pruritus

In Cutaneous Lupus Erythematosus

Whereas in psoriasis our current rather detailed pathogenetic knowledge has led to novel and targeted therapeutic interventions, the immunologic background of LE seems heterogeneous, especially regarding skin involvement and its precise pathogenetic mechanisms, let alone precipitating factors. Despite the progress in our immunologic knowledge, treatment today is still symptomatic rather than curative.

Squamous Cell Carcinoma

Differential Diagnosis For Lymphocytosis

INTRODUCTION Squamous cell carcinoma is a malignant tumor that most commonly affects elderly, fair-skinned individuals. It arises from keratinocytes of the epidermis. Unlike the more common basal cell carcinoma, squamous cell carcinoma tends to arise in precancerous areas of skin alteration or in areas of skin damaged by chronic sun exposure, ionizing radiation, carcinogens (e.g., arsenic), psoralen plus ultraviolet A (PUVA) therapy for psoriasis, and the human papilloma virus. Intrinsic factors that may contribute to its development include xeroderma pigmentosum, oculocutaneous albinism, and immunodeficiency. Chronic skin dermatoses, inflammation, ulceration, and contracted scars also are associated with the development of this tumor. In fact, scarring of the skin is the most common intrinsic factor leading to this tumor in black patients. Lymphatic spread and perineural invasion are possible.

Infection Of The Skin

Eczema or psoriasis, but is often solitary. Tinea cruris (ringworm affecting the groin) presents as a well-demarcated pruritic erythematous scaling rash affecting the groins. The rash may extend onto the thigh and genitalia. Trichophyton rubrum and Epi-dermophyton floccosum are the most common causative fungi. Tinea pedis (ringworm affecting the feet) may affect the skin of the toe web spaces, sole, or may extend onto the sides and dorsal aspect of the feet. Trichophyton rubrum, T. mentagrophytes and E. floccosum are the most common causative organisms.

Subacute Cutaneos Lupus Erythematosus Differential Diagnosis

Psoriasis Erythematosus

Psoriasis (Fig. 11.3B) is the skin disorder that most closely resembles SCLE. The size, nummular shape, and color of the individual lesions may be quite comparable, but the predilection sites are different (SCLE has no lesions on the knees, elbows, scalp, and sacral areas), as are the types of scaling (psoriasiform vs small and thin lamellar) and the presence of slight (mostly central) atrophy in SCLE. Fig. 11.3. A Annular subacute cutaneous lupus erythematosus lesions. Except for their slight central atrophy, almost indistinguishable from annular psoriasis (B). C Erythema annulare centrifugum no epidermal involvement (scaling and atrophy) Differential diagnosis of neonatal NLE also includes atopic dermatitis, which usually sets in at a later time and presents as a more widespread eruption with predilection of the face, extremities, and intertriginous areas. There is pruritus and skin irritability. Neonatal psoriasis may look similar to neonatal LE, but it lacks annular patterns and...

Structure Based Drug Design for Nuclear Receptors

Structure Based Drug Discovery

Retinoids are used in the treatment of various skin diseases, including psoriasis and acne, and in the treatment or chemoprevention of cancer, such as acute promyelocytic leukemia and skin, cervical, and breast cancer.31 RARb gene is frequently deleted or its expression is epigenetically silenced during cancer progression and RARb re-expression can restore retinoic acid-mediated growth control, suggesting that the anticancer action of retinoids is mediated by RARb. RARb has been viewed as a tumor suppressor.

Historical Perspectives

Brocq (1856-1928) in his article in 1902 reviewed the American, French, and German cases and reported 10 cases of his own (3). He coined the term parapsoriasis because of the similarities of the disease to psoriasis, seborrhoic eczema, and lichen (paralichen). 1. ''Parapsoriasis en gouttes'' (guttate parapsoriasis). Today, this disease usually is referred to as pityriasis lichenoides chronica or as parapsoriasis guttata of Jadassohn and Juliusberg. It resembles papular syphilis or guttate psoriasis. Nosologically, it is completely unrelated to mycosis fungoides even though otherwise stated by some authors (4). Pityriasis lichenoides et varioliformis acuta (Mucha-Habermann's disease) is an acute variant of this form, which has to be differentiated from lymphoma-toid papulosis. These diseases except lymphomatoid papulosis are not related to mycosis fungoides or other CTCLs.

Indications

Glycolic acid has been recognized as an important adjunctive therapy in a variety of conditions including photodamage, acne, rosacea, striae albae pseudofolliculitis barbae, hyper-pigmentation disorders, actinic keratoses, fine wrinkles, lentigines, melasma and seborrheic keratoses 5 . Moreover, it can reduce UV-in-duced skin tumor development and it has been proposed as a therapeutic modality against skin exfoliative conditions such as ichthyosis, xeroderma and psoriasis. In post-menopausal women a cream containing 0.01 estradiol and 15 glycolic acid, applied to one side of the face for 6 months, induces a significant improvement in reversing markers (rete peg pattern, epidermal thickness) of skin aging 6 .

History

Patients with cutaneous T-cell lymphoma (CTCL) will recall a preceding chronic dermatitis for many years that may have been considered as therapeutically resistant chronic contact dermatitis, atopic dermatitis, eczema, or psoriasis. Because of histologic unspecific morphology of the prelymphomatous patch stage and the difficulty in distinguishing those changes from inflammatory skin diseases in early stages, it may take an average of 2-10 years until a definite diagnosis can be established (1,2).

Clinical Patterns

Several clinical patterns in psoriasis are recognized. The most common is chronic plaque psoriasis in which there are erythematous plaques of psoriasis with an overlying silvery scale usually affecting the elbows, knees, and at times, the scalp and lower back (Fig. 1). Guttate psoriasis, which may be precipitated by a streptococcal infection of the throat, is characterized by numerous small, scaling erythematous plaques on the trunk and limbs. Psoriasis may also affect the flexures and may cause a glazed erythematous appearance similar to that seen in seborrheic eczema. Erythrodermic psoriasis is characterized by severe erythema affecting the whole of the patient's skin. This may develop following deterioration of the patient's psoriasis or be precipitated by use of potent topical or systemic steroids. There may be associated systemic symptoms, and the patient is at risk from hypothermia owing to excessive heat loss, dehydration, and cardiac failure. Figure 1 A large plaque of...

Specific History

Peak onset is in the second and third decades however, first activity has been reported at birth and as late as the tenth decade. The most common onset consists of the gradual development of raised scaling papules and plaques over the pressure points of joints and other loci of chronic skin friction or trauma. Common trigger sites include the posterior scalp, the skin of the presacral and upper gluteal cleft regions, and the glans penis. These are typical locations for stable plaque psoriasis. The other common presentation is eruptive exanthematic, or so-called guttate psoriasis. Hundreds of scaling papules arise suddenly on large body areas over a period of weeks. Rare and atypical forms such as pustular, acral, and nail psoriasis will not be discussed here. Untreated, stable plaque psoriasis can remain static for years. Some of these patients may experience acute exacerbations when they encounter exogenous or endogenous provoking factors. With treatment, chronic plaque lesions may...

Emollients

Emollients act by blocking transepidermal water loss and help to soften and soothe the skin. In psoriasis, they help reduce scaling and may make the skin more comfortable. Patients should be encouraged to use an emollient bath oil or shower gel when bathing and to apply emollients when other treatments (see later discussion) have been washed off. There are numerous emollients available, and it is important that the patient tries several until they find one that suits them best. Emollients are particularly beneficial in patients with erythrodermic or pustular psoriasis who are unable to tolerate other more ''active'' forms of topical therapy.

Cold weather

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been variously reported to flare or improve psoriasis. Because of their extensive use, a decision should be made in each case based on history of disease activity relative to the indication for the NSAID. A psoriatic patient starting one of these agents should be warned to report flaring promptly.

Topical Steroids

Topical steroids have anti-inflammatory, immunosuppressive, antimitotic, and vaso-constrictive effects on the skin. Topical steroids are effective in reducing the inflammatory changes seen in psoriasis, but there is a risk of precipitating widespread erythroderma, particularly if potent preparations are used, or if topical steroids are suddenly withdrawn. For these reasons, topical steroids are usually avoided in the general treatment of psoriasis. However, weak topical steroids are useful in treating areas such as the scalp, face, and flexures, where other treatments such as tar, an-thralin, or calcipotriene are likely to cause irritation.

Pruritus Itch

Periungual Pigmentation Nail

Pediculosis capitis (lice), psoriasis, seborrheic dermatitis Contact dermatitis (axillae, waistline), erythrasma (axillae), pediculosis corporis, psoriasis, scabies, seborrheic dermatitis (chest), seborrheic keratoses, urticaria Candidiasis, contact dermatitis, gonorrhea, hemorrhoids, pinworms, psoriasis, tinea cruris Contact dermatitis dermatitis herpetiformis eczema atopic, nummular, bullous pemphigoid, mycosis fungoides, psoriasis, PUPPP, urticaria, xerosis

Atenolol

Ness, drowsiness, fatigue, hallucinations, insomnia, lethargy, mental changes, memory loss, strange dreams. GI Diarrhea, ischemic colitis, nausea, mesenteric arterial thrombosis, vomiting. Hematologic Agranulocytosis, thrombocytopenia. Allergic Fever, sore throat, respiratory distress, rash, pharyngitis, laryngos-pasm, anaphylaxis. Skin Pruritus, rash, increased skin pigmentation, sweating, dry skin, alopecia, skin irritation, psoriasis. Ophthalmic Dry, burning eyes. GU Dysuria, impotence, nocturia. Other Hypoglycemia or hyperglycemia. Respiratory Bronchospasm, dyspnea, wheezing. Drug Interactions See also Drug Interactions for Beta-Adrenergic Blocking Agents and Antihypertensive Agents.

Overview

The retinoids are a diverse class of pharmacological compounds, consisting of vitamin A (retinol) and its naturally occurring and synthetic derivatives, which possess biological vitamin A activity (Tables 1 and 2). Vitamin A generically encompasses retinol (vitamin A alcohol), retinal (vitamin A aldehyde), and retinoic acid (vitamin A acid) (Fig. 1). In clinical use, retinoids have established their effectiveness in treating acneiform eruptions (e.g., isotretinoin), disorders of keratinization, such as psoriasis (e.g., acitretin), as well as some neoplastic processes (e.g., tretinoin for leukemia, isotretinoin for squamous cell carcinomas). Additional retinoids are currently being investigated, as are novel uses of retinoids already established in clinical practice. The main focus of retinoid usage in cosmeceuticals has been its role as the mythical ''fountain of youth'' (i.e., reversal of photoaging) (Table 3). Retinoids, like all drugs, have adverse effects, the most infamous one...

Fogo selvagem

Impetigo lupus erythematosus pemphigus vulgaris seborrheic dermatitis atopic dermatitis subcorneal pustular dermatosis epidermolysis bullosa glucagonoma syndrome erythema multiforme Other causes of erythroderma drug reaction cutaneous T-cell lymphoma psoriasis pityriasis rubra pilaris contact dermatitis

Function

LCs may play a role in the pathogenesis of LE (Bos et al. 1986, Mori et al. 1994, Sontheimer and Bergstresser 1982), atopic dermatitis (Bruynzeel-Koomen et al. 1986), allergic contact eczema (Silberberg et al. 1973), psoriasis vulgaris (Bos et al. 1983), and mycosis fungoides (Pimpinelli et al. 1994) by presentation of (auto)antigens to T cells.

Distribution

Whereas LCs are resident DCs of the epidermis, IDECs are assumed to migrate de novo in the epidermis after chemotactic stimuli (Wollenberg and Bieber 2002). IDECs typically represent 30 -80 of the total epidermal DCs in inflammatory skin diseases such as atopic dermatitis, psoriasis, and contact dermatitis but are almost absent in lesional skin of patients with LE (Wollenberg et al. 1996,2002). The reduced number of LCs and IDECs in LE may result from an attack of cytotoxic T cells, but the exact cause is unknown.

Photocarcinogenesis

There is a strong association between exposure to reactive oxygen species generating sunlight and human nonmelanoma skin cancer. The relation between UV induction and melanoma is less clear and still controversially discussed in the scientific community. However, recent epidemiological studies and results from animal studies30-36 support the concept that recreational UV-exposure and sunburns with subsequent influx of ROS- generating inflammatory cells into the skin may play an important role in the etiology of cutaneous malignant melanoma. In a recent paper, the long-term combined application of the photosensitizing agent 8-methoxypsoralen and UVA irradiation, widely used for the treatment of psoriasis and other dermatological diseases, resulted in an increased incidence in melanoma development.37

Ichthyosis

Epidermolytic Hyperkeratosis

DIFFERENTIAL DIAGNOSIS Few other disorders give the clinical picture of ichthyosis. Most notably the differential includes psoriasis, exfoliative dermatitis, collodion baby syndrome, harlequin fetus, Refsum's disease, Sjogren-Larsson syndrome, Conradi's disease, KID syndrome, and Trichothiodystrophy.

Therapy

Come available in new formulations such as mi-crosponges or propylpolymers in order to minimize irritation. Adapalene is a naphtoic acid derivative with retinoid-like activity.Adapalene has been demonstrated to be equally effective as tretinoin, but better tolerated than the latter (Fig. 11.17a, b). It is available as gel, cream and solution. Isotretinoin is an alternative preparation with similar properties to tretinoin. It is available as cream or gel, either alone or in combination with topical antibiotic (erythrom-ycin, clindamycin). Tazarotene is a synthetic acetylenic retinoid authorized in psoriasis and

Candidiasis

Thrush Fordyce spots hairy leukoplakia lichen planus aphthous stomatitis pemphigus vulgaris herpes simplex virus infection Candida intertrigo tinea cruris contact dermatitis seborrheic dermatitis Inverse psoriasis mucocutaneous variant acrodermatitis enteropathica immunodeficiency diseases such as HIV infection, DiGeorge syndrome, Nezelof syndrome or

Basal Cell Carcinoma

Chalazion Canthus

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes malignant melanoma, sebaceous cell carcinoma, squamous cell carcinoma, actinic keratosis, radiation dermatitis, keratoacanthoma, cutaneous horns, dermoid and sebaceous cysts, eccrine and apocrine cysts, papillomatous lesions, seborrheic kertosis, blepharitis, chalazion, eczema, psoriasis, and seborrheic dermatitis.

Contraindications

In the case of a history of porphyria, seizures (in individual cases, exacerbation of seizures), and severe liver or kidney insufficiency (risk of additional kidney damage and impaired chloroquine excretion), limiting chloroquine use is recommended. This also holds true for psoriasis, although in larger patient series no general deterioration of this skin disease was described (see Ochsendorf and Runne 1991).

Chemistry

Retinoids are naturally occurring compounds and synthetic derivatives of retinol (vitamin-A alcohol) that show vitamin A activity. There are three generations of synthetic retinoids today. Manipulation of the polar group and the polyene side chain of vitamin A forms the first generation of retinoids, which includes tretinoin (all-trans-retinoic acid), isotretinoin (13-cis-retinoic acid), and alitretinoin (9-cis-retinoic acid). The aromatic retinoids, etretinate and acitretin, are produced by replacing the cyclic end group of vitamin A with different substituted and nonsubstituted ring systems and are synthetic retinoids of the second generation. The third-generation retinoids, tazarotene and adapalene, known as polyaromatic compounds, are topical agents for the treatment of psoriasis and acne (Fig. 27.3). Bexarotene is also a third-generation retinoid and is approved for the systemic treatment of cutaneous T-cell lymphoma (Brecher and Orlow 2003, Orfanos et al. 1987).

Methotrexate

Methotrexate was used extensively a couple of decades ago for various inflammatory processes (Jeffes et al. 1995, Cronstein 1996). Within dermatology, the drug has gone out of fashion by the misconception of dose restriction at a cumulative dose of 1.5-2 g because of possible liver damage and fibrosis. It is not clear if rheumatologic patients show different incidences of methotrexate-related liver disease than patients with psoriasis. Blood cell counts, liver enzyme levels, and fibrotic processes (procollagen III peptide at biannual intervals) should be monitored regularly.

Tazarotene

Mild to moderate facial acne vulgaris. Contraindications Pregnancy. Use on eczematous skin. Use of cosmetics or skin medications that have strong drying effect. Special Concerns Use with caution during lactation. Safety and efficacy have not been determined in children less than 12 years of age. Psoriasis may worsen from month 4 to 12 compared with first 3 months of therapy. Use with caution with drugs that cause photosensitivity. Side Effects Dermatologic Pruritus, photosensitivity, burning stinging, erythema, worsening of psoriasis, skin pain, irritation, rash, desquamation, contact dermatitis, skin inflammation, fissuring, bleeding, dry skin, localized edema, skin discoloration. Drug Interactions T Risk of photo-sensitivity when used with fluoro-quinolones, phenothiazines, sulfon-amides, tetracyclines, thiazides.

AntiB7

Accordingly, studies in NZB NZW mice have shown that the combined application of monoclonal antibodies directed against both B7-1 and B7-2 decreases anti-double-stranded (ds) DNA antibodies and prolongs survival. Treatment with either mAb alone did not have a similar strong efficacy. The results of first clinical trials using anti-B7 (IDEC-114) for the treatment of patients with psoriasis (Schopf 2001) and clinical studies based on these strategies in patients with lupus nephritis are forthcoming (Diamond et al. 2001).

The Web Interface

When the user clicks on an identified concept the UltraLink creation process is called and displays a menu of possible links. Figure 31.2C shows the list of links that are generated at run time when the user clicks on Psoriasis (second document in the hit list in Fig. 31.2A), which has been classified as a disease. It can clearly be seen how the internal logical structures from the previous section are exposed to the user when calling the UltraLink (Fig. 31.2, B and C). 100 Differential effects of and etretinate on serum cytokine levels in patients with psoriasis psoriasis psoriasis diseases Portfolio Analysis Products in development for psoriasis Figure 31.2 From search to UltraLink. A. results of a simple query. B. list of extracted entity types. C. list of links for psoriasis.

Beyond the Ultra Link

The purpose of the UltraLink is not only to comfortably navigate across distributed knowledge sources but also to access a variety of analysis tools. In this section, we illustrate this functionality through a few of the implemented tools, building on the previous psoriasis example. Let's follow the UltraLink provided for psoriasis in Figure 31.2C psoriasis disease Portfolio Analysis It links to a proprietary strategic analysis platform that uses the normalized term for performing a portfolio analysis on published information (display of the number of products per phase of development for that disease in Fig. 31.5A). arfctfagng spcnct tK, Ootm Launched disease, Juvenie rheumatoid artfrits , psoriasis, pscratic artt ite, rfieumatotd arthrite graft rejection , nflamfnaton, Launched psoriasis, psoriatic arthritis , rheumatoid arthritis, scleroderma enteritis, psoriasis , rheumatc d Ph n Figure 31.5 Sample of analysis tools offered by the UltraLink. A. Link to the Competitive Intelligence...

Natural Treatments For Psoriasis

Natural Treatments For Psoriasis

Do You Suffer From the Itching and Scaling of Psoriasis? Or the Chronic Agony of Psoriatic Arthritis? If so you are not ALONE! A whopping three percent of the world’s populations suffer from either condition! An incredible 56 million working hours are lost every year by psoriasis sufferers according to the National Psoriasis Foundation.

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