The condition results from a complex interaction of genetic, environmental, and immune system factors. It significantly impacts quality of life, contributing to increased mortality rates and a shorter lifespan.
Plaque psoriasis, the most prevalent form, affects ~85% of patients. Common symptoms include scaling (94% of patients), itching (79%), redness, skin tightness, and discomfort, all of which can greatly disrupt daily activities.
Psoriasis has a global prevalence ranging from 0.3% to 2.5%, with a higher incidence in South Africa, where between 7%-8% of the population may be affected.
The disease typically presents in two peaks: Early onset between 16- to 22- years, often linked with a severe form and family history, and late onset between 57- to 60-years, usually milder and less likely to have familial connections.
Psoriasis is also associated with various comorbidities, including metabolic syndrome, diabetes, cardiovascular diseases, psoriatic arthritis, and mental health issues such as depression and anxiety. These comorbidities contribute to the reduced life expectancy in psoriasis patients.
Diagnosing psoriasis can be complex due to its similarity to other dermatological conditions such as fungal infections, eczema, and skin cancers. A biopsy may be required to differentiate it from conditions like cutaneous T-cell lymphoma or mycosis fungoides.
Management of psoriasis involves a tailored approach based on disease severity, affected areas, and patient quality of life. Treatment options range from topical therapies for mild cases to systemic treatments and biologics for moderate to severe cases.
The latest advancements include biologics, particularly interleukin inhibitors, which offer near-complete skin clearance and represent a significant improvement in psoriasis management. These therapies have heightened patient expectations, making them less willing to revert to previous treatments.
Effective psoriasis management requires a holistic approach, addressing both medical and psychological aspects of the disease. Long-term strategies often involve combination therapies to minimise toxicity and enhance outcomes.
Regular monitoring is essential, especially with drugs like methotrexate, which require frequent liver function tests. Lifestyle factors such as stress, smoking, and alcohol consumption can exacerbate the condition, necessitating careful management.
For mild to moderate psoriasis, topical therapies remain the cornerstone of treatment. Emollients are crucial for symptom relief and enhancing the effectiveness of other treatments.
A combination of vitamin D analogs and corticosteroids is effective for long-term maintenance. For more severe cases, treatments like UVB phototherapy and systemic agents are used, with biologics offering promising results for those with moderate to severe forms of the disease.
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