Lehigh County Health & Medicine Fall 2019 - 21

L C M E D S O C .O R G

soriasis is a chronic autoim- so many autoimmune diseases, comes in
The downside of systemic therapies is
mune disease of the skin. Most to play. Some environmental exposure that they are widespread and tend to have
commonly, it manifests as a activates our innate immunity and some side effects. The goal of new research is to
plaque-like rash. The disease genetic predisposition allows our adaptive make medications more targeted. Ideally,
is not curable; however, it can be treated immune system to become activated. In treatment would turn down the immune
and controlled. Patients will experience the case of psoriasis, cells in our skin are system as it pertains to psoriasis, but not
periodic flare ups of the rash often followed activated. The innate immune system and necessarily around the entire body. This
by long periods of latency. Psoriasis affects the adaptive immune system synergize is where the injectable medications enter
as many as 7.5 million Americans. Both (using cytokines), causing inflammation the picture.
males and females are equally affected; and and an overproliferation of our skin cells.
while it is primarily a disease of adulthood,
For those patients with treatment reit can also affect children. Fortunately, this
Given the process of inflammation sistant psoriasis, new types of injectable
disease does not often cause life threatening being inherent to psoriasis, the risk of medications are becoming available. These
systemic complications. It can, however, the disease increases with other diseases medications are part of a new trend in
seriously impact one's quality of life.
that also cause inflammation. If there is medicine called "Biologics," which are
already inflammation present, the immune often incredibly expensive and sometimes
Our Skin and Psoriasis
system is more likely to become activated impractical. These therapies tend to end
Our skin is made up of several different and start attacking our bodies. Some other in the suffix "-umab." The goals of these
layers which are constantly dying, shedding, conditions associated with psoriasis are medications is to target those cytokines
and replenishing. Psoriasis is the overpro- obesity, hypertension, metabolic syndrome, discussed earlier. These drugs are beneficial
duction of cells within these layers of skin. smoking, and infections. And also, pso- because unlike the other kinds of immune
(See Image 1.) There are several different riasis often arises in areas of trauma or modulating therapies, they do not turn
subtypes of psoriasis which are categorized skin breakdown.
down the immune system in totality. They
by both clinical features as well as which
can target a more specific process. These
part(s) of the body it affects. (See Table
Treatments and New Advances
medications do still come with their own
1.) The severity of psoriasis is graded as
The National Psoriasis Foundation group of side effects. While these types of
mild to severe based on the amount of skin outlined goals of therapy for plaque therapies are exciting and show promise
involved, and is measured as a percentage psoriasis as the following: after three in the field, at this time, they are not
of body surface area.
months of treatment, less than 3% body practical for widespread use.
surface area (BSA) involvement or 75
Our Immune System and Psoriasis percent improvement. In other words,
Patient Advocacy
The immune system defends our bodies patients should expect improvement but
Over time, with education efforts and
from disease, and like most things in life, perhaps not total eradication in 3 months the assistance of celebrities including Kim
functions in a delicate balance. Too little of treatment. Treatment is focused both Kardashian and Johnathan Van Ness, the
immunity, and we end up with infections. topically and if necessary, orally.
national opinion is transitioning away from
Too much immunity, and we end up with
hiding this affliction and toward honesty
autoimmune conditions, such as psoriasis.
The goal of topical therapies is roughly and acceptance. This type of spotlight
The immune system has a component for divided into hydration and reducing in- supports new research and with it, the
general functions (innate immunity) and flammation. The reduction of inflammation discovery of new treatments.
a component that is highly specialized is accomplished by toning down the innate
(adaptive immunity). These two compo- and the adaptive immune system, and by
Dermatological diagnoses are often
nents are intimately interconnected and attempting to turn off the excessive cell based on visual observations and thereconstantly activating and deactivating one proliferation.
fore can become more subjective than
another. How they communicate is highly
other disease diagnoses. Dermatologists
complex, but the word to remember is
If the psoriasis is really severe and covers themselves attest that psoriasis is often
cytokines. Cytokines are usually called a large surface area of the body, medica- misdiagnosed, especially in those with
"IL" and numbered (ex. IL-23). The cells in tions can be given orally. It is impractical atypical presentations. This is not to say
our bodies use cytokines to communicate. to apply a topical therapy to large surface that all patients should continue to get
area of skin, and oral delivery ensures that another opinion until they finally hear
The adaptive immune system does not medication distributes to the entire body. someone tell them they have psoriasis.
attack things at random - it needs to be Most of these medications have similar
told to do so. This is where the genetic targets to the topical therapies.
Continued on page 22
and environmental interaction, seen in
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Lehigh County Health & Medicine Fall 2019

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