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PSORIASIS –
A SYSTEMIC DISEASE
Edited by Jose O'Daly
Psoriasis – A Systemic Disease
Edited by Jose O'Daly
Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia
Copyright © 2012 InTech
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Publishing Process Manager Marija Radja
Technical Editor Teodora Smiljanic
Cover Designer InTech Design Team
First published March, 2012
Printed in Croatia
A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from orders@intechweb.org
Psoriasis – A Systemic Disease, Edited by Jose O'Daly
p. cm.
ISBN 978-953-51-0281-6
Contents
Preface VII
Chapter 1 Psoriasis, a Systemic Disease Beyond the Skin, as
Evidenced by Psoriatic Arthritis and Many Comorbities –
Clinical Remission with a Leishmania Amastigotes
Vaccine, a Serendipity Finding 1
J.A. O’Daly
Chapter 2 History of Psoriasis 57
Ines Brajac and Franjo Gruber
Chapter 3 Psoriasis: Epidemiology, Clinical and Histological
Features, Triggering Factors, Assessment of
Severity and Psychosocial Aspects 69
Susana Coimbra, Hugo Oliveira, Américo Figueiredo,
Petronila Rocha-Pereira and Alice Santos-Silva
Chapter 4 Psoriasis and Malassezia Yeasts 89
Asja Prohić
Chapter 5 SAPHO Syndrome 103
Gunter Assmann
Chapter 6 Peptidylarginine Deiminases and
Protein Deimination in Skin Physiopathology 117
Shibo Ying, Michel Simon, Guy Serre and Hidenari Takahara
Chapter 7 Insights into the Pathogenesis and
Treatment of Psoriasis 133
Robyn S. Fallen, Aupam Mitra and Hermenio C. Lima
Chapter 8 Psoriasis 159
Adolfo Fernandez-Obregon
Preface
The purpose of this book is to present a comprehensive analysis of Psoriasis, a disease
that affects approximately 2-3% of humanity in all countries. Psoriasis existence is
surveyed since the clay tablets of Assyrians and Babylonians 3.000-5.000 years ago,
thru the middle ages, the renaissance, XIX and XX centuries. In the first and second
part of the XX century clinical forms were described, as well as the role of
keratinocytes, multifactorial genes, T lymphocytes, mast cells, natural killer cells,
nerve growth factor, psychosomatics, neuropeptides and environmental factors
triggering the disease. Treatment of psoriasis is detailed thru history from old
ointments in the XVIII and XIX centuries, up to UVA irradiation, new
immunosuppressive and immunomodulatory drugs as parasite vaccines in the XX and
XXI centuries. Epidemiology of psoriasis, a disease that affects around 125 million
people (mainly Caucasians ), is described. Psoriasis is less common in Chinese,
Eskimos, West Africans and African-Americans. The course and evolution of psoriasis
is very hard to predict. A description of the wide clinical spectra is presented,
considering psoriasis as a systemic disease a better concept to explain its pathogenesis,
with manifestations in skin, nails, tendons, ligaments, spinal cord, joints and
ophthalmic complications easily missed. The balance between angiogenic and
antiangiogenic factors are proposed to explain the pathogenesis in psoriatic skin.
Psoriasis and atherosclerosis are interrelated; pathogenic mechanisms are shared
between the two diseases inducing inflammation.
Histological characteristics are discussed in depth in plaque psoriasis describing cells
and cytokines involved in the process as well as the genes responsible for
inflammation. Assessment of psoriasis severity is explained in an easy way useful for
the clinician and researcher working in psoriasis. The role of streptococcal infections
and fungal infections as well as Malassezia species and lipophilic yeast are presented
as well as antifungal treatments for control of psoriasis.
Synovitis, acne, pustulosis hyperostosis, and osteitis (SAPHO syndrome) are discussed
in its relation with psoriasis with many features in common with ankylosing
spondilytis and psoriatic arthritis. Peptidylarginine deiminases are discussed
concerning their expression in keratinocytes, their association with skin diseases and
as therapeutics and prophylactic targets in severe psoriasis.
VIII Preface
We would like to acknowledge to the contributors to the several chapters as follows:
Ines Brajac and Franjo Gruber
Department of Dermatovenerology, University Hospital Centre Rijeka Croatia
Susana Coimbra
1,2
, Hugo Oliveira
3
, Américo Figueiredo
3
,
Petronila Rocha-Pereira
1,4
and Alice Santos-Silva
1,5
1
Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
2
Centro de Investigação das Tecnologias da Saúde (CITS) – Instituto Politécnico da Saúde
Norte, CESPU, Gandra-Paredes, Portugal
3
Serviço de Dermatologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal
4
Centro de Investigação em Ciências da Saúde (CICS), Universidade da Beira Interior, Covilhã,
Portugal
5
Departamento de Ciências Biológicas, Laboratório de Bioquímica, Faculdade de Farmácia,
Universidade do Porto, Porto, Portugal
Asja Prohić
Department of Dermatovenerology, University Clinical Center of Sarajevo
Bosnia and Herzegovina
Gunter Assmann
University Medical School of Saarland, Germany
Shibo Ying
1
, Michel Simon
2
, Guy Serre
3
and Hidenari Takahara
1
1
Ibaraki University, Japan
2
CNRS-University of Toulouse III, France
Jose O'Daly
Astralis Ltd, Irvington, NJ
USA
[...]... molecules, and was only implicated in few diseases, such as, cancer, arthritis, and psoriasis, now its research offers a potential to cure a variety of diseases such as Alzheimer's and AIDS Angiogenesis may have an impact similar to that of antibiotics had in the twentieth century (Bisht et al., 2010) Angiogenic factors, such as vascular endothelial growth factor (VEGF), may dominate the activity of anti-angiogenic... years and median disease duration of 8 years Eighty-six patients were diagnosed with AS, 242 with PsA, 25 with ReA, 10 with SpA associated with inflammatory bowel disease, 33 with undifferentiated SpA and 6 with juvenile AS (Buschiazzo et al., 2011) A cohort of 233 SpA patients, observed in 2 centers in Guatemala City, Guatemala, and in hospitals in San Salvador, El Salvador, and San José, Costa Rica... about the PsA disease state, its genetics, pathophysiology, and comorbidities, as well as our ability to assess and treat the disease, has advanced as a result of significant collaborative efforts by rheumatologists and dermatologists (Mease, 201 0a) For many years the concept of PsA as a separate disease entity was controversial, its importance has been underestimated Dermatologists focus on psoriatic... the inflammatory process with a relative differential involvement of adaptive and innate immunity in the psoriatic disease (McGonagle et al., 2010) Nail fold psoriasis and DIP joint arthritis were associated with nail involvement and Psoriasis, a Systemic Disease Beyond the Skin, as Evidenced by Psoriatic Arthritis and Many Comorbities – Clinical Remission with a Leishmania Amastigotes Vaccine, a Serendipity... dyslipidemia (Federman et al., 2009) and the recognition that psoriasis itself is an independent risk factor for vascular disease (Gelfand et al., 2011) The latter is probably mediated by systemic inflammation associated with psoriasis, similar to that observed in patients with rheumatoid arthritis Patients whose psoriasis develops at a young age and those with more severe disease are at the greatest risk... in PsA patients Nail psoriasis has been postulated to be related to the Koebner phenomenon and local inflammatory DIP joint arthritis, and probably indicative of distal phalanx enthesitis in PsA patients (Maejima et al., 2010) PsA is classified as a SpA and characterized by synovitis, enthesitis, dactylitis, and spondylitis, usually manifesting in a person with skin and nail psoriasis Our understanding... response and characterized by hyperproliferation and altered differentiation of keratinocytes, as well as mast cell accumulation and activation (Harvima et al., 2008) Mast cells are increased in lesional psoriatic skin (Özdamar et al., 1996), and have important functions as sensors of environmental and emotional stress (Paus et al., 2006; Harvima et al., 1993) possibly due to direct activation by corticotrophin... patients with severe psoriasis, demonstrating that these patients have about a 6-year reduction in life expectancy and that excess risk of CV death is the largest contributor to this premature mortality (Abuabara et al., 2010; Gelfand et al., 2011) 4.2 Metabolic syndrome Psoriasis is associated with metabolic syndrome, cardiovascular disease, and osteoporosis and may be considered a systemic disease. .. both psoriasis and PsA patients together in the same subject, thus, psoriasis is a systemic 12 Psoriasis – A Systemic Disease disease, induced by cytokines in all body organs, being expressed in each tissue according to genetic and environmental factors due to shared inflammatory pathways Development of psoriasis and PsA is centered in the blood vessels behavior Both diseases start by proliferation... sclerosis Many of these conditions have a similar immunologic pathogeneses Canadian and international studies have not only confirmed the presence of these comorbidities but also have demonstrated that patients with psoriasis have a significantly reduced life span Given that patients with psoriasis are often unaware Psoriasis, a Systemic Disease Beyond the Skin, as Evidenced by Psoriatic Arthritis and Many . PSORIASIS –
A SYSTEMIC DISEASE
Edited by Jose O'Daly
Psoriasis – A Systemic Disease
Edited by Jose O'Daly
. Oliveira, Américo Figueiredo,
Petronila Rocha-Pereira and Alice Santos-Silva
Chapter 4 Psoriasis and Malassezia Yeasts 89
Asja Prohić
Chapter 5 SAPHO
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