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 All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. 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 [...]... 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... 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... 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... 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. .. 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... vascular diseases in patients with psoriasis compared with controls Psoriasis was also found to be an independent risk factor for mortality Psoriasis is associated with atherosclerosis This association applies to coronary artery, cerebrovascular, and peripheral vascular diseases and results in increased mortality (Prodanovich et al., 2009) Patients with psoriasis (N = 4752) between 1999 and 2001 and patients... 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... greater for patients with psoriasis than for comparison patients (Lin et al., 2011).The event rates and rate ratios (RRs) of cardiovascular death, myocardial infarct (MI), coronary revascularization, stroke and a composite of MI, stroke and cardiovascular death were increased in patients with psoriasis The RRs increased with disease severity and decreased with age of onset The risk was similar in patients... response to therapy (Nestle et al., 2009) Psoriasis may lead to disability and significant effects on patients' quality of life A challenge in psoriasis management is to use an effective therapy early in the disease course in order to achieve a safe and well tolerated maintenance of remission with an improvement of both skin and joint manifestations Recent advances in Psoriasis, a Systemic Disease Beyond . 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. believed to be a detrimental factor in diseases such as systemic sclerosis, atopic dermatitis, psoriasis, eczema and UV radiation damage (Gilliver et al., 2011). Psoriasis, a Systemic Disease Beyond. 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