How Is Psoriasis Diagnosed
Your doctor will take a detailed medical history to determine whether you have symptoms of psoriasis typical for this disease. They may then perform physical examinations to look closely at the skin on your trunk, limbs, palms of hands, and soles of feet. Your doctor can also use these steps to help decide if you need more tests:
Skin Biopsy: Your doctor may take a small scrap of your skin and send it to a lab for testing. This procedure is usually painless and doesnt require stitches. The results determine if you have psoriasis or some other condition that causes symptoms like those of psoriasis. If necessary, the sample can also tell how severe your symptoms are.
Blood Tests: These tests may help rule out conditions such as lupus erythematosus, fungus infection, or an underactive thyroid gland . Blood tests may also show how well your liver and kidneys function if youre receiving psoriasis treatment.
Make sure you describe exactly where it hurts and how long it has been present. Ask about any family history of arthritis, fever, rash, or infections. Figure out whether the inflammation worsens at certain times of the year or after specific exposures, such as changes in weather, conditions, or stress.
Can Psoriasis Lead To Other Autoimmune Issues
Possibly. Remember how having a genetic tendency for autoimmune disorders means youre 2 to 5 times more likely to develop one? Well, that *might* mean youre also more likely to develop additional autoimmune diseases on top of psoriasis.
While research linking psoriasis with other autoimmune probs is older, its still worth a look. A 2012 study found that peeps with psoriasis are almost twice as likely to have another autoimmune disease compared to folks without it. A small 2020 study also backed up that previous research.
Why Do We Get Autoimmune Diseases
People may inherit specific genes that increase the risk of developing autoimmune diseases. People who have these gene mutations are said to be autoimmune prone. The tendency to create this type of disease is often triggered or worsened by environmental exposures, such as infections, chemicals in the environment , and certain medications .
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Thyroid Disease Research Paper
This disease is something that affects my everyday life and makes my normal routine very hard. My family at least my main family that is almost every single one of us has thyroid. We are a family of 13 6 girls and 4 boys counting my parents thats 13 right now I think only two of my siblings dont have it but are close to getting it. Often times, I find myself depressed and tired. More symptoms are pain in your joints, impaired memory, irregular periods cold, weakness and a puffy face there are
Thyroid Disease Can Cause Dry Skin Hair Loss And Weight Gain
An underactive thyroid means you are producing too few thyroid hormones, in turn, your metabolism may slow down. Symptoms of hypothyroidism develop over time and may include dry skin, hair loss, weight gain, fatigue, and a sensation of being cold. Often hypothyroidism is a result of Hashimotos disease, when the immune system attacks the thyroid.
Hypothyroidism cant be cured, but it is generally easy to treat. You will have to take a synthetic form of the hormone as a daily pill. Periodic blood tests will help your doctor ensure you are taking the right dose. Once you have the condition under control, your symptoms will start to improve.
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Zagazig University Faculty Of Medicine Rheumatology
Zagazig UniversityFaculty of Medicine Rheumatology and Rehabilitation DepartmentSerum Interleukin-23 Level in Patients With Rheumatoid Arthritis and its Correlation with Disease Activity and Severity Protocol of thesisSubmitted for partial fulfillmentOf M.Sc. DegreeIn Rheumatology and RehabilitationByEnas Tawkal EldesokyMB.B.ChResident of Rheumatology and RehabilitationAt Dekrens General HospitalUnder supervision of Pro. Dr.
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How Psoriasis Affects Your Immune System
Your bodyâs immune system is supposed to protect you from diseases. When itâs working the way it should, immune cells identify and attack invaders like bacteria and viruses. But when you have an autoimmune disease, cells in your immune system go haywire.
With psoriasis, your T cells become highly active and attack skin cells by mistake. Then other parts of your immune system spring into action. Inflammation happens, and skin cells grow too fast.
Whatâs âtoo fastâ? In healthy people, new skin cells normally travel from deep within the skin to the surface of the skin in about a month. The process is called cell turnover. With psoriasis, new skin cells rise to the surface within days. The rapid cell turnover leads to thick patches of skin.
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The Plot Thickens: Actual Auto
Pathogenic T cells in psoriatic skin lesions facilitate hyperproliferation of keratinocytes, influx of neutrophilic granulocytes, as well as production of other inflammatory cytokines, chemokines and antimicrobial peptides. They feature a Th17 signature, i.e., they express IL-17A, IL-22, and IFN- . Dendritic cells maintain activation and differentiation of lesional Th17 cells primarily through secretion of IL-23 .
Figure 2. Initiation of psoriasis by antigen-dependent and antigen-independent immune mechanisms. Complexes of self-DNA with fragments of the antimicrobial peptide, cathelicidin, can stimulate plasmacytoid dendritic cells through TLR9. They can also be presented by HLA-C*06:02 molecules and specifically activate T cells through their TCR. Likewise, the melanocyte-derived ADAMTSL5 can activate pathogenic CD8+ T cells after presentation by HLA-C*06:02.
In general, both HLA restriction and peptide specificity of a given T cell are determined by its T cell receptor repertoire . Activation and clonal expansion of T cells occur upon antigenic stimulation. In the absence of foreign antigens, clonal T cell expansion is highly suggestive for autoimmunity in inflammatory diseases . Indeed, oligoclonal T cell expansion has been identified in psoriatic lesions in early well-designed studies as well as in more recent investigations . It has been interpreted as an indicator for antigen-specific immune responses.
What Medications Or Treatments Are Used To Treat Scalp Psoriasis
Your healthcare provider may prescribe the following as a cream, lotion or gel to treat mild cases of scalp psoriasis:
In more severe or widespread cases of scalp psoriasis, your healthcare provider may prescribe:
- Medicine injections. Your healthcare provider will use a thin needle to inject medicine into your skin, a vein in your arm or directly into your plaques. These medicines may include adalimumab, etanercept or ustekinumab.
- Oral medicines. Oral medicines are pills or tablets you swallow with water. These medicines may include acitretin, cyclosporine or methotrexate.
- . Phototherapy uses ultraviolet light , usually ultraviolet B , from special lamps. The ultraviolet light waves in sunlight can help certain skin disorders, including scalp psoriasis.
Treating scalp psoriasis may be difficult. Your body is unique, and it might not respond to certain treatments. Talk to your healthcare provider about the best treatment for you.
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Why Do People Get Psoriasis
Both genetic and environmental factors are believed to be responsible for whether or not a person will get psoriasis. The theory is that those who develop the disease are born with a particular genetic makeup that causes vulnerability to psoriasis, and those who actually develop the disease are exposed to something in the environment that triggers the disorder.
Encountering certain environmental triggers seems to jump-start the machinery of the body’s immune system in vulnerable individuals. Some of the environmental factors that seem to be able to trigger psoriasis or to cause a flare-up of the condition in someone who already has the disorder include:
- Infections. Psoriasis often starts or worsens after you’ve had some kind of infection, especially one caused by streptococcus bacteria .
- Medications. Lithium, anti-malaria drugs, high blood pressure medicines and the anti-inflammatory drug Indocin are some of the drugs that seem to be possible triggers.
- Skin injury. Overly dry skin, sunburn, cuts, and scratches sometimes lead to psoriasis.
- Stress. Some studies suggest that stress can serve as a trigger for psoriasis.
Psoriasis Treatment And Autoimmunity
Treatments for psoriasis generally focus on reducing inflammation. A health care provider such as a dermatologist may prescribe topical or systemic corticosteroids. A corticosteroid is a synthetic version of the naturally occurring hormone cortisol. Corticosteroids work by reducing inflammation and suppressing the immune system. Topical steroids in the form of creams or ointments can also reduce the rate of skin growth.
Doctors also prescribe injected or infused medications known as monoclonal antibodies or biologics to treat some people with psoriatic disease. Biologics target and block specific molecules associated with inflammation, such as IL-17a. Examples of biologic therapies that target inflammatory substances include:
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What Are The Different Types Of Psoriasis
There are several significant classes of psoriasis:
Plaque psoriasis: It is the most common type of psoriasis. It occurs when new skin cells form too quickly, piling up on top of one another in thick, scaly patches that are red and itchy. This type of psoriasis accounts for about 80 percent of all cases.
Guttate psoriasis: This type of psoriasis occurs in children and young adults. Small, red, or purple-colored spots appear on the trunk and sometimes on the limbs. The sites are often itchy and may occur after a streptococcal throat infection. This condition tends to go away on its own after a few months.
Inverse psoriasis: In this form of psoriasis, the skin is smooth instead of scaly. Inverse psoriasis usually appears inside skin folds that rub together, such as under the breasts, between fingers and toes, armpits, or groin. This form also tends to go away without treatment within a year or two.
Pustular psoriasis: In this type of psoriasis, abnormal skin cell growth is accompanied by pus-filled blisters and redness. Pustular psoriasis can occur alone or in combination with other types of psoriasis. It tends to be more severe than other forms and may require hospitalization for treatment.
Erythrodermic psoriasis: It appears when plaque psoriasis or guttate psoriasis spreads over your entire body, causing widespread redness and peeling of your skin. This type of psoriasis can be severe and requires immediate medical attention.
Psoriatic Arthritis Vs Rheumatoid Arthritis
If you have psoriasis and consistently experience joint pains and aches, you should see your healthcare provider. Thats because joint pain can be a symptom of psoriatic arthritis and rheumatoid arthritis both very real possibilities for people with psoriasis.
Indeed, a study published in the Journal of the American Academy of Dermatology in June 2021 found that adults with psoriasis experience an increased likelihood of having rheumatoid arthritis compared to adults without psoriasis.
Determining whether you have psoriatic or rheumatoid arthritis can be challenging, but making the distinction is important, says Natalie E. Azar, MD, a clinical assistant professor of medicine and rheumatology at New York University Langone Medical Center in New York City.
Although rheumatoid arthritis and psoriatic arthritis share many traits joint pain, stiffness, swelling they also have unique symptoms. For instance, psoriatic arthritis symptoms can include a skin rash as well as nail damage.
Its important to distinguish which type of arthritis you have to manage it well and know what to expect, Dr. Azar says.
Although treatment options can be strikingly similar, Azar says, significant advances have been made in the development and discovery of new biologic therapies very specifically for psoriatic arthritis.
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Getting The Right Diagnosis
If you think you have psoriasis, see your doctor right away. It shouldnât take long to get an answer once youâre there. Usually, all it takes to diagnose psoriasis is a discussion about your medical history and an exam of your skin, scalp, and nails. Some doctors may also take a small sample of skin to examine under a microscope. This test is called a biopsy.
While youâre at the doctor, be sure to speak up if you have any other symptoms besides skin and/or nail problems — especially if you have joint issues, including:
- Morning stiffness that improves during the day
- Swelling just above your heel
- Swollen or tender joints
Because psoriasis often goes along with PsA, youâll want to know as soon as possible if you have both. Early diagnosis and treatment of PsA can help prevent permanent damage to your joints.
How Is Psoriasis Genetically Inherited
Psoriasis has a strong genetic link when one parent carries two defective genes for any of several main forms of psoriasis, there is approximately a 20% chance that their children will have the disease. There are also several less common gene patterns associated with an increased risk of developing psoriasis. Researchers are currently working to understand better these patterns and why they contribute to autoimmune diseases like psoriasis.
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How Is Psoriasis Diagnosed And Treated
Psoriasis often has a typical appearance that a primary care doctor can recognize, but it can be confused with other skin diseases , so a dermatologist is often the best doctor to diagnose it. The treatment of psoriasis usually depends on how much skin is affected, how bad the disease is , or the location . Treatments range from creams and ointments applied to the affected areas to ultraviolet light therapy to drugs . Many people who have psoriasis also have serious health conditions such as diabetes, heart disease, and depression. Some people with psoriasis also have an inflammatory condition which affects their joints, called psoriatic arthritis.
Psoriatic arthritis has many of the same symptoms as other types of arthritis, so a rheumatologist is often the best doctor to diagnose it. The treatment of psoriatic arthritis usually involves the use of drugs .
Psoriatic disease may be treated with drugs or a combination of drugs and creams or ointments.
Rheumatoid Arthritis And Psoriasis
Around one-third of people with psoriasis develop a type of arthritis called psoriatic arthritis. This affects the joints and bones.
It is also possible for people to develop other types of arthritis, such as rheumatoid arthritis. Indeed, the risk of developing rheumatoid arthritis is higher in people with psoriasis than in people without.
However, many of the symptoms of rheumatoid arthritis and psoriatic arthritis overlap. This may mean that doctors avoid giving multiple diagnoses where one is enough.
Talk with your doctor if you think you are developing symptoms of rheumatoid arthritis or psoriatic arthritis, which include swelling and joint pain.
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What Questions Should I Ask My Healthcare Provider
- How can you tell that I have scalp psoriasis?
- If I dont have scalp psoriasis, what other skin condition might I have?
- How can I prevent flare-ups and control my symptoms?
- What medicines do you recommend?
- Do the medicines have any side effects?
- What at-home treatments do you recommend?
- Do the at-home treatments have any side effects?
- What else can I do to improve my symptoms?
- Is there a shampoo, cream or ointment you can prescribe?
Contribution Of Resident Skin Cells To Immunological Processes In Psoriasis
Multiple genetic and environmental factors influence the immunopathology of psoriasis . The mechanisms leading to the first occurrence of psoriasis in predisposed individuals are only partly known. Infections with streptococci, medications such as lithium, antimalarials, or ß-blockers, or physical or chemical stress may trigger the disease. Minimal trauma can induce rapid immigration and activation of immune cells including T-cells and neutrophils , the so-called Köbner phenomenon . Feedback loops between adaptive immune cells , innate immune cells , and resident skin cells result in an amplification and chronification of the inflammatory response. Aspects of systemic inflammation in patients with severe psoriasis are thought to contribute to comorbid diseases .
Several other skin-derived alarmins such as S100 proteins are inflammatory AMPs also implicated in the pathogenesis of psoriasis. Indeed, IL-17A induces the production of S100A7 and S100A15 by keratinocytes . Likewise, myeloid cells and keratinocytes produce the calgranulins, S100A8 and S100A9 , both of which induce T-cell mediated autoimmune reactions and inflammatory changes in keratinocytes . Similar to LL37, human ß-defensin 2 and HBD4 bind DNA, trigger TLR9 and stimulate pDC . Innate immune sensing is also facilitated by IL-26 bound to self-DNA .
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Should I Avoid Any Foods Or Drinks If I Have Scalp Psoriasis
Certain foods or drinks may contribute to scalp psoriasis flare-ups. If you have scalp psoriasis, its a good idea to keep track of what you eat and drink in a food journal. Keeping track of what you eat and drink can help you and your healthcare provider determine any causes of your flare-ups.
An anti-inflammatory diet may limit your scalp psoriasis flare-ups. Foods that have anti-inflammatory properties include:
- Oily fish, such as mackerel, salmon or sardines.
- Leafy greens, such as spinach and kale.
Foods and drinks that may cause flare-ups include:
- Dairy, including cows milk, and eggs.
- Citrus fruits, including lemons, limes and oranges.
- Nightshade vegetables, including peppers, potatoes and tomatoes.
The Role Of Inflammation
Inflammation is an important reaction to infection, injuries, and toxins. When the immune response of the body is triggered in cases of psoriatic disease, it can lead to inflammation that can cause skin and/or joint symptoms to flare , along with systemic inflammation that can affect other parts of the body.
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Psoriasis Linked To Other Autoimmune Diseases
Not only is psoriasis likely an autoimmune disease, it is also linked with other autoimmune diseases. The most common tie is with psoriatic arthritis .
Some research shows that around 30% of people, when diagnosed with psoriasis, already have PsA, a disease that affects joints and the areas where tissue attaches to bone. Other research suggests that even more people with psoriasis — as many as 40% — will get PsA, usually within 5 to 10 years of skin symptoms.
Signs of PsA include:
- A swollen, sausage-like finger or toe
- Nail changes or problems