ABSTRACT

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Psoriasis is a dynamic systemic disease that can have a profound affect on a patient’s self-esteem. Fortunately, numerous therapeutic advances have been made over the last 10 years. In order to help patients manage their disease, healthcare providers should be aware of the modifiable risk factors that may exacerbate psoriasis. Additionally, exploring the impact the disease has on a patient and how it may change over their lifespan will help ensure appropriate therapies are used. Patients are unique so one medication will not fit all of our patients’ needs. In this paper, the authors look at available treatment options for psoriasis and psoriatic arthritis. Educating psoriasis patients, in addition to collaborating with patients and other healthcare providers, may help initiate therapies that will result in patients living their lives to the fullest.

Psoriasis and Psoriatic Arthritis a

JENNIFER CLAY CATHER, MD; aMELODIE YOUNG, A/GNP-c; bMARTIN JAN BERGMAN, MD Modern Dermatology and Modern Research Associates, Dallas, Texas; bDrexel University College of Medicine, Philadelphia, Pennsylvania; Taylor Hospital, Ridley Park, Pennsylvania a

Psoriasis is a Prevalent disorder estimated to affect about two percent of the general population of europe and north america and more than a quarter of these cases (27%) will present as psoriasis in children under the age of 16 years.1 although much remains to be discovered, the pathophysiology of psoriasis has been increasingly elucidated in recent years. activated immune cells elaborate proinflammatory cytokines (such as tnF-alpha, interferon-γ, interleukin 17 [il-17], il-22, il-23, il-12, and il-1β), which promote keratocyte hyperproliferation, angiogenesis, and inflammation in the skin. these proinflammatory cytokines have emerged as promising pharmaceutical targets for psoriasis and psoriatic arthritis.2 Children, adolescents, young adults, pregnant women, seniors, men, women, and those suffering from diabetes, heart disease, cancer, and other conditions may have different treatment objectives and distinct needs

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J Clin Aesthet Dermatol. 2017;10(3 Suppl 1):S16–S25

in psoriasis care. For example, geriatric patients with psoriasis require special considerations in that these patients may suffer from comorbidities and the risks of polypharmacy with medications that could potentially interact with psoriasis drugs. additionally, seniors have slower drug metabolism than younger patients, diminished renal and bone marrow function, and may experience drug-induced or drugexacerbated forms of psoriasis. Finally, they are also more likely to have difficulty in self-administering medications or presenting for clinicbased therapies.3 in summary, psoriasis patients need individualized care throughout their lifespan. THE CLINICAL CONTINUUM OF PSORIASIS

the clinical presentation of psoriasis may vary across the lifespan of the patient with differences noted between adult, adolescent, and childhood variants. While children

Disclosure: Dr. Cather: AbbVie, Celgene, Janssen, Lilly, Regeneron Pharmaceuticals, Inc., Sanofi Genzyme, Sun Pharmaceutical—consultant and speaker; Actelion, Boehringer Ingelheim, Corrona, Cutanea, Dermira, Galderma, GlaxoSmithKline, Janssen, Lilly, Novartis, Merck, Pfizer, Regeneron Pharmaceuticals, Inc., PSOLAR, Valeant—investigator. Dr Young: AbbVie, Celgene, Janssen, Lilly, Regeneron Pharmaceuticals, Inc., Sanofi Genzyme,— consultant and speaker; Actelion, Boehringer Ingelheim, Corrona, Cutanea, Dermira, Galderma, GlaxoSmithKline, Janssen, Lilly, Novartis, Merck, Pfizer, Regeneron Pharmaceuticals, Inc., PSOLAR, Valeant—investigator. Dr. Bergman: Abbvie, Amgen, BMS, Janssen, Novartis, Pfizer, Genentech, Celgene—consultant and speaker . Author correspondence: Jennifer C. Cather, 9101 N. Central Expressway, Suite 160, Dallas, TX 75231

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JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY March 2017 • vol. 10 • no. 3 • supplement 1

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TABle 1. managing psoriasis across the patient lifespan. note that for all groups, the types of psoriasis include psoriatic plaques (mild to moderate-severe), guttate psoriasis, and psoriatic arthralgia and treatment options for all groups include phototherapy, topicals, systemics, and biologics. All patient groups are vulnerable to psychosocial issues and comorbid conditions. PoPulATion

PhoToTherAPY

ToPiCAls

sYsTemiCs

BioloGiCs

CommenTs

Children

Psoriasis and Psoriatic Arthritis.

Psoriasis is a dynamic systemic disease that can have a profound affect on a patient's self-esteem. Fortunately, numerous therapeutic advances have be...
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