Bab 3 Discussion Randa

8/12/2019 Bab 3 Discussion Randa

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DISCUSSION

The major manifestation of psoriasis is chronic inflammation of the skin. It

is characterized by disfiguring, scaling, and erythematous plaques that may be

painful or often severely pruritic and may cause significant. Psoriasis is a chronic

disease that waes during a patient!s lifetime, is often modified by treatment

initiation and cessation and has few spontaneous remissions Inverse psoriasis is

characterized by lesions in the skin folds. "ecause of the moist nature of these

areas, the lesions tend to be erythematous plaques with minimal scale. #ommon

locations include the ail$lary, genital, perineal, intergluteal, and inframammary

areas. %leural surfaces such as the antecubital fossae can ehibit similar lesions.&

In case we find the patient with chief complaint Itch and red spot on the back side

around the body and hand. itchy sensation. The red spott were getting bigger '

months ago. In the first of the symptom start with a small of white lesion with the

severe itching then the patient starching the lesion every time until the last month

before she goes to polyclinic the lesion begin a red spot with the bigger plaque.

The patient admitted she had ever felt like this condition ( year ago.

Psoriasis is universal in occurrence how ever different population varies

from ).* percent to **.+ percent. Psoriasis may begin at any age, but is

uncommon under age *) years. It most likely appears *($&) years. It certain -$

#/0 antigen carier from family. Psoriasis is a chronic inflammation skin

deases with a strong genetic basic characteristic by comple dermal growth

*

%g '. Type the lesion of psoriasis



epidermal diferentation and multiple biochemical, immunologic, vascular

abnormality. It caused poor keratinocyte.' in case we find the lesion at regio

thora posterior patch demarcated hypopigmented with firm boundaries, plaque

size, the number of multiple over rough scaly lesions found generalized

distribution premises and on regio etrimitas superior patch demarcated

hypopigmented with firm boundaries, plaque size, the number of multiple over

smooth scaly lesions found generalized distribution premises.

Initial lesion in the pin head sized macular lesion there marked edema, and

monoclear cell inflarates are found in the upper dermis. the overlying epidermis

soon becomes spogiotic with the focal loss of the granular layyer.' Plaque

psoriasis is the most common form, affect$ing approimately +)1 to 2)1 of

patients. The vast majority of all high$quality and regulatory clinical trials in

psoriasis have been conducted on patients with this form of psoriasis. Plaque

psoriasis manifests as well$defined, sharply demarcated, erythematous plaques

varying in size from * cm to several centi$meters These clinical findings are

mirrored histologically by psoriasiform epidermal hyperplasia, parakeratosis with

intracorneal neutro$phils, hypogranulosis, spongiform pustules, an infiltrate of

neutrophils and lymphocytes in the epidermis and dermis, along with an epanded

dermal papillary vasculature. Patients may have involvement ranging from only a

few plaques to numerous lesions covering almost the entire body surface. The

plaques are irregular, round to oval in shape, and most often located on the scalp,

trunk, buttocks, and limbs, with a predilection for etensor surfaces such as the

elbows and knees. 3maller plaques or papules may coalesce into larger lesions,

especially on the legs and trunk. Painful fissuring .&,'

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5epression6suicide Psoriasis is associated with lack of self esteem and

increased prevalence of mood disorders including depression. The prevalence of

depression in patients with psoriasis may be as high as 0)1. 5epression may be

severe enough that some patients will contemplate suicide. In one study of 4*7

patients with psoriasis, almost *)1 reported a wish to be dead and (1 reported

active suicidal ideation. Treatments for psoriasis may affect depression. 8ne study

demonstrated that patients with psoriasis treated with etanercept had a significant

decrease in their depression scores when compared with control subjects.

owever, clinically diagnosed depression was an eclusionary criterion for entry

into this study.& Therefore, treatment of psoriasis with etanercept lessened

symptoms of depression in patients without overt clinical depression. Increased

rates of depression in patients with psoriasis may be another factor leading to

increased risk of cardiovascular disease. lthough there is some suggestive

&

%g (. Picture of pathogenesis lesion on

psoriasis'

clarification

1.#apillary dilatation increased

the numbered of dermal

mononuclear cells and mast

cell. The process increase in

epidermal thicknes

4.mast cell, macrophages, T

cell 9the component mediator

inflamation:

&. lagerhan cell begin eit the

idermis and inflamtory

dendritic cell, cd+; t cell begin

to epidermal cell



evidence that treatment of depression with selective serotonin reuptake inhibitors

may reduce cardiovascular events.& in case we find the patient she get a stress in

her life and she never talk to her son and daughter. nd when he getting start to

remember her kid she always feel the symptom going severe, like itch and red

spot, in that case related with the literatur.

8besity has become an epidemic within the <nited 3tates. body mass

inde 9"=I: of more than &) is defined as obese with overweight being defined as

a "=I between 4( and &). In the <nited 3tates, 0(1 of people older than 4) years

are either overweight or obese. 8besity has serious health consequences including

hypertension, vascular dis$ease, and type 4 diabetes mellitus. Psoriasis was first

associated with obesity in several large, >uropean epidemiologic studies. 3tudies

from the <nited 3tates also show an elevated "=I in patients with psoriasis.

These analyses of "=I compared subjects with and without psoriasis while

controlling for age, se, and race. nalysis of data from the <tah Psoriasis

Initiative revealed that patients with psoriasis had a significantly higher "=I than

control subjects in the general <tah population.& The ?urses ealth 3tudy II,

which contains prospective data from 7+,040 women followed up during a *'$

year period, indi$cates that obesity and weight gain are strong risk factors for the

development of psoriasis in women. In this study, multiple measures of obesity,

including "=I, waist and hip circumference, waist$hip ratio and change in

adiposity as assessed by weight gain since the age of *+ years, were substantial

risk factors for the development of psoriasis. =ultivariate anal$ysis demonstrated

that the relative risk of developing psoriasis was highest in those with the highest

"=Is. In contrast, a low "=I 9@4*: was associated with a lower risk of psoriasis,

further supporting these findings. %urthermore, the average weights of pa$tientswith psoriasis in the large clinical trials of the biologic agents have been in the 2)$

to 2($kg range 9although these clinical trials all enrolled more men than women:

whereas the average body weight for the <3 population from the ??>3

database from*222 to 4))4 was +0 kg. n association between psoriasis and

elevated "=I appears to be yet another factor that predisposes individuals with

psoriasis to cardiovascular disease.& in that case the patient occurrence of obesity

'



with psoriasis vulgaris related with the literature, she have a "=I A&) that

condition show she get a obesity.

#ombination of topical therapies 3ince all topical medications for the

treatment of psoriasis have limitations, combination regimens, utilizing

medications from different categories, have been studied and shown to be

potentially beneficial.( #orticosteroids and salicylic acid The combination of

topical corticosteroids and salicylic acid may be valuable because of the ability of

salicylic acid to enhance the efficacy of corticosteroids by increasing penetration.

To ensure that there is not an increase in steroid toicities when adding salicylic

acid to topical corticosteroid preparations, it is recommended that this

combination belimited to no more than medium$potency 9class &$': topical

corticosteroids. The strength of recommendations for the treatment of psoriasis

using topical corticosteroids and salicylic acid.0 #orticosteroids and vitamin 5

analogues The combination of topical corticosteroids and vitamin 5 analogues

appears to be more efficacious than either therapy alone, with fewer side effects

noted in most, but not all, studies. This point has been demonstrated for several

different corticosteroid $ calcipotriol combinations 9please also see prior section

on combination calcipotriene6betamethasone ointment:. The strength of

recommendations for the treatment of psoriasis using topical corticosteroids and

vitamin 5 analogues.(,7

#orticosteroids and tazarotene 8wing to the potential irritancy of topical

tazarotene, adding topical corticosteroids to a regimen of tazarotene is an

appropriate option. In fact, one study has shown that the combination of

tazarotene and either mid$ or high$potency topical corticosteroid is more effective

than therapy with tazarotene aloneB however, this study did not determine iftazarotene plus topical steroid is superior to topical corticosteroid alone. There

may be a synergistic effect between tazarotene and topical corticosteroids as a

clinical trial comparing tazarotene gel plus mometasone cream to mometasone

cream alone showed superior efficacy of the combination over mometasone cream

used alone both for efficacy during the therapy and for the duration of therapeutic

effect. #ombination therapy may increase the duration of treatment benefit as well

as length of remission. nother potential advantage of using combination

(



tazarotene and topical corticosteroid is potential decrease in steroid$induced

atrophy. The strength of recommendations for the treatment of psoriasis using

topical corticosteroids and tazarotene.0,7 in that case we find the Patients received

systemic and topical therapy when she get on the polyclinic of dermatology

C3<D "anda ceh.

0



DAFTAR PUSTAKA

*. Erueger F.GB "owcock .Psoriasis pathophysiologyH current concepts of

pathogenesis. Ann Rheum Dis. al. ii&)$ii&0. 4))(.

4. -owes =.B "owcock .= and Erueger, F.G. Pathogenesis and Therapy of

Psoriasis. olume ''(. ?ew JorkH Nature Publishing Group. al. +00$7&.

4))7.

&. Guidelines of care for the management psoriasis and psoriatic arthritis 3ection

*. 8verview of psoriasis and guidelines of for the treatment of psoriasis with

biologics /ork GroupH lan =enter, =5, #hair, lice Gottlieb, =5, Ph5,

3teven C. %eldman, bby 3. an oorhees, =5, #raig -. -eonardi, =5,

Eenneth ". Gordon, , #aliforniaB "irmingham, labamaB and #leveland,

8hio 4)*&.'. Fohan > gundjonson james t elder Fean of Psoriasis InH %itzpattrick!s

5ermatology in General =edicine 7thed. ?ew JorkH =c Graw ill. 4))+.p*02

$*7*.

(. -owes =B Eikuchi TB 5uculan F%B #rdinale IB Daba -#B aider 3B

"owman >PB Erueger FG. Psoriasis ulgaris -esion contain 5iscrete

Populations of Th* and Th*7 T #ells. olume *4+. Journal of Investigative

Dermatology. al. *4)7$4**. 4))+.

0. Guidelines of care for the management psoriasis and psoriatic arthritis 3ection

&. 8verview of psoriasis and guidelines of for the treatment of psoriasis with biologics /ork GroupH lan =enter, =5, #hair, lice Gottlieb, =5, Ph5,

3teven C. %eldman, bby 3. an oorhees, =5, #raig -. -eonardi, =5,

Eenneth ". Gordon, , #aliforniaB "irmingham, labamaB and #leveland,

8hio 4))2.

7. #oimbra 3B 8liveira B %igueiredo B Pereira PCB 3ilva 3. PsoriasisH

>pidemiology, #linical and istological %eatures, Triggering %actors,

ssesment of 3everity and Psychosocial spect. 5alam 8!daly FH Psoriasis a

3ystemic 5esease. #hinaH Intech. al. 02$++. 4)*4.

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Bab 3 Discussion Randa