PSORIASIS

Psoriasis is a chronic inflammatory auto-immune skin disorder recurring and causes scales. The pathophysiology of psoriasis is due to the immature of the keratinocytes in the epidermis. In normal skin, new keratinocytes produce in the stratum basale and these cuboidal cells migrating upwards towards the stratum corneum to become stratified squamous keratinised epithelium corneocytes, and usually will take the keratinocytes cycle around every 21 to 45 days. The maturation journey is important to determine the role for our skin barrier function. However, in psoriasis there are no maturation of the keratinocytes because the keratin protein journey from the basal layer until their reach the outermost epidermis layer happens within 4 to 7 days (Benhadou et al., 2019). Hence, psoriasis condition strongly linked with impaired barrier function of the skin.

Psoriasis is the most common type of psoriasiform dermatitis, an inflammatory skin condition in which the epidermis thickens due to rete ridge elongation from the over proliferation of the keratinocytes and abnormal differentiation (Rendon & Knut, 2019). Cells involved in the abnormalities of psoriasis are the immunologic role of IL-17, antimicrobial peptides (AMPs) which secreted by the keratinocytes, cathelicidin (LL37) secreted by the damaged keratin cells, β-defensins, IL-12, IL-21, IL-22, IL-1, IL-6, TNF-α, chemokine, and LL-37 bound to DNA stimulates toll-like receptors (TLR) 9 in plasmacytoid dendritic cells (pDCs) which characterized the production of type I IFN (IFN-α and IFN-β) (Hammer, et al., 2019; D'Mello, et al., 2016).

Treatment for psoriasis may include systemic medication such as isotretinoin (prescription medication from GP or dermatologist) to normalise the abnormal cell proliferation and help in cellular renewal. In-clinic treatment such as superficial chemical peels can also perform to help the harden plaques desquamate from the outermost surface. Other treatment would be UVA photo dynamic therapy and ultrasound dermal delivery to manage the pruritus from the condition (Rendon & Knut, 2019).

We have direct referral with dermatologists in severe cases of psoriasis as this condition can be potentially a life threatening.

References:

Benhadou, F., Mintoff, D., & Del Marmol, V. (2019). Psoriasis: Keratinocytes or Immune Cells - Which Is the Trigger?. Dermatology (Basel, Switzerland), 235(2), 91-100. doi:https://doi.org/10.1159/000495291

D'Mello, S. A., Finlay, G. J., Baguley, B. C., & Askarian-Amiri, M. E. (2016). Signaling pathways in Melanogenesis. International journal of molecular sciences, 17(7), 1144. doi:https://doi.org/10.3390/ijms17071144

Hammer, G. D., & McPhee, S. J. (Eds.). (2019). Pathophysiology of Disease: An Introduction To Clinical Medicine (Eighth ed.). McGraw-Hill Education.

Rendon, A., & Knut, S. (2019). Psoriasis Pathogenesis and Treatment. International Journal of Molecular Sciences, 20(6), 1475. doi:https://doi.org/10.3390/ijms20061475