Guías para el diagnóstico y manejo de la psoriasis
Resumen
La psoriasis es un desorden crónico inflamatorio de la piel, que afecta a un 2.6% de la población mundial. La susceptibilidad para desarrollar la psoriasis se encuentra en la región HLA del cromosoma 6, o cerca de ella. Las citoquinas involucradas incluyen interleuquinas 1-2-4-5-7-10, FNTa, IFNy, hemopoyetinas, factor estimulante de colonias granulocito-macrófago, quimioquinas, factores de crecimiento, endotelina 1. Entre los factores precipitantes se encuentran drogas, infección, alcohol y tabaquismo.
Clínicamente se caracteriza por lesiones con bordes delimitados, superficie compuesta por escamas plateadas, debajo de las cuales la piel muestra un eritema brillante y homogéneo; signo de Auspitz y fenómeno de Koebner.
A la histopatología se puede apreciar un espesor epidérmico 3-5 veces mayor, ausencia de las papilas dérmicas, paraqueratosis, aumento en el número de mitosis, y en la dermis se observan papilas finas, alongadas y prominentes, capitales tortuosos dilatados, estroma papilar edematoso,
infiltrado inflamatorio compuesto por linfocitos, macrófagos, neutrófilos y mastocitos en la dermis papilar, y microabscesos de Munro.
El diagnóstico se hace por los hallazgos clínicos e histopatológicos. Los objetivos generales del tratamiento son lograr remisiones largas y el antenimiento del paciente con pocos efectos secundarios; para ello existen diferentes estrategias terapéuticas como monoterapia, terapia combinada, terapia rotacional, terapia secuencial y terapia continua.
Biografía del autor/a
Carolina Alejandra Palacio Valencia, Universidad Militar Nueva Granada
RII Dermatología Universidad Nueva Granada, Hospital Militar Central, Bogotá, Colombia.
Referencias bibliográficas
1. Koo J, Lee E, Lee es, Lebwohl M. Psoriasis. J Am Acad Dermatol. 2004; 50(4):613-22.
https://doi.org/10.1016/j.jaad.2003.11.046
2. Koo JP population-based epidemiologic study of psoriasis with emphasis on quality of life assessment. Dermatol Clin 1996; 14(3): 485 - 96.
https://doi.org/10.1016/S0733-8635(05)70376-4
3. Leder RO, Mansbridge JN, Hallmayer J, Hodge SE. Familia! psoriasis and HLA-B: unambiguous support for linkage in 97 published families. Hum Hered 1998; 48(4): 198 - 211.
https://doi.org/10.1159/000022802
4. Elder JT, Nair RP, Henseler T, Jenisch S, Stuart P, Chia N, Christophers E, Voorhees JJ. The genetics of psoriasis 2001 > the odyssey continues. Arch Dermatol 2001; 137 (11): 1447 - 54.
https://doi.org/10.1001/archderm.137.11.1447
5. Prinz JC Psoriasis vulgaris a sterile antibacterial skin reaction mediated by cross-reactive T cell? An immunological view of pathophysiology of psoriasis. Clin Exp Dermatol 2001; 26(4): 326-32.
https://doi.org/10.1046/j.1365-2230.2001.00831.x
6. Bonifati C. Cytokines in psoriasis. lnt J Dermatol 1999; 24: 291- 5.
https://doi.org/10.1046/j.1365-4362.1999.00622.x
7. Tsankov N, Kazandjieva J, Drenovska K. Drugs in exacerbation and provocation of psoriasis. Clin Dermatol 1998; 16(3): 333-51.
https://doi.org/10.1016/S0738-081X(98)00005-4
8. Rasmussen JE. The relationship between infection with group A betta hemolitic streptococco and the development of psoriasis. Pediatr lnfect Dis J 2000; 19 (2): 153-4.
9. Higgins E. Alcohol, smoking and psoriasis. Clin Exp Dermatol 2000 25(2): 107- 10.
https://doi.org/10.1046/j.1365-2230.2000.00588.x
10. Rook. Textbook of Dermatology. Blackwell Science 6a. ed 1988; 3:1589.
11. Fitzpatrick TB, Eisen A, Wolf K, et al. Dermatology in General Medicine. USA, McGraw-Hill, 5a. ed; 2001.
12. Miller JJ.Roling D. Failure to demonstrate therapeutic tachyphylaxis to topically applied steroids in patients with psoriasis. J Am Acad Dermatol 1999; 4(4)1: 546- 9.
https://doi.org/10.1016/S0190-9622(99)80050-4
13. Katz HI, Prawer SE, Medansky RS, Krueger GG, Mooney JJ, Jones ML, Samson CR lntermitent corticosteroid maintenance treatment of psoriasis: a double-blind multicenter trial of augmented betamethasone dipropionate ointment in a pulse dose treatment regimen. Dermatológica, 1991, 183(4): 269-74.
https://doi.org/10.1159/000247698
14. Volden G. Bjornberg A, Tegner E, Pedersen NB, Arles UB, Agren S, Brolund L. Short contasct treatment at home with micanol . Acta Derm Venereol. 1992; 172, 20-2.
15. Bruce S, Epinette WW, Funicella T, lson A, Jones EL, Loss R Jr, McPhee ME, Whitmore C. Comparative study of calcipotriene ointment and fluocinonine ointment in the treatment of psoriasis. J Am Acad Dermatol 1994; 31 (5 Pt 1 ): 755-9.
https://doi.org/10.1016/S0190-9622(94)70237-3
16. Lebwohl LM, Yoles A, Lombardi K, Lou W. Calcipotriene ointment and halobetasol ointment in the long-term treatment of psoriasis : effects on the duration of improvement. J Am Acad Dermatol 1998; 39(3): 447-50.
https://doi.org/10.1016/S0190-9622(98)70323-8
17. Patel B, Siskin S, Krazmien R, Lebwohl M. Compatibility of calcipotriene with other topical medications. J Am Acad Dermatol 1998; 38(6 Pt 1 ): 1010-1.
https://doi.org/10.1016/S0190-9622(98)70171-9
18. Lebwoht M. Strategies to optimize efficacy duration of remission and safety in the treatment of plaque psoriasis by using tazarotene in combination with a corticosteroid. J Am Acad Dermatol, 2000; 43(2 Pt 3): S43-6.
https://doi.org/10.1067/mjd.2000.108319
19. Hecker D, Worsley J, Yueh G, Kuroda K, Lebwohl M. lnteractions between tazarotene and ultraviolet light. .J Am Acad Dermatol 1999; 41 (6): 927-30.
https://doi.org/10.1016/S0190-9622(99)70248-3
20. Schissel DJ, Elston DM. Topical 5 FU treatment for psoriatic trachonychia. Cutis 1998; 62 (1): 27-8.
21. Nouri K, Chartier TK, Eaglstein WH, Taylor JR. Cryoteraphy for psoriasis. Arch Dermatol 1997; 133 (12): 1608-9.
https://doi.org/10.1001/archderm.1997.03890480134028
22. Stern RS. Non-melanoma skin cancer occurring in patiens treatment with PUVA five to ten years after first treatment. J lnvest Dermatol 1988; 91: 120-4.
https://doi.org/10.1111/1523-1747.ep12464137
23. Stern RS, Laird N. The carcinogenic risk of treatment of severe psoriasis. Photochemotherapy follow-up study. Cancer 1994; 73(11 ):2759-64.
https://doi.org/10.1002/1097-0142(19940601)73:11<2759::AID-CNCR2820731118>3.0.CO;2-C
24. Walters IB, BurackLH, Coven TR, Gilleaudeau P, Krueger JG. Suberythemogenic narrow band UVB is markedly more effective than conventional UVB in treatment of psoriasis vulgaris. J Am Acad Dermatol 1999; 40(6 Pt 1 ): 893-900.
https://doi.org/10.1016/S0190-9622(99)70076-9
25. Feldman SR, Mellen BG, Housman TS, Fitzpatrick RE, Geronemus RG, Friedan PM. Efficacy of the 308 - nm excimer laser for treatment of psoriasis: results of a multicenter study. J Am Acad Dermatol 2002; 46 (6) :900- 6.
https://doi.org/10.1067/mjd.2002.120454
26. Roenigkl HH Jr, Auerbach R, Maibach H, Weinstein G, Lebwohl M. Methotrexate in psoriasis: consensus conference. J Am Acad Dermatol 1998; 38(3): 478-85.
https://doi.org/10.1016/S0190-9622(98)70508-0
27. Gutierrez S. Pancitopenia secondary to MTX therapy in AR. Arthritis Rheumatol 1996; 39: 272 - 276.
https://doi.org/10.1002/art.1780390214
28. Malatja D. MTX hepatotoxicity in psoriatic patients submited to long - term therapy. J Gastroenterol 1996; 1 O: 369 -75.
29. Roenigk HH Jr, Auerbach R, Maibach HI, Weinstein GD. Methotrexate in psoriasis: revised guidelines. J Am Acad Dermatol. 1988; 19(1 Pt 1 ): 145-56.
https://doi.org/10.1016/S0190-9622(88)80237-8
30. Lebwohl M, Ali S. Treatment of psoriasis. Part 2. Systemic therapies. J Am Acad Dermatol 2001; 45 (5): 649- 61.
https://doi.org/10.1067/mjd.2001.117047
31. Zachariae H, Steen Olsen T. Efficacy of cyclosporin A (CyA) in Psoriasis: an overview of dose/response, indications, contraindications and side-effects. Clin Nephrol 1995:43(3): 154-158.
32. Srivastava T, Zwick DL, Rothberg PG, Warady BA. Posttransplant lymphoproliferative disorder in pediatrie renal transplantation. Prediatic Nephol 1999; 13(9):748-54.
https://doi.org/10.1007/s004670050692
33. Solganic J, Tan MH. Adverse effects of systemic treatments: Cyclosporine. Psoriasis Forum 1998; 4-5.
https://doi.org/10.1177/247553039804a00104
34. Systemic tacrolimus (FK 506) is effective for the treatment of psoriasis in a double-blind, placebo-controlled study. The European FK 506 Multicentre Psoriasis Study Group ARCDermatol 1996; 132(4):419-23.
https://doi.org/10.1001/archderm.132.4.419
35. Callen JP, Krueger GG, Lebwohl M, McBurney El, Mease P, Menter A, Palier AS , Pariser DM, Weinblatt M, Zimmerman G; AAD. AAD consensus statement on psoriasis therapies. J Am Acad Dermatol. 2003; 49(5):897-9.
https://doi.org/10.1016/S0190-9622(03)01870-X
36. Lebwohl M. lnnovations in the treatment of psoriasis. J Am Acad Dermatol. 2004; 51(1 Suppl):S40-1.
37. Lebwohl M, Ali S. Treatment of psoriasis. Part 1. Topical therapy and phototherapy. J Am Acad Dermatol. 2001; 45(4):487-98; quiz 499-502.
https://doi.org/10.1067/mjd.2001.117046
https://doi.org/10.1016/j.jaad.2003.11.046
2. Koo JP population-based epidemiologic study of psoriasis with emphasis on quality of life assessment. Dermatol Clin 1996; 14(3): 485 - 96.
https://doi.org/10.1016/S0733-8635(05)70376-4
3. Leder RO, Mansbridge JN, Hallmayer J, Hodge SE. Familia! psoriasis and HLA-B: unambiguous support for linkage in 97 published families. Hum Hered 1998; 48(4): 198 - 211.
https://doi.org/10.1159/000022802
4. Elder JT, Nair RP, Henseler T, Jenisch S, Stuart P, Chia N, Christophers E, Voorhees JJ. The genetics of psoriasis 2001 > the odyssey continues. Arch Dermatol 2001; 137 (11): 1447 - 54.
https://doi.org/10.1001/archderm.137.11.1447
5. Prinz JC Psoriasis vulgaris a sterile antibacterial skin reaction mediated by cross-reactive T cell? An immunological view of pathophysiology of psoriasis. Clin Exp Dermatol 2001; 26(4): 326-32.
https://doi.org/10.1046/j.1365-2230.2001.00831.x
6. Bonifati C. Cytokines in psoriasis. lnt J Dermatol 1999; 24: 291- 5.
https://doi.org/10.1046/j.1365-4362.1999.00622.x
7. Tsankov N, Kazandjieva J, Drenovska K. Drugs in exacerbation and provocation of psoriasis. Clin Dermatol 1998; 16(3): 333-51.
https://doi.org/10.1016/S0738-081X(98)00005-4
8. Rasmussen JE. The relationship between infection with group A betta hemolitic streptococco and the development of psoriasis. Pediatr lnfect Dis J 2000; 19 (2): 153-4.
9. Higgins E. Alcohol, smoking and psoriasis. Clin Exp Dermatol 2000 25(2): 107- 10.
https://doi.org/10.1046/j.1365-2230.2000.00588.x
10. Rook. Textbook of Dermatology. Blackwell Science 6a. ed 1988; 3:1589.
11. Fitzpatrick TB, Eisen A, Wolf K, et al. Dermatology in General Medicine. USA, McGraw-Hill, 5a. ed; 2001.
12. Miller JJ.Roling D. Failure to demonstrate therapeutic tachyphylaxis to topically applied steroids in patients with psoriasis. J Am Acad Dermatol 1999; 4(4)1: 546- 9.
https://doi.org/10.1016/S0190-9622(99)80050-4
13. Katz HI, Prawer SE, Medansky RS, Krueger GG, Mooney JJ, Jones ML, Samson CR lntermitent corticosteroid maintenance treatment of psoriasis: a double-blind multicenter trial of augmented betamethasone dipropionate ointment in a pulse dose treatment regimen. Dermatológica, 1991, 183(4): 269-74.
https://doi.org/10.1159/000247698
14. Volden G. Bjornberg A, Tegner E, Pedersen NB, Arles UB, Agren S, Brolund L. Short contasct treatment at home with micanol . Acta Derm Venereol. 1992; 172, 20-2.
15. Bruce S, Epinette WW, Funicella T, lson A, Jones EL, Loss R Jr, McPhee ME, Whitmore C. Comparative study of calcipotriene ointment and fluocinonine ointment in the treatment of psoriasis. J Am Acad Dermatol 1994; 31 (5 Pt 1 ): 755-9.
https://doi.org/10.1016/S0190-9622(94)70237-3
16. Lebwohl LM, Yoles A, Lombardi K, Lou W. Calcipotriene ointment and halobetasol ointment in the long-term treatment of psoriasis : effects on the duration of improvement. J Am Acad Dermatol 1998; 39(3): 447-50.
https://doi.org/10.1016/S0190-9622(98)70323-8
17. Patel B, Siskin S, Krazmien R, Lebwohl M. Compatibility of calcipotriene with other topical medications. J Am Acad Dermatol 1998; 38(6 Pt 1 ): 1010-1.
https://doi.org/10.1016/S0190-9622(98)70171-9
18. Lebwoht M. Strategies to optimize efficacy duration of remission and safety in the treatment of plaque psoriasis by using tazarotene in combination with a corticosteroid. J Am Acad Dermatol, 2000; 43(2 Pt 3): S43-6.
https://doi.org/10.1067/mjd.2000.108319
19. Hecker D, Worsley J, Yueh G, Kuroda K, Lebwohl M. lnteractions between tazarotene and ultraviolet light. .J Am Acad Dermatol 1999; 41 (6): 927-30.
https://doi.org/10.1016/S0190-9622(99)70248-3
20. Schissel DJ, Elston DM. Topical 5 FU treatment for psoriatic trachonychia. Cutis 1998; 62 (1): 27-8.
21. Nouri K, Chartier TK, Eaglstein WH, Taylor JR. Cryoteraphy for psoriasis. Arch Dermatol 1997; 133 (12): 1608-9.
https://doi.org/10.1001/archderm.1997.03890480134028
22. Stern RS. Non-melanoma skin cancer occurring in patiens treatment with PUVA five to ten years after first treatment. J lnvest Dermatol 1988; 91: 120-4.
https://doi.org/10.1111/1523-1747.ep12464137
23. Stern RS, Laird N. The carcinogenic risk of treatment of severe psoriasis. Photochemotherapy follow-up study. Cancer 1994; 73(11 ):2759-64.
https://doi.org/10.1002/1097-0142(19940601)73:11<2759::AID-CNCR2820731118>3.0.CO;2-C
24. Walters IB, BurackLH, Coven TR, Gilleaudeau P, Krueger JG. Suberythemogenic narrow band UVB is markedly more effective than conventional UVB in treatment of psoriasis vulgaris. J Am Acad Dermatol 1999; 40(6 Pt 1 ): 893-900.
https://doi.org/10.1016/S0190-9622(99)70076-9
25. Feldman SR, Mellen BG, Housman TS, Fitzpatrick RE, Geronemus RG, Friedan PM. Efficacy of the 308 - nm excimer laser for treatment of psoriasis: results of a multicenter study. J Am Acad Dermatol 2002; 46 (6) :900- 6.
https://doi.org/10.1067/mjd.2002.120454
26. Roenigkl HH Jr, Auerbach R, Maibach H, Weinstein G, Lebwohl M. Methotrexate in psoriasis: consensus conference. J Am Acad Dermatol 1998; 38(3): 478-85.
https://doi.org/10.1016/S0190-9622(98)70508-0
27. Gutierrez S. Pancitopenia secondary to MTX therapy in AR. Arthritis Rheumatol 1996; 39: 272 - 276.
https://doi.org/10.1002/art.1780390214
28. Malatja D. MTX hepatotoxicity in psoriatic patients submited to long - term therapy. J Gastroenterol 1996; 1 O: 369 -75.
29. Roenigk HH Jr, Auerbach R, Maibach HI, Weinstein GD. Methotrexate in psoriasis: revised guidelines. J Am Acad Dermatol. 1988; 19(1 Pt 1 ): 145-56.
https://doi.org/10.1016/S0190-9622(88)80237-8
30. Lebwohl M, Ali S. Treatment of psoriasis. Part 2. Systemic therapies. J Am Acad Dermatol 2001; 45 (5): 649- 61.
https://doi.org/10.1067/mjd.2001.117047
31. Zachariae H, Steen Olsen T. Efficacy of cyclosporin A (CyA) in Psoriasis: an overview of dose/response, indications, contraindications and side-effects. Clin Nephrol 1995:43(3): 154-158.
32. Srivastava T, Zwick DL, Rothberg PG, Warady BA. Posttransplant lymphoproliferative disorder in pediatrie renal transplantation. Prediatic Nephol 1999; 13(9):748-54.
https://doi.org/10.1007/s004670050692
33. Solganic J, Tan MH. Adverse effects of systemic treatments: Cyclosporine. Psoriasis Forum 1998; 4-5.
https://doi.org/10.1177/247553039804a00104
34. Systemic tacrolimus (FK 506) is effective for the treatment of psoriasis in a double-blind, placebo-controlled study. The European FK 506 Multicentre Psoriasis Study Group ARCDermatol 1996; 132(4):419-23.
https://doi.org/10.1001/archderm.132.4.419
35. Callen JP, Krueger GG, Lebwohl M, McBurney El, Mease P, Menter A, Palier AS , Pariser DM, Weinblatt M, Zimmerman G; AAD. AAD consensus statement on psoriasis therapies. J Am Acad Dermatol. 2003; 49(5):897-9.
https://doi.org/10.1016/S0190-9622(03)01870-X
36. Lebwohl M. lnnovations in the treatment of psoriasis. J Am Acad Dermatol. 2004; 51(1 Suppl):S40-1.
37. Lebwohl M, Ali S. Treatment of psoriasis. Part 1. Topical therapy and phototherapy. J Am Acad Dermatol. 2001; 45(4):487-98; quiz 499-502.
https://doi.org/10.1067/mjd.2001.117046
Cómo citar
1.
Palacio Valencia CA. Guías para el diagnóstico y manejo de la psoriasis. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 1 de diciembre de 2005 [citado 23 de abril de 2024];13(4):287-300. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/547
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2005-12-01
Cómo citar
1.
Palacio Valencia CA. Guías para el diagnóstico y manejo de la psoriasis. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 1 de diciembre de 2005 [citado 23 de abril de 2024];13(4):287-300. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/547
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