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Dermatologie

Curs: Psoriasis var. engleza


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Psoriasis

 

 

Psoriasis is an inflammatory, noncontagious, genetically determined skin disorder that most commonly appears as inflamed, edematous skin lesions covered with a silvery white scale.
Up to 2% of the population develop Ps during their lifetime.
Stress, trauma and infections may induce Ps in susceptible individuals. 
*Ps can be present at any time from the first few weeks of life until 80 or more years of age 
*Most patients experience onset in the third decade of life
*There is a definite familial tendency to inherit Ps: when one parent is affected, there is a one in four chance of Ps in each child; with two affected parents, the rate is one in two
*Some genetic linkage between Ps and the HLA-Cw6 phenotype      
 
*An infiltrate comprising activated T cells is localized in the dermal papillae of skin and the sublining layer of the joint synovium. Other key cells include various forms of dendritic cells and macrophages; B cells are present but their role is as yet not well defined. These cells generate a number of proinflammatory cytokines, such as tumor necrosis factor (TNF)-alpha, interleukin (IL)-1, and IL-6, which in turn contribute to activation of additional pathogenic cells. In the skin, through the influence of proinflammatory cytokines such as TNF-alpha, keratinocytes proliferate and have prolonged survival, leading to skin thickening and plaque. Proinflammatory cytokines such as TNF-alpha are instrumental in activating endothelial cells to express adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1), and E-selectin (upregulated more in the skin), which promote lymphocyte migration to sites of inflammation. Cutaneous lymphocyte-associated antigen (CLA) is expressed on lymphocytes homing to skin lesions, but not to areas of synovitis.
*Vascular pathology is similar in both the skin and synovium, characterized by prominent angiogenesis with abnormal tortuous vessels. Upregulation of angiogenic growth factors, partly via the action of TNF-alpha, including vascular endothelial growth factor (VEGF), transforming growth factor beta (TGF-beta), platelet-derived growth factor (PDGF), and angiopoietins contribute to this phenomenon. Neovascularization is an important component of the inflammatory, erosive nature of the disease. TNF-alpha also contributes to the increased production of proteases such as matrix metalloproteinases (MMPs), which are involved in cartilage destruction.
*Abnormal bone remodeling is a key feature of Ps arthritis. Joint-space narrowing and joint erosions occur, as well as osteolysis of both digital tufts and joint areas. However, juxta-articular periosteal new bone formation occurs, as well as ankylosis. 

 

 

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