Overall, the way psoriasis develops is unpredictable, alternating between flares and more or less complete remissions. Everything takes place as if, under certain conditions - probably genetically determined for many patients, external events were capable of triggering outbreaks or facilitating remissions. These events vary from one sufferer to another, and it seems particularly important for each sufferer, with the help of his or her dermatologist and GP, to try to identify the factors responsible for flares or favourable to remissions. This self-observation will allow sufferers to manage their illness with increasing success and to greatly enhance the effectiveness of treatment.
A number of trigger factors have been identified:
- the skin traumas responsible for the phenomenon described by Köebner are the most familiar. Köebner’s phenomenon is chiefly observed in subjects undergoing a flare, but also in patients whose disorder started early in life and who present frequent relapses. Köebner’s phenomenon is observed in 38 to 76% of patients, according to studies. Psoriasis plaque appears one to two weeks after the triggering trauma (photos 44 and 45). The traumas concerned are extremely varied. Mechanical traumas spring firstly to mind (photo 46), of course, but any cutaneous inflammation connected with external agents or pathological events can bring upon a Köebner’s response. Therefore, one needs to look for evidence of contact eczema, of secondary skin infection, of lichen planus, of toxidermia or of scabies. Interestingly, psoriasis appears sometimes on a vitiligo patch, and there is no knowing of which direction Köebner’s phenomenon is working in: is the psoriasis promoting the vitiligo patch or vice versa? At experimental level, the majority of skin traumas can bring upon a Köebner’s response, but in order to observe this phenomenon, an epidermal and dermal wound usually has to be induced. It is noteworthy, however, that a psoriatic patch can be induced to appear after a suction or cantharidin blister is produced and the blister’s roof is removed.
- Infections, especially streptococcal sore throat, are a classic trigger for psoriasis and, particularly in children, for guttate psoriasis. The classic notion according to which eruptive guttate psoriasis disappears more easily is currently being questioned. On the contrary, it would seem that psoriasis that starts during infancy is often more progressive and more resistant to treatment.
- Endocrine factors can influence psoriasis, and more frequent attacks are observed at puberty and menopause. Psoriasis remains unmodified by pregnancy in 40% of female patients; in others, it may be improved or exacerbated, without being reproducible from one pregnancy to another in the same patient.
- The sun, and particularly sunshine coupled with sea baths have a favourable influence on psoriasis in 70% of patients. [|The effect of salt water
alone is very small.|auteur193] The two have no effect in 20%. They can aggravate psoriasis in 10% of patients.
- Excess alcohol consumption is significantly linked with the occurrence of psoriasis. It is not known whether alcohol is directly to blame for eruptions or if such drinking is associated to a decrease in therapeutic compliance. It is certain that alcohol abuse lessens the efficacy of systemic treatments, probably by altering the metabolism of these drugs: psoralens, retinoids, methotrexate (whose toxicity it also increases) and probably cyclosporine. It is important to explain to patients that it is impossible to keep control of their psoriasis if they are incapable of keeping control of their alcohol consumption.
- The emotions have long been recognized as being able to trigger a psoriasis attack. A major emotion shortly before the first psoriasis attack is found in 46 to 80% of patients, according to studies. The psoriasis flare occurs between a fortnight and several months after the emotional trigger. The emotions are often connected with an acute or chronic attack in the areas in which any individual expresses himself (affective, professional, intellectual, artistic...). The patient is often someone who keeps his emotions under excessively tight rein or gives them little or no airing. The whole thing takes place, then, as if the patient was expressing some pent-up sensitivity through the skin, due to a particular genetic condition. It is very important to explore this avenue with the patient, because if this correlation is confirmed, any technique that allows him to give free rein to his emotions will make treatment more effective, making easier to keep the illness under control on the long run and allowing some alleviation of the psychological suffering caused by the illness.
- If tracing stress and emotions is an important part of a psoriasis flare beginnings, it is equally important not to forget medication. Independently of the toxidermias, all of which can trigger Köebner’s phenomenon, some drugs may aggravate or trigger a psoriasis attack. The most well known are the beta-blockers, lithium, an abrupt halt in systemic corticotherapy. Synthetic antimalarial agents may trigger severe attacks in some patients, but this complication is rare. Non-steroidal anti-inflammatory drugs (NSAID) may favour an inflammatory attack. Less frequently, potassium iodide, progesterone, the sulphonamides and clonidine have been held responsible for these attacks. Interestingly, some attacks of the disease have been clearly linked with taking angiotensin-converting enzyme inhibitors and calcium inhibitors, thus making the treatment of hypertension difficult in psoriatic patients.
[|The role of trauma, infections, endocrine aspects, diet and excess alcohol consumption, is well discussed. A fact in psoriasis that intrigues me, and which was the subject of 2 major international meetings in 2006 and 2008 under the auspices of the International Psoriasis Council, is obesity. Why is the average weight of patients in the United States entering a clinical research study over 90 Kg? Admittedly, two thirds of these are males, but even in Europe the average weight is over 80 Kg, which appears to be higher than the non-psoriatic population. Does obesity trigger psoriasis or does psoriasis trigger obesity? Are the genetic factors triggering both? The comorbidities associated with obesity, including liver disease, diabetes, cardiac disease, have to be carefully explored in the psoriatic population as well as the increase in mortality in patients with more severe psoriasis.|auteur215]
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Recent publications on Psoriasis and Atopic Dermatitis
Integrated analysis of gene expression profiles identifies transcription factors potentially involved in psoriasis pathogenesis.
J. Cell. Biochem.. 2019 Aug , 120, (8):12582-12594.
Psoriasis is a common inflammatory skin disease mediated by cells and molecules in both the innate and adaptive immune systems. Recently, gene expression profile analysis revealed a large set of immune-related differentially expressed genes (DEGs) in psoriasis. However, the associations between these DEGs and their transcriptional regulation mechanisms have not been completely elucidated. In this study, several psoriasis Gene Expression Omnibus data sets were systematically analyzed using (...)see on pubmed
Models of human psoriasis: Zebrafish the newly appointed player.
Dev. Comp. Immunol.. 2019 Aug , 97:76-87.
Psoriasis is a human chronic, immune disease with severe cutaneous and systemic manifestations. Its prevalence, among the world population, highly varies with ethnicity and geography, but not sex from remarkable low levels in Asia to 2.3% in Spain, or an impressive 11.5% in Norway. The pathogenesis of psoriasis derives from complex genetic and environmental interactions, which creates aberrant crosstalk between keratinocytes and variated immune cell, resulting in open amplified inflammatory (...)see on pubmed
A vivid cytokines interaction model on psoriasis with the effect of impulse biologic (TNF-α inhibitor) therapy.
J. Theor. Biol.. 2019 Aug 07, 474:63-77.
Psoriasis is a chronic skin condition that produces plaques of condensed, scaling skin due to excessively rapid proliferation of keratinocytes. During the disease progression, keratinocyte proliferation is influenced by many immune cells and cytokines. This article deals with a five dimensional deterministic model, which has been derived using quasi-steady-state approximation for describing the dynamics of psoriasis in various cytokines environment. Equilibrium analysis of the system shows (...)see on pubmed
Synthesis of chitosan derivatives with organoselenium and organosulfur compounds: Characterization, antimicrobial properties and application as biomaterials.
Carbohydr Polym. 2019 Sep 01, 219:240-250.
In this study, Schiff bases of chitosan (CS) were synthesized using citronellal, citral, and their derivatives containing selenium and sulfur. Organoselenium and organosulfur compounds show attractive biological and pharmaceutical activities, which can be beneficial to CS-based materials. From the characterization analyses, it was found that the CS-derivatives containing organoselenium and organosulfur compounds exhibited the highest conversion degrees (23 and 28%). Biological assays were (...)see on pubmed
Skin inflammation induced by ambient particulate matter in China.
Sci. Total Environ.. 2019 Sep 10, 682:364-373.
Most published studies on particulate matter (PM) concerning PM and PM have focused on PM-induced effects on the respiratory system (particularly lung) and cardiovascular system effects. However, epidemiological and mechanistic studies suggest that PM and PM also affects the skin, which is a key health issue. In this study, we first reviewed the current status of PM and PM in China, including relevant regulations, concentration levels, chemical components, and emission sources. Next, we (...)see on pubmed
Effect of cinnamamides on atopic dermatitis through regulation of IL-4 in CD4 cells.
J Enzyme Inhib Med Chem. 2019 Dec , 34, (1):613-619.
This study aimed to evaluate the effects of cinnamamides on atopic dermatitis (AD) and the mechanisms underlying these effects. To this end, the actions of two cinnamamides, (E)-3-(4-hydroxyphenyl)-N-phenylethyl acrylamide (NCT) and N-trans-coumaroyltyramine (NCPA), were determined on AD by orally administering them to mice. Oral administration of the cinnamamides ameliorated the increase in epidermal and dermal thickness as well as mast cell infiltration. Cinnamamides suppressed serum (...)see on pubmed