[|I agree to the historical overview, but miss the
history of psoriatic arthritis, where the association between psoriasis and
arthritis was first noted by Alibert in 1818, and the term psoriatic arthritis
(psoriasis arthritiques) first used by the French physician Pierre Bazin
in 1860. In the late19th and
early 20th century however, there was no consensus that psoriatic
arthritis was an entity of its own. But
following the clarification of a circulating rheumatoid factor associated with
rheumatoid arthritis in 1948 and a later
finding that the majority of patients with arthritis and psoriasis were
seronegative a distinction became
easier. In spite of this, opposing
concepts of psoriatic arthritis still went on in the early nineteen sixties. Eugene Farber supported a smaller group of
rheumatologists who kept holding on so-called psoriatic arthritis as a
coincidental association between rheumatoid arthritis and psoriasis, while the
majority of rheumatologists lead by Wright & Moll presented their evidence
for the distinction between the two entities. An assumption which to-day is well established.|auteur196]
[|Psoriasis has always “lagged behind” other autoimmune (immune-mediated) diseases such as rheumatoid arthritis, Crohn’s disease, and even lupus erythematosus. The “fathers of psoriasis” mentioned in this chapter, including Willan, Köbner, Auspitz, and Munro, paved the way for the modern generation to understand not only the clinical manifestations but the genetics and immunopathology of this unique disease called “psoriasis”. I enjoyed the discussion relating to serendipitous discoveries of important treatments, some of which are still in use today. I do believe dermatologists need to be given a great deal of credit for the initial use of methotrexate well before our rheumatology colleagues discovered it for rheumatoid arthritis. Thus, a number of California dermatologists in the 1950’s established aminopterin, the forerunner of methotrexate, as a viable treatment option for psoriasis. Thereafter, with dogged determination, they continued to conduct clinical studies with methotrexate until finally the Food and Drug Administration of the United States “gave way” in 1971 and approved methotrexate usage for what they considered a “benign skin disorder”. Another serendipitous discovery in the history of psoriasis, which I do believe changed the total research focus on psoriasis from that of a hyperproliferative epidermal disease to a T-cell driven disease was that of ciclosporin’s value in the treatment of psoriasis in 1979. This brings us to the 21st century and the biological revolution, a direct result of our understanding of how ciclosporin affects T-cells.|auteur215]
The history of psoriasis falls under four headings: a social history, an identification process, the search for aetiology and the development of therapy. Each of these approaches shed light on the present-day situation in its own particular way.
In social terms, psoriasis clearly is and always has been a part of those disorders that bring with it social exclusion. Having been long confused with leprosy, it led since biblical times to a verdict of social exclusion on the grounds of impurity. This form of branding persists down to this day, and the look of others is often to blame for the psychological suffering caused by psoriasis and hence for its severity.
The development of semiology applied to the skin, based on the analysis of the elementary lesions, enabled psoriasis to be identified at the heart of the large group of squamous or scaling dermatoses by Robert Willan in 1805. Interestingly, psoriasis is described by this author in two chapters: the one entitled psoriasis and the one entitled leprosy. In it, psoriasis is called Lepra vulgaris, a good illustration of the old confusion between the two diseases. Today the question is one of knowing whether psoriasis is an illness with various clinical manifestations or rather a syndrome grouping together diseases with different physiopathologies, whose only common trait is clinical manifestations linking proliferation, abnormal differentiation of epidermis and skin inflammation.
The succession of theories about the cause of psoriasis is also very interesting, with confusion still prevailing in the minds of patients between the causes and the triggers.
The interactions between microbial agents and psoriasis are still under study. Bacteria can play the role of super antigen, and some believe that fragments of the HPV genome in the lesions can trigger the inflammatory reaction.
The isomorphic response described by Köebner in 1872 still arouses excitement. It remains the only model that allows studying the kinetics of the emergence of a psoriatic lesion. Recall that this reaction requires an attack on the epidermis and the dermis.
Psychological factors have only been taken into account much more recently. This approach is associated in particular with the works of P. de Graciansky in the 1960s.
The development of histology during the second half of the 19th century, enabled in particular Auspitz and Munro to identify acanthosis, parakeratosis and neutrophilic polynuclear microabscesses. Thirty years ago, I. Braverman drew attention to the importance and persistence of anomalies in the microcirculation of the superficial dermis in psoriasis plaques. Only very recently, thanks to the development of immunopathology enabling intratissual identification of the lymphocytic subpopulations, has the attention been directed towards the importance of T lymphocyte infiltrates, CD 4 predominating in the dermis and CD8 predominating in the epidermis. Progress in cellular biology has allowed research on psoriasis to be focused firstly on epidermal proliferation, then on the role of the epidermal inflammation mediators, then on the role of the neutrophils on the maintenance of psoriatic plaques, then on the anomalies of the non-lesional psoriatic skin, then on the role of the fibroblasts in epidermal proliferation, then on the role of proteases expressed in the subcorneal region and finally on the role of lymphocytes T activation. As a result of advances in molecular genetics, analysing families affected by psoriasis has made it possible to try to identify the gene modifications implicated in this illness. Progress in immunology is currently allowing the study of lymphocytic activation mechanisms in psoriasis and ways of controlling this activation pharmacologically. Finally, there are around ten models of genetically modified mice expressing skin anomalies reminiscent of psoriasis: inflammation and epidermal proliferation. The multiplicity of these animal models is a powerful argument for thinking that numerous genetic anomalies may result in a common phenotype with the clinical and histological features of psoriasis.
As to the treatments for psoriasis, most have been discovered by chance. The reason for this is that the majority of the new therapeutic families discovered throughout time have been empirically tried on psoriasis: sulphur, tar, arsenic, salicylic acid, chrysophanic acid, X-rays in the 19th century, anthralin, UV rays, psoralens, topical and systemic corticosteroids, then methotrexate, retinoids, cyclosporine, and calcipotriol in the 20th century. The reasons for these drugs’ antipsoriatic activity are not known with certainty, and the molecular targets responsible for their activity are poorly understood. Only very recently, synthesized biological molecules to inhibit a particular cellular interaction or a specific cytokine have been made available to patients. In the course of this therapeutic development, we have progressed from a situation in which efficacy was the main preoccupation to a period when the efficacy/toxicity ratio was the main assessment criterion, to finally arrive to a point where, in addition to the preceding criteria, account is taken of the treatment’s impact on the patients’ quality of life.
- 2019/08/12 Focus on...Latin American Clinical Practice Guidelines on the Systemic Treatment of Psoriasis
- 2019/06/03 Focus on...News from our SPIN Columbian members
- 2019/05/21 Focus on...SPIN2019 is now available on your screen!
- 2019/04/18 Focus on...SPIN Congress 2019 in Paris coming soon
- 2019/04/17 Focus on...Do not miss Spin Congress 2019 highlights
News from the web office
- 2017/06/05PIN becomes SPIN - Skin Inflammation & Psoriasis International Network
- 2016/10/29PSO 2016 Congress - Webcasts Available!
- 2016/05/26PIN Survey on Phototherapy
- 2016/02/20PIN Study on Therapeutic Patient Education
- 2016/02/19World Directory of Psoriasis Medical Resources - February 2016 Update
- 2019/04/18 Focus on...SPIN Congress 2019 in Paris coming soon
- 2018/07/16SPIN Symposium at the Spring continental meeting - Tehran, 25-27 April 2018
- 2018/02/222nd National Meeting of the Egyptian Society for Psoriasis
- 2018/02/211st Psoriasis Symposium - Sarajevo 2017
- 2017/06/2815th São Paulo Meeting of Psoriasis and Vitiligo
News from medical groups
- 2018/04/183rd Turkish National Psoriasis Symposium
- 2017/06/21Brazilian Center for Psoriasis Studies joins SPIN!
- 2017/06/21Costa Rica Psoriasis Group - Meet them!
- 2017/02/02Works of the 1st Senegalese Psoriasis Day published!
- 2016/07/29Swiss S1 Guidelines for Systemic treatment of psoriasis vulgaris
News from patients associations
- 2017/02/08France Psoriasis - 2016 World Psoriasis Day
- 2016/05/26Senegal Patients Association joins PIN!
- 2015/08/04Epidermia Greece: a new partner association of PIN
- 2015/08/01Canadian Association of Psoriasis Patients joins PIN!
- 2015/04/09AEPSO Argentina launches digital map to find people with psoriasis in the country
Recent publications on Psoriasis and Atopic Dermatitis
JAK-inhibitors in dermatology: current evidence and future applications.
J Dermatolog Treat. 2019 Nov , 30, (7):648-658.
The Janus kinase (JAK) and signal transducer and activator of transcription (STAT) pathway is a ubiquitous intracellular signaling network. Selective JAK-inhibitors have anti-inflammatory properties and have been approved in many countries for the treatment of rheumatoid arthritis (tofacitinib, baricitinib) and myelofibrosis or polycythemia vera (ruxolitinib). The aim of the publication was to summarize and critically analyze the efficacy and safety of JAK-inhibitors in skin diseases, such (...)see on pubmed
Patient preferences for attributes of topical anti-psoriatic medicines.
J Dermatolog Treat. 2019 Nov , 30, (7):659-663.
Patient preferences should be considered when prescribing topical treatments to drive up adherence and improve clinical outcomes. The aim of this work was to identify the most important attributes of topical medicines for psoriasis treatment in the patients' view, and explore the sociodemographic and clinical determinants of these preferences. A questionnaire for the evaluation of the relevancy given to specific attributes of topical medicines used for psoriasis treatment was developed (...)see on pubmed
Salidroside inhibits MAPK, NF-κB, and STAT3 pathways in psoriasis-associated oxidative stress via SIRT1 activation.
Redox Rep.. 2019 Dec , 24, (1):70-74.
To unveil the role of SIRT1 in limiting oxidative stress in psoriasis and to further discuss the therapeutic prospects of salidroside in psoriasis. Literature from 2002 to 2019 was searched with "psoriasis", "oxidative stress", "SIRT1", "salidroside" as the key words. Then, Oxidative stress in psoriasis and the role of SIRT1 were summarized and the potential role of salidroside in the disease was speculated. Oxidative stress might contribute to the pathogenesis of psoriasis. High levels (...)see on pubmed
A case of infective endocarditis associated with atopic dermatitis perioperatively treated with dupilumab.
J Dermatolog Treat. 2019 Nov , 30, (7):674-676.
Several case reports and reviews support a relationship between atopic dermatitis (AD) and infective endocarditis (IE). Here, we present a case of severe AD suspected of causing IE. A 21-year-old man with severe AD was admitted to our hospital due to unidentified fever, syncope, and headache. He was diagnosed with IE with cerebral embolism and mitral regurgitation. Before elective cardiac surgery, he was subcutaneously administered dupilumab for 2 months to control AD. Dupilumab improved (...)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
Sublingual immunotherapy of atopic dermatitis in mite-sensitized patients: a multi-centre, randomized, double-blind, placebo-controlled study.
Artif Cells Nanomed Biotechnol. 2019 Dec , 47, (1):3540-3547.
Allergen-specific immunotherapy is widely used for allergic rhinitis and asthma treatment worldwide. This study explored the efficacy and safety of sublingual immunotherapy (SLIT) with the extracts of ( Drops) on house dust mites (HDM)-induced atopic dermatitis (AD). 239 patients with HDM-induced AD were recruited and exposure to a multi-centre, randomized, double-blind, and placebo-controlled clinical trials for 36 weeks, which were randomly divided into placebo and sublingual Drops (...)see on pubmed