General Guidelines for the Detection, Diagnosis and Treatment of Psoriasis

While it is true that the inflammation, rash and lacerations of the skin can be caused by allergic reactions or dermatitis, the possibility of diagnosing psoriasis should not be ruled out.

Dr. Damaris Torres Paoli, current president of the Dermatological Society of Puerto Rico. Photo: Journal of Medicine and Public Health, Fabiola Plaza.

In Puerto Rico, it is estimated that at least 35,000 to 100,000 people suffer from psoriasis. Generally, this condition concerns the palms of the hands, the soles of the feet, the nails, the labial semi-mucosa and/or the genital mucosa; it depends on the manifestations and the type of psoriasis that develops.

In addition to this, studies have shown that patients with this condition are more likely to be diagnosed with depression, Crohn’s disease, metabolic syndrome, uveitis, certain types of cancer, and certain forms of arthritis; in fact, the medical literature indicates that between 10% and 30% of patients with psoriasis develop psoriatic arthritis.

Based on the prevalence data of this condition on the island, the Journal of Medicine and Public Health spoke with Dr. Damaris Torres Paoli, current president of the Dermatological Society of Puerto Rico, in an attempt to dig deeper into the main diagnostic criteria for this condition. .

What is certain is that psoriasis it does not appear in the same way in all patients, many factors depend on it, among which it is worth highlighting, first of all, the type of this condition that develops, “for example, we can have patients patients with psoriasis only on the scalp who are also diagnosed with a form of arthritis,” he said.

An important point for the expert, begins from the consultation with the primary care physician, since it ensures that the professional in this area must be clear about the typical lesions of this pathology, such as reddish patches with scalesand the areas of the body where they occur.

“When patients go to medical offices with photos similar in which there is also peeling of the skin, it should be suspected that these manifestations can be triggered by adverse effects of certain drugs or an allergy. But also, you should think about the possibility that this patient has psoriasis.

The expert added that psoriasis It has many variants, among which are: plaque psoriasis, which is characterized by plaques on the elbows, knees, back, between the buttocks, in the navel; psoriasis in gout which usually occurs after a strep infection and can also be seen in children. psoriasis The reverse, on the other hand, tends to appear in typical areas such as the elbows, under the breasts, between the folds or under the armpits.

“A lot of times psoriasis The reverse is treated as a fungus because it occurs in areas of heat and sweat, so people think it’s candida. However, when you start treatment with antifungals, the patient is not going to see any improvement,” he explained. psoriasis Conversely, you don’t necessarily see the silvery scales on the skin, but you do see very burning or itchy reddish patches in those crease areas.”

Another area in which it develops psoriasis and this can generate great confusion, it is precisely in the nails, because just like psoriasis reversed, the nail variant can mimic fungus due to “pitting” on the outer layer or oily feeling under the nails.

“The first step is observation and evaluation; it is prudent to ask the patient about their manifestations,” he added. “Some patients may have palmoplantar psoriasis, but it’s mistaken for hand dermatitis, dyshidrotic dermatitis, or an allergic reaction.”

There are patients who start with the disease, but in general family history also plays an important role, so it is important to take this into account when providing a diagnosis to the individual.

Diagnosis and treatment of psoriasis

Despite the fact that at first glance the specialist determines that the clinical picture corresponds to psoriasisit is necessary to perform a biopsy to exclude other pathologies such as cutaneous lymphoma (a type of skin cancer).

However, once the patient is assessed by the attending physician, he is given topical steroids as the skin lesions respond favorably to these, however, when there is no improvement in symptoms, the patient is referred to a dermatologist for a diagnosis. .

“For the treatment of psoriasis, topical steroids are used. Now there are more vitamin D-derived creams that work too, and there are professionals who can recommend intramuscular steroids,” he said. “This last option is rather dangerous, because once the symptoms of psoriasisthere may be a flare-up and the patient may develop pustular psoriasis.”

When psoriasis it is in a moderate to severe stage, it is usually treated with biological products. However, the expert states that in order to start this type of treatment with a certain patient, it is necessary for him to carry out certain tests such as laboratories, chest X-rays and to exclude a history of hepatitis; It is also necessary to follow the progress of the treatment, to evaluate the possible side effects and to be able to provide the necessary information to the patient, his family and his environment.

“You have to educate the patient; the primary care physician has to give them hope that even if psoriasis There is no cure, it can be treated and it can be controlled.

30% of psoriasis patients develop psoriatic arthritis

There are patients who have been diagnosed with seronegative arthritis, that is, they do not detect antibodies against cyclic citrullinated peptide (anti-CCP), or rheumatoid factor, in the blood, who apparently do not have psoriasis. However, it is necessary that the health professional carries out an exhaustive examination because he can develop it in a piece of skin: “The sooner we can diagnose psoriasisthe better the response to treatment.

In addition to the skin psoriasis It can cause inflammation of other body organs such as the heart (especially the coronary arteries), increasing the risk of heart attack.

Another of the alerts issued by the Dermatological Society of Puerto Rico concerns the increase in the number of patients diagnosed with depression triggered by psoriasis“It is important for patients to know that they have the support of mental health professionals such as psychologists and psychiatrists, because indeed, it is an illness that affects them emotionally”, concluded the president.

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