General guidelines in the detection, diagnosis and treatment of psoriasis

Although it is true that dermatitis, spreads, and lacerations can be caused by allergic reactions or dermatitis, we should not rule out the possibility of diagnosing psoriasis.

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

In Puerto Rico, it is estimated that as many as 35,000 to 100,000 people have psoriasis. In general, this condition includes the palms of the hands, soles of the feet, nails, the mucous-labial half and / or the mucous membrane of the genitals; This depends on the manifestations and the type of psoriasis that develops.

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

Based on prevalence data for this condition on the island, the Journal of Medicine and Public Health spoke with Dr. Damaris Torres Pauli, current president of the Puerto Rican Dermatological Society, with the goal of delving into the main diagnostic criteria for this condition.

The truth is psoriasis They do not appear symmetrically in all patients, many factors depend on this, among which it is worth highlighting, first of all, what kind of this condition develops, “For example, we can have only psoriasis patients of the scalp who She was also diagnosed with some pictures of arthritis.

An important point for the expert, starting from a consultation with a primary care physician, as it ensures that the specialist in this field must be clear about the typical lesions of this pathology, such as Roasted sheets with peelsand areas of the body in which they arise.

When patients go to medical offices pictures Similar if peeling of the skin is also present, it should be suspected that these manifestations may be caused by the adverse effects of certain medications or allergies. But also, you should consider the possibility that this patient has psoriasis.

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

“many times psoriasis Inverse is treated as if it were a fungus, because it occurs in areas of heat and sweat, so people think it is candida. However, when starting treatment with antifungals, the patient will not notice any improvement.” “In psoriasis Conversely, you don’t necessarily see silvery scales on the skin, but you do see red plaques that cause a lot of burning or itching in these fold areas. “

Another area to develop in psoriasis And it can make a lot of noise, it happens exactly in the nails, because just like psoriasis In the opposite direction, the nail variant can mimic the fungus due to “pecking” on the outer layer, or the feeling of oil under the nails.

“The first step is observation and evaluation; it is wise to ask the patient about their manifestations.” “There are patients who may have seborrheic psoriasis, but it is often confused with dermatitis of the hand, dyshidrotic dermatitis or an allergic reaction.”

There are patients who have the condition for the first time, but in general, family history also plays an important role, so it is important to consider this when making the diagnosis to the individual.

Diagnosis and treatment psoriasis

Despite the fact that at first glance, the specialist decides that the clinical picture corresponds to psoriasisA biopsy is necessary to rule out other diseases such as cutaneous lymphoma (a type of skin cancer).

However, once the patient is evaluated by the primary physician, he receives topical steroids because the skin lesions respond favorably to these elements, however, when there is no improvement in symptoms, the patient is referred to a dermatologist to be able to obtain a diagnosis. .

“to treat psoriasis, topical steroids. Now there are more vitamin D-derived creams that work as well, and there are specialists who can recommend intramuscular steroids.” “This last option is somewhat dangerous, because once symptoms appear, psoriasisThere may be regrowth and there is a possibility that the patient will develop pustular psoriasis.”

When psoriasis It is in a moderate to severe stage and is usually treated with biology. However, the expert states that in order to start this type of treatment with a particular patient, it is necessary to perform some tests such as laboratories, chest x-rays and to exclude the presence of a history of hepatitis; It is also necessary to monitor the progress of treatment, evaluate possible side effects, and be able to provide the necessary information to the patient, family and environment.

“You have to educate the patient; the primary care physician has to give that person hope that… psoriasis It has no cure and can be treated and controlled.”

30% of patients with psoriasis develop psoriatic arthritis

There are patients diagnosed with sero-negative arthritis, that is, they do not detect antibodies against cyclic citrullinated peptide (anti-CCP), or rheumatoid factor, in their blood, who apparently do not have psoriasis. However, it is necessary for a health professional to conduct a thorough examination because it can develop in a piece of skin: “The sooner the diagnosis psoriasisThe response to treatment was better.”

In addition to the skin psoriasis It can cause inflammation of other parts of the body such as the heart (especially the coronary arteries), which increases the risk of heart attacks.

Another alert raised by the Puerto Rican Dermatological Society is an increase in the number of patients diagnosed with depression due to psoriasis“It is important for patients to know that they are receiving the support of mental health professionals such as psychiatrists and psychiatrists, because this really is an illness that affects them emotionally,” the president concluded.

See the full interview: