30% of patients with psoriasis develop psoriatic arthritis

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

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. This condition usually includes the palms of the hands, the soles of the feet, the nails, the labial mucosa, and / or the genital mucosa; it depends on the manifestations and type of developing psoriasis.

In addition, studies have shown that patients with this condition are more likely to be diagnosed with other conditions such as depression, Crohn’s disease, metabolic syndrome, uveitis, some cancers 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 data on the prevalence 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, to delve into the basic diagnostic criteria for this condition.

The truth is that psoriasis does not occur equally in all patients, many factors depend on this, among which it is worth emphasizing in the first place the type of this condition that develops, “for example, we can have patients with psoriasis only on the scalp, who are also diagnosed with some form of arthritis, “he said.

An important point for the expert begins with the consultation with the primary care physician, as it ensures that the specialist in this field should be aware of the typical lesions of this pathology, such as. reddish flakesand the areas of the body where they occur.

“When patients go to medical offices with photos similar, in which there is flaking of the skin, it should be suspected that these manifestations may be caused by side effects of certain drugs or allergies. But you should also consider the possibility of this patient having psoriasis.

This was added by the expert psoriasis There are many options, including: 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 streptococcal infection and can also occur in children. Psoriasis Conversely, on the other hand, it tends to occur in typical areas such as the elbows, under the chest, between the folds or in the armpits.

“Many times psoriasis Inverse is treated like a fungus because it occurs in areas of heat and sweat, so people think it is candida. However, when you start treatment with antifungal drugs, the patient will not feel improvement, “he explained. psoriasis Conversely, you don’t have to see the silvery scales on your skin, but you do see a lot of burning or itchy reddish spots in these folds.

Another area in which it is developing psoriasis and can cause great confusion, right in the nails, because just like psoriasis inverted, the nail variant can mimic fungus due to “touching” on the outer layer or a feeling of grease under the nails.

“The first step is monitoring and evaluation; it is reasonable to ask the patient about their manifestations, “he added. “There are patients who may have palmoplantar psoriasis, but it is confused with dermatitis of the hands, dyshidrotic dermatitis or an allergic reaction.”

There are patients who debut with the condition, but in general the family history also plays an important role, so it is important to consider when diagnosing the individual.

Diagnosis and treatment of psoriasis

Despite the fact that at first glance the specialist determines that the clinical picture corresponds to psoriasisa biopsy is needed to rule out other pathologies such as skin lymphoma (a type of skin cancer).

However, after being evaluated by the primary care physician, the patient is given topical steroids because the skin lesions respond favorably to these elements, but when there is no improvement in symptoms, the patient is referred to a dermatologist for diagnosis.

“For the treatment of psoriasis, topical steroids are used. There are now more vitamin D-derived creams that also work, and there are professionals who can recommend intramuscular steroids, “he said.” The latter option is quite dangerous because once the symptoms of psoriasisthere may be an exacerbation and the patient is likely to develop pustular psoriasis. “

When psoriasis is in moderate to severe stage, usually treated with biological preparations. However, the expert points out that in order to start this type of treatment in a certain patient, it is necessary for him to do some tests such as laboratory tests, chest X-ray and to exclude a history of hepatitis; It is also necessary to monitor the course of treatment, assess possible side effects and provide the necessary information to the patient, family and environment.

“You have to educate the patient; the primary care physician must give this person hope for that time psoriasis There is no cure, it can be treated and it can be controlled.

There are patients who have been diagnosed with seronegative arthritis, ie those who do not have antibodies to cyclic citrullinated peptide (anti-CCP) or rheumatoid factor in their blood, who have apparently not had psoriasis. However, it is necessary for the healthcare professional to perform a thorough examination, because he can develop it into 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 organs in the body, such as the heart (especially the coronary arteries), increasing the risk of heart attacks.

Another report from the Dermatological Society of Puerto Rico concerns the increase in the number of patients diagnosed with depression caused by psoriasis“It is important for patients to know that they have the support of mental health professionals such as psychologists and psychiatrists, because in practice it is a disease that affects them emotionally,” the president concluded.

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