EN 
SI 
Psoriasis
Psoriasis is a complex chronic inflammatory skin disease with aberrant immunopathogenetic mechanisms. The pathogenesis includes hyperkeratotic plaques, usually localized on the scalp, elbows, knees and buttocks, and are characterized by cutaneous inflammatory infiltrates, epidermal hyperplasia and impaired keratinocyte differentiation, and hypervascularity in the upper skin (epidermis / dermis). Clinically, it manifests as redness and peeling. Psoriasis is quite common and affects about 2% of the general population. It is more common in the white population and has a bimodal age distribution, with a maximum incidence between 20 and 30 years and between 50 and 60 years.
The molecular mechanisms involved in psoriasis are not yet fully understood. Scientists in the field agree that the disease involves a variety of immune cells, including dendritic cells, Th1 and Th17 lymphocytes, which interact with keratinocytes. Psoriasis can be explained by immune dysregulation against Th1/Th17 differentiation, which plays a key role in disease development.
The cause of psoriasis is multifactorial with genetic and environmental components. Usually (but not always) a family history can be determined. If one parent has psoriasis, the risk of this disorder in a child is about 14%. This figure jumps to 41% if both parents have been diagnosed.
In most cases, psoriasis develops in a mild to moderate form. It most commonly occurs in outbreaks where improvement and deterioration alternate. Existing forms of treatment include primarily topical treatment and phototherapy, systemic drugs, or a combination of different therapeutic categories for advanced cases. Environmental factors involved in triggering psoriasis or psoriatic outbreaks include physical trauma (isomorphic or Koebner phenomenon), infections (streptococcal pharyngitis), hypocalcemia, stress, and medications such as lithium, beta blockers, antimalarials, and corticosteroids, and so on.
Research into psoriasis began around 1950, before that only its descriptions appear in the literature. After 1950, however, the professional literature on this topic began to appear and is growing exponentially from year to year to this day.
Risk factors for psoriasis are not yet fully understood and future studies should successfully establish preventive approaches for psoriasis.
Types of psoriasis
We know several different types of psoriasis. Some species are more pronounced in mild form and some in moderate or severe form. About 90% of patients get the chronic form. Changes in the skin are visible in the form of plaques and can occur anywhere on the body. They are usually symmetrical in shape, the scales are usually pink. The ‘droplet’ form usually occurs in the younger population, where changes in the skin are visible as tiny scaly bumps. Usually, changes in the skin are visible mainly on the torso. Pustular psoriasis is characterized by the appearance of pus-filled lumps that appear locally. The inverse form of psoriasis is more common in women. Changes in the skin occur mainly in the folds of the joints, under the armpits, in the genital area and buttocks. The erythrodermic form is characterized by redness with associated peeling of the skin.
Psoriatic arthritis or inflammation of the joints also joins psoriasis in 30 percent of patients. The joints of the toes and feet are usually affected. Those with a more severe form of psoriasis are usually more susceptible, but it is also becoming more common in patients treated with systemic corticosteroids. An increasingly common side effect is depression, which occurs in some patients with lower self-esteem.
Treatment
There are several types and options for treating psoriasis. Approximately 65-70% of patients have a mild form, approx. 20-25% of patients have a moderate form, and approx. 5-10% have a more severe form.
In classical medicine, mild forms of topical treatment are most commonly used and include topical medications (creams and ointments). About three-quarters of patients have a milder form of psoriasis, where visible changes are limited to a smaller area of skin. Among topical drugs, topical corticosteroids are mainly used. The effect of the treatment is quickly seen, but it is also important to be aware that corticosteroids thin the skin and long-term use can do more harm than good. Hydrocortisone (mild), alcomethasone (moderate) and betamethasone (a strong medicine) are mainly used. Keratolytics are another type of drug used to treat mild forms. These are preparations with salicylic acid or urea, which remove scales that appear on the skin. This also makes other medicines more accessible to the inside of the skin. The third group of drugs includes preparations with vitamin D3 analogues, which inhibit epidermal thickening and trigger normal differentiation and have an immunomodulatory effect. The effects of these drugs do not appear immediately, but only after some time.
Phototherapy is also suggested for people with moderate psoriasis and those who are not helped by topical treatment alone. It is a therapy where light improves the condition. UVB light in the range of 290-320 nm is mainly used, which penetrates to the boundary layer between the epidermis and the dermis. Phototherapy has a biological effect, as molecules in the skin (chromophores) absorb light.
For the severe form of psoriasis, systemic treatment drugs are used, where retinoid drugs, cyclosporine, methotrexate are used, and biologics, which are a novelty in the field of psoriasis treatment, are increasingly used. These are medicines that are used mainly in cases where all other treatment options have been exhausted. These are specific drugs, where their action is focused primarily on immune mechanisms that cause skin changes in the skin. Biologics have dramatically changed the treatment of psoriasis.
Alternative treatment with cannabinoids
Although there is limited research to confirm the alleged local benefits of cannabinoids, it is certain that skin biology is modulated by the human endocannabinoid system (ECS). Cannabinoid CB1 receptors are present in the nervous system (brain and spinal cord), and CB2 receptors are present primarily in the peripheral nervous system (limb nerves), digestive system, and immune system. Research shows that CB1 receptors like CB2 are also found in epidermal keratinocytes, skin nerve fibers, dermal cells, melanocytes, sweat glands, and hair follicles. Numerous preclinical evidence suggests that topical application of cannabinoids may be effective in some skin conditions such as eczema, psoriasis, pruritus, and various inflammatory conditions. Because ECS has an important regulatory function in the skin, it is very likely that treatment with topical cannabinoids could be effective in certain disorders and skin health in general.
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Resources:
https://www.sciencedirect.com/topics/medicine-and-dentistry/psoriasis
Kamiya K, Kishimoto M, Sugai J, Komine M, Ohtsuki M. Risk Factors for the Development of Psoriasis. Int J Mol Sci. 2019 Sep 5;20(18):4347. DOI: 10.3390/ijms20184347. PMID: 31491865; PMCID: PMC6769762.
Langley RG, Krueger GG, Griffiths CE. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis. 2005 Mar;64 Suppl 2(Suppl 2):ii18-23; discussion ii24-5. DOI: 10.1136/ard.2004.033217. PMID: 15708928; PMCID: PMC1766861.
Baswan SM, Klosner AE, Glynn K, Rajgopal A, Malik K, Yim S, Stern N. Therapeutic Potential of Cannabidiol (CBD) for Skin Health and Disorders. Clin Cosmet Investig Dermatol. 2020 Dec 8;13:927-942. DOI: 10.2147/CCID.S286411v. PMID: 33335413; PMCID: PMC7736837.
Palmieri B, Laurino C, Vadalà M. A therapeutic effect of cbd-enriched ointment in inflammatory skin diseases and cutaneous scars. Clin Ter. 2019 Mar-Apr;170(2):e93-e99. DOI: 10.7417/CT.2019.2116. PMID: 30993303. [PubMed]
Wójcik P, Garley M, Wroński A, Jabłońska E, Skrzydlewska E. Cannabidiol Modifies the Formation of NETs in Neutrophils of Psoriatic Patients. Int J Mol Sci. 2020 Sep 16;21(18):6795. DOI: 10.3390/ijms21186795. PMID: 32947961; PMCID: PMC7554718.
https://luskavica-psoriaza.si/
https://sl.wikipedia.org/wiki/Luskavica
https://en.wikipedia.org/wiki/Psoriasis
https://sl.wikipedia.org/wiki/Ko%C5%BEa#Usnjica
https://www.dolenjske-lekarne.si/strokovni-clanki/luskavica-bolezen-ki-seze-globoko-pod-kozo
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