Psoriasis

Descripción General

Epidemiología

• Relativamente común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños y adultos
  • 0,5%–11% de personas a nivel mundial
  • 1%–3% de personas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos
• Puede verse a cualquier edad, pero la incidencia alcanza sus puntos máximos a los LOS Neisseria 20–30 años y a los LOS Neisseria 50–60 años (la mediana de edad es de 28 años)
• ⅓ de los LOS Neisseria pacientes tienen un familiar de primer grado con la enfermedad.
• Variación estacional: peor en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum invierno que en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum verano
• Ligeramente más prevalente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mujeres
• Los LOS Neisseria hombres son más propensos a tener enfermedad ocular.
• Más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caucásicos

Etiología

• Predisposición genética
  • Genes Genes A category of nucleic acid sequences that function as units of heredity and which code for the basic instructions for the development, reproduction, and maintenance of organisms. DNA Types and Structure del complejo mayor de histocompatibilidad (CMH) → locus Locus Specific regions that are mapped within a genome. Genetic loci are usually identified with a shorthand notation that indicates the chromosome number and the position of a specific band along the P or Q arm of the chromosome where they are found. For example the locus 6p21 is found within band 21 of the P-arm of chromosome 6. Many well known genetic loci are also known by common names that are associated with a genetic function or hereditary disease. Basic Terms of Genetics de susceptibilidad a la psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis ( PSORS1 PSORS1 Psoriasis)
  • HLA-B27 → artritis psoriásica
• Desencadenantes ambientales
  • Infecciones → psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis eritrodérmica y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum placas
    • Streptococcus Streptococcus Streptococcus is one of the two medically important genera of gram-positive cocci, the other being Staphylococcus. Streptococci are identified as different species on blood agar on the basis of their hemolytic pattern and sensitivity to optochin and bacitracin. There are many pathogenic species of streptococci, including S. pyogenes, S. agalactiae, S. pneumoniae, and the viridans streptococci. Streptococcus → psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis guttata
    • Virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la inmunodeficiencia humana (VIH) → psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis eritrodérmica
  • Clima frío
  • Traumatismo
  • Medicamentos:
    • El litio, los LOS Neisseria betabloqueadores y los LOS Neisseria antipalúdicos son los LOS Neisseria más comunes.
    • El interferón-alfa, los LOS Neisseria inhibidores del factor de necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage tumoral ( TNF TNF Tumor necrosis factor (TNF) is a major cytokine, released primarily by macrophages in response to stimuli. The presence of microbial products and dead cells and injury are among the stimulating factors. This protein belongs to the TNF superfamily, a group of ligands and receptors performing functions in inflammatory response, morphogenesis, and cell proliferation. Tumor Necrosis Factor (TNF), por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)-alfa y los LOS Neisseria medicamentos antiinflamatorios no esteroideos (AINE) también pueden contribuir.
    • Uso de corticoides → psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis pustulosa y eritrodérmica
  • Consumo de alcohol y tabaco
  • Obesidad
  • Tabaquismo
  • Embarazo
  • Estrés

Fisiopatología

La psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis es una enfermedad compleja caracterizada por un proceso inflamatorio desregulado mediado por linfocitos T, que da como resultado la proliferación de queratinocitos y una diferenciación disfuncional.

• No se comprende del todo
• Fase de iniciación: los LOS Neisseria queratinocitos responden a un desencadenante → estimulan las células dendríticas → producción de citoquinas → diferenciación de linfocitos T colaboradores
• Fase de mantenimiento: los LOS Neisseria linfocitos T colaboradores liberan citocinas → activan la proliferación de queratinocitos → activan más células inflamatorias, lo que da como resultado una respuesta inflamatoria autoamplificadora
• Lleva a:
  • Hiperplasia epidérmica (acantosis)
  • Recambio celular acelerado → retención celular de núcleos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el estrato córneo (paraqueratosis)
  • Los LOS Neisseria queratinocitos no liberan los LOS Neisseria lípidos necesarios para la adhesión celular → conduce a placas descamativas
  • Microabscesos
  • Ingurgitación vascular por dilatación de vasos sanguíneos superficiales

Presentación Clínica

Subtipos principales

• Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis crónica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum placas
  • Forma de presentación más común (aproximadamente el 80% de los LOS Neisseria casos)
  • Placas simétricas, bien definidas, de color salmón
  • Escamas gruesas y plateadas
  • Prurito
  • Sitios más frecuentes:
    • Codos (lado extensor)
    • Rodillas (lado extensor)
    • Cuero cabelludo
    • Ombligo
    • Hendidura glútea
  • Clasificación basada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la superficie corporal total (SCT):
    • Enfermedad leve a moderada → < 5%
    • Enfermedad moderada a grave → > 5%
  • La afectación de las uñas es común.
  • Signo de Auspitz: hemorragia puntiforme con la eliminación de escamas
  • Fenómeno de Koebner: lesiones inducidas por traumatismos, como el rascado
• Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis guttata (“ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum gota”)
  • Erupción aguda de múltiples pápulas pequeñas de color salmón
    • 1–10 mm MM Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies. Multiple Myeloma de tamaño
    • Aparecen como “gotas de rocío” con escamas finas
  • Se encuentran en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el tronco y extremidades proximales
  • Fuerte asociación con infecciones estreptocócicas
• Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis pustulosa
  • Parches o placas dolorosas
  • Localización: afecta principalmente las palmas de las manos y las plantas de los LOS Neisseria pies
  • Anular generalizada:
    • Erupción recurrente y subaguda de placas eritematosas anulares
    • Pústulas y escamas periféricas
  • Variante de Von Zumbusch:
    • Parches eritematosos dolorosos y generalizados con pústulas puntiformes
    • Los LOS Neisseria pacientes pueden presentar fiebre, malestar, leucocitosis e hipocalcemia.
    • Puede haber compromiso de las membranas mucosas
    • Complicaciones potencialmente mortales: sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock, colangitis neutrofílica, neumonitis y síndrome de dificultad respiratoria aguda
  • Durante el embarazo, la afección se conoce como impétigo herpetiforme.
• Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis eritrodérmica
  • Poco común
  • Puede ser aguda o crónica
  • Eritema generalizado con descamación variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables
  • Afecta a toda la superficie corporal → ↑ riesgo de complicaciones por pérdida de la barrera cutánea
    • Sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock → fiebre y escalofríos
    • Pérdida de líquidos → deshidratación y desequilibrio electrolítico

Sitios especiales

• Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis inversa (intertriginosa)
  • Se encuentra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum áreas intertriginosas:
    • Inguinal
    • Perineal y genital
    • Interglútea
    • Axilar
    • Inframamaria
  • Placas simétricas, lisas, brillantes, eritematosas
  • Generalmente, no tiene escamas debido a la humedad de la zona
• Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis ungueal
  • Pequeños hoyuelos a través de la uña son característicos.
  • Otros hallazgos:
    • Leuconiquia (líneas o puntos blancos que aparecen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la uña)
    • Manchas rojas de la lúnula
    • Onicolisis (desprendimiento indoloro del lecho ungueal)
• Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis palmoplantar
  • Involucra las palmas de las manos o las plantas de los LOS Neisseria pies
  • Placas eritematosas e hiperqueratósicas
  • Puede presentarse con fisuras dolorosas

Trastornos asociados

• Artritis psoriásica
  • Se observa en hasta el 30% de los pacientes con psoriasis
  • Puede ser discapacitante
  • Síntomas:
    • Dolor articular
    • Dolor de espalda
    • Rigidez articular matutina
  • Hallazgos del examen físico:
    • Artritis distal, particularmente de las articulaciones interfalángicas distales
    • Entesitis (inflamación en el sitio de inserción del tendón)
    • Tenosinovitis (inflamación de la vaina llena de líquido que rodea un tendón)
    • Dactilitis (“dedos de salchicha”)
    • Artritis mutilante (resorción de los LOS Neisseria huesos que conduce al AL Amyloidosis colapso de los LOS Neisseria tejidos blandos)
    • Espondiloartropatía
• Trastornos oculares
  • Blefaritis (inflamación del párpado)
  • Conjuntivitis
  • Xerosis Xerosis Sjögren Syndrome (sequedad)
  • Lesiones corneales
  • Uveítis
  • Síntomas asociados:
    • Molestias oculares
    • Ojos rojos
    • Párpados edematizados
    • Descamación o formación de costras en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las pestañas
    • Cambios visuales
    • Lesiones psoriásicas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria párpados
• Comorbilidades:
  • Obesidad
  • Síndrome metabólico
  • Hipertensión
  • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
  • Enfermedad aterosclerótica
  • Enfermedad inflamatoria intestinal
  • Malignidad
  • Infecciones graves
  • Trastornos autoinmunes

Diagnóstico

El diagnóstico se establece mediante los LOS Neisseria antecedentes clínicos y los LOS Neisseria hallazgos del examen físico.

• Biopsia de piel
  • Puede utilizarse para la confirmación, pero rara vez es necesaria
  • Hallazgos:
    • Acantosis con crestas interpapilares alargadas
    • Paraqueratosis
    • Microabscesos neutrofílicos (microabsceso de Munro)
    • Capa de células granulares adelgazada o ausente
    • Capilares papilares dérmicos dilatados
  • Ácido periódico de Schiff más diastasa → descarta infección fúngica superficial
• Tamizaje y diagnóstico de la artritis psoriásica
  • Hallazgos del examen físico
  • Factor reumatoide negativo
  • ↑ Velocidad de eritrosedimentación (VES) y proteína C reactiva ( PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR))
  • Prueba de HLA-B27 (útil si no existen lesiones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la piel)
  • Radiografías de la columna y de las articulaciones afectadas
    • Erosiones periarticulares y resorción ósea → apariencia de “lápiz en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum copa”
    • Proliferación ósea → aspecto “borroso” del hueso alrededor de la articulación
    • Osteólisis y colapso articular → artritis mutilante
    • Sacroilitis

Tratamiento

El tratamiento se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la gravedad, la distribución de la lesión, el tipo, las comorbilidades y la respuesta.

Tratamiento basado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la gravedad

• Enfermedad leve a moderada:
  • Corticoides tópicos (hidrocortisona, triamcinolona, fluocinonida)
  • Análogos de la vitamina D ( calcitriol Calcitriol The physiologically active form of vitamin d. It is formed primarily in the kidney by enzymatic hydroxylation of 25-hydroxycholecalciferol (calcifediol). Its production is stimulated by low blood calcium levels and parathyroid hormone. Calcitriol increases intestinal absorption of calcium and phosphorus, and in concert with parathyroid hormone increases bone resorption. Parathyroid Glands: Anatomy, calcipotrieno)
  • Retinoides tópicos (tazaroteno)
  • Alquitrán de hulla
  • Fototerapia
  • Inhibidores de la calcineurina ( tacrolimus Tacrolimus A macrolide isolated from the culture broth of a strain of streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. Immunosuppressants, pimecrolimus Pimecrolimus Immunosuppressants)
• Enfermedad de moderada a grave:
  • Retinoides
  • Metotrexato
  • Ciclosporina
  • Apremilast Apremilast Phosphodiesterase Inhibitors (inhibidor de la fosfodiesterasa)
  • Agentes biológicos (nota: los LOS Neisseria inhibidores del TNF-alfa también pueden exacerbar la psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis)
  • Fototerapia

Terapia adyuvante

• Emolientes
• Modificaciones de estilo de vida
  • Pérdida de peso
  • Reducción de estrés
  • Abandonar el tabaquismo

Consideraciones adicionales

• Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis inversa:
  • Corticosteroides de baja potencia
  • Las áreas afectadas tienen un mayor riesgo de atrofia cutánea inducida por corticosteroides.
• La psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis guttata puede resolverse espontáneamente sin intervención.
• Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis pustulosa y eritrodérmica: hospitalización por enfermedad grave y complicaciones
• Los LOS Neisseria pacientes pueden tener enfermedad refractaria o sufrir múltiples recaídas.
• El objetivo del tratamiento es una reducción de aproximadamente el 75% de la psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis, o una reducción a < 3% de la SCT.

Artritis psoriásica

• Terapia farmacológica:
  • AINE para la enfermedad leve
  • Agentes biológicos ( infliximab Infliximab A chimeric monoclonal antibody to tnf-alpha that is used in the treatment of rheumatoid arthritis; ankylosing spondylitis; psoriatic arthritis and Crohn’s disease. Disease-Modifying Antirheumatic Drugs (DMARDs), etanercept Etanercept A recombinant version of soluble human tnf receptor fused to an IgG Fc fragment that binds specifically to tumor necrosis factor and inhibits its binding with endogenous tnf receptors. It prevents the inflammatory effect of tnf and is used to treat rheumatoid arthritis; psoriatic arthritis and ankylosing spondylitis. Immunosuppressants, adalimumab Adalimumab A humanized monoclonal antibody that binds specifically to tnf-alpha and blocks its interaction with endogenous tnf receptors to modulate inflammation. It is used in the treatment of rheumatoid arthritis; psoriatic arthritis; Crohn’s disease and ulcerative colitis. Disease-Modifying Antirheumatic Drugs (DMARDs))
  • Medicamentos antirreumáticos modificadores de la enfermedad (metotrexato, leflunomida)
• Terapia no farmacológica:
  • Terapia física y ocupacional
  • Ejercicio
  • Ortótica
  • Protección de las articulaciones
  • Reducción de peso

Diagnóstico Diferencial

• Dermatitis atópica: una enfermedad inflamatoria crónica de la piel, generalmente debida a una combinación de genética, disfunción inmunológica y factores ambientales. Los pacientes tendrán prurito y lesiones eritematosas en las superficies flexoras, a menudo con un aspecto exudativo o supurante. Las escamas plateadas no están presentes. El diagnóstico se basa en los antecedentes y el examen físico, y diferenciarán la afección de la psoriasis. El tratamiento incluye evitar los desencadenantes, y emplear humectantes y esteroides tópicos.
• Tiña corporal: una infección fúngica cutánea superficial. El examen físico de la piel revelará un parche anular rosado con un borde descamativo y un centro más claro. También se pueden observar lesiones en las uñas. Estos signos no suelen encontrarse en los lugares característicos de la psoriasis. El diagnóstico es principalmente clínico. Se pueden tomar raspados de piel para la preparación de hidróxido de potasio (KOH), que mostrará hifas segmentadas. El tratamiento incluye medicamentos antimicóticos tópicos o sistémicos.
• Dermatitis numular: inflamación de la piel, a menudo observada en pacientes mayores y asociada con piel seca. El examen físico mostrará placas eritematosas redondas y pruriginosas en las superficies extensoras que se asemejan a la psoriasis; sin embargo, estas placas no suelen ser escamosas. El diagnóstico es clínico y el tratamiento incluye corticosteroides tópicos, fototerapia y cuidados de soporte.
• Dermatitis seborreica: inflamación de la piel en regiones con una alta densidad de glándulas sebáceas. Se desconoce la causa. Los pacientes pueden presentar descamación en el cuero cabelludo y prurito. También se pueden ver pápulas eritematosas con escamas amarillas. La dermatitis seborreica puede coexistir con la psoriasis y el diagnóstico es clínico. Se pueden utilizar antimicóticos tópicos, corticosteroides e inhibidores de la calcineurina para el tratamiento.
• Pitiriasis rosada: una enfermedad inflamatoria autolimitada debida a una infección viral (generalmente el virus del herpes). Los pacientes presentarán placas ovales pruriginosas de color salmón con descamación en la periferia. La pitiriasis rosada se caracteriza por un solo parche heraldo, seguido de un patrón de “árbol de Navidad” en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la espalda. El diagnóstico es clínico y diferenciará la afección de la psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis. No existe un tratamiento específico, por lo que la atención se centra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el control de los LOS Neisseria síntomas con corticosteroides tópicos y antihistamínicos.
• Liquen plano: una afección inflamatoria idiopática recurrente que se presenta con pápulas púrpuras, poligonales y pruriginosas y placas escamosas, que pueden localizarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las muñecas, la parte inferior de las piernas, los LOS Neisseria genitales y la mucosa oral. El diagnóstico se realiza con base en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hallazgos clínicos y la biopsia, que también mostrará hiperqueratosis, pero la afección no tiene paraqueratosis como la psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis. El tratamiento incluye esteroides, retinoides, inmunosupresores y fototerapia.
• Sífilis secundaria: una infección adquirida sexualmente por Treponema pallidum Treponema pallidum The causative agent of venereal and non-venereal syphilis as well as yaws. Treponema que puede conducir a una enfermedad sistémica. Los LOS Neisseria hallazgos incluyen una erupción macular, papular o pustular difusa, simétrica, escamosa, de color cobrizo y que puede incluir las palmas de las manos y las plantas de los LOS Neisseria pies. Estas placas son generalmente más pequeñas que en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis. El diagnóstico se realiza mediante una la prueba de reagina plasmática rápida positiva y es posible que se observen espiroquetas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la biopsia. La penicilina G es el tratamiento estándar.
• Liquen simple crónico: cambios en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la piel que ocurren por rascado excesivo. Una causa subyacente de prurito está generalmente presente. Pueden desarrollarse placas de piel engrosada con escamas superpuestas e hiperpigmentación, lo que causa confusión con la psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis. Las áreas que el paciente no puede alcanzar se observarán normales, lo que ayuda a distinguir las 2 afecciones. El diagnóstico es clínico y el tratamiento se centra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum aliviar el prurito con corticosteroides y antihistamínicos.
• Artritis reactiva: una espondiloartropatía aguda que se desarrolla debido a una infección gastrointestinal o genitourinaria. Los LOS Neisseria pacientes pueden tener lesiones cutáneas psoriasiformes, oligoartritis asimétrica de grandes articulaciones y síntomas constitucionales. Las articulaciones afectadas difieren de la artritis psoriásica. El diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria síntomas, los LOS Neisseria hallazgos del examen físico y la presencia de una infección previa. El tratamiento incluye el tratamiento de la infección, AINE, esteroides e inmunosupresores.