Psoriasis: A Closer Look Jayakar Thomas, Parimalam Kumar, Sindhu Ragavi Balaji
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IntroductionCHAPTER 1

Psoriasis is a T-cell mediated chronic inflammatory disorder of the skin seen in about 3.5% of the population.1 One-third of psoriasis cases in a dermatology center are seen in pediatric age-group.2 Psoriasis is a lifelong inflammatory disorder of the skin that can vary widely in its presentation but is characterized by the common features of erythema, skin thickening and scaling. The diagnosis is usually made on clinical grounds by any well-trained clinician. Despite considerable research into its etiology, there are still no definitive genetic or biochemical markers for psoriasis, and it continues to be diagnosed primarily based on skin manifestations. Its impact on a patient depends not only on the percentage of body surface area of the lesions, but also on their location. Involvement of the hands, feet, scalp and genital areas can have a disproportionate effect on quality of life and disability. Additionally, in a significant subset of psoriasis patients, the disease process involves progressive damage to the articular joints. Moreover, clinical studies have increasingly revealed associations of psoriasis and its treatments with many systemic diseases. Although establishing causality in these associations remains problematic, these associations have immediate diagnostic and therapeutic implications.
Timely diagnosis and appropriate management cannot only arrest progression, but also minimize the psychosocial burden imposed by this illness. Thereby disfiguring states and its evolution into a metabolic syndrome requiring extensive treatment can well be averted. This book will cover almost all aspects of pediatric psoriasis including the rare clinical form like congenital erythrodermic psoriasis and present the latest update, especially on the etiopathogenesis and treatment options. An evidence-based approach has been given while discussing these issues. There is increasing awareness the world over that psoriasis is more than “skin deep” and is now emerging as a systemic disease. It is attempted to emphasize the role of inflammation as a major factor, leading to multiple organ dysfunction. Similarly, the concept “psoriatic march” is also thrashed out though it is not yet formally proven. Finally the reader will accept that a holistic approach, including education, aggressive treatment wherever necessary along with psychological support in the form of empathy rather than sympathy, is all that is needed for care of psoriatic patients. The main aim of treatment should be to reduce the burden of the disease over time by controlling symptoms, helping the patient to cope with the chronic nature of the disease, limiting psychological and relational consequences, and preventing systemic complications and comorbidity.
REFERENCES
  1. Kurd SK, Gelfand JM. The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003–2004. J Am Acad Dermatol. 2009;60(2):218–24.
  1. Raychaudhuri SP, Gross J. A comparative study of pediatric onset psoriasis with adult onset psoriasis. Pediatr Dermatol. 2000;17(3):174–8.