Psoriasis – Differentialdiagnosen und Therapie

Zusammenfassung

Die Psoriasis vulgaris, syn. Schuppenflechte, stellt eine der häufigsten ambulanten als auch stationären Behandlungsdiagnosen der Dermatologie dar. Die klassischerweise durch erythematosquamöse Plaques gekennzeichnete Hauterkrankung ist mit einem chronisch schubweisen Verlauf, sowie verschiedenen Komorbiditäten assoziiert. Die Patienten leiden im Falle einer Plaque-Psoriasis an typischen rötlichen, scharf begrenzten Plaques mit einer festhaftenden, groblamellären und weißlich-silbrigen Schuppung, wobei dies je nach Subtyp variieren kann. Typische Komorbiditäten aufgrund einer systemischen Inflammation betreffen unter anderem das kardiovaskuläre System, als auch den Bewegungsapparat. Neuartige, systemische Therapien ermöglichen es mittlerweile auch schwer Betroffenen eine Therapie-Option anzubieten und die Lebensqualität um ein hohes Maß zu steigern.

Abstract

Psoriasis vulgaris is one of the most frequent outpatient and inpatient diagnoses for treatment in dermatology. The skin disease, classically accompanied by erythematosquamous plaques, is associated with a chronic relapsing course and various comorbidities. In the case of plaque psoriasis, patients suffer from typical reddish, sharply defined plaques with adherent, coarse lamellar and whitish-silvery scaling, though this can vary in many ways, depending on the subtype. Typical comorbidities due to systemic inflammation include the cardiovascular as well as the musculoskeletal system. Novel, systemic therapies now make it possible to offer even severely affected patients a therapy option and to increase the quality of life by a high degree.

Schlüsselwörter

Psoriasis vulgaris - Therapie - Biologika

Key words

dermatology - Psoriasis - therapy

Publication History

Article published online:
18 July 2022

• Literatur

• 1 Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol 2017; 31: 205-212 DOI: 10.1111/jdv.13854.
• 2 Augustin M, Reich K, Glaeske G. et al. Co-morbidity and age-related prevalence of psoriasis: Analysis of health insurance data in Germany. Acta Derm Venereol 2010; 90: 147-151 DOI: 10.2340/00015555-0770.
• 3 Jungen D, Augustin M, Langenbruch A. et al. Cost-of-illness of psoriasis - results of a German cross-sectional study. J Eur Acad Dermatol Venereol 2018; 32: 174-180 DOI: 10.1111/jdv.14543.
• 4 Griffiths CEM, Armstrong AW, Gudjonsson JE. et al. Psoriasis. Lancet 2021; 397: 1301-1315 DOI: 10.1016/s0140-6736(20)32549-6.
• 5 Mrowietz U, Prinz JC. Psoriasis. In Braun-Falco’s Dermatologie, Venerologie und Allergologie. Springer; 2018: 677-702
• 6 Armstrong AW, Read C. Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. Jama 2020; 323: 1945-1960 DOI: 10.1001/jama.2020.4006.
• 7 Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med 2009; 361: 496-509 DOI: 10.1056/NEJMra0804595.
• 8 Eyerich S, Onken AT, Weidinger S. et al. Mutual antagonism of T cells causing psoriasis and atopic eczema. N Engl J Med 2011; 365: 231-238 DOI: 10.1056/NEJMoa1104200.
• 9 Garzorz-Stark N, Eyerich K. Psoriasis Pathogenesis: Keratinocytes Are Back in the Spotlight. J Invest Dermatol 2019; 139: 995-996 DOI: 10.1016/j.jid.2019.01.026.
• 10 Fritsch P, Schwarz T. Erythematosquamöse/hyperkeratotische Hautkrankheiten. In Dermatologie Venerologie: Grundlagen Klinik Atlas. Berlin, Heidelberg: Springer Berlin Heidelberg; 2018: 361-390 DOI: 10.1007/978-3-662-53647-6_8
• 11 Chan CS, Van Voorhees AS, Lebwohl MG. et al. Treatment of severe scalp psoriasis: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol 2009; 60: 962-971 DOI: 10.1016/j.jaad.2008.11.890.
• 12 Quimby SR, Markowitz H, Winkelmann RK. Antideoxyribonuclease B titers in psoriasis. Acta Derm Venereol 1980; 60: 485-490
• 13 Marrakchi S, Puig L. Pathophysiology of Generalized Pustular Psoriasis. Am J Clin Dermatol 2022; 23: 13-19 DOI: 10.1007/s40257-021-00655-y.
• 14 Singh RK, Lee KM, Ucmak D. et al. Erythrodermic psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckl) 2016; 6: 93-104 DOI: 10.2147/ptt.S101232.
• 15 Bardazzi F, Starace M, Bruni F. et al. Nail Psoriasis: An Updated Review and Expert Opinion on Available Treatments, Including Biologics. Acta Derm Venereol 2019; 99: 516-523 DOI: 10.2340/00015555-3098.
• 16 Veale DJ, Fearon U. The pathogenesis of psoriatic arthritis. Lancet 2018; 391: 2273-2284 DOI: 10.1016/s0140-6736(18)30830-4.
• 17 Takeshita J, Grewal S, Langan SM. et al. Psoriasis and comorbid diseases: Epidemiology. J Am Acad Dermatol 2017; 76: 377-390 DOI: 10.1016/j.jaad.2016.07.064.
• 18 Cohen AD, Dreiher J, Birkenfeld S. Psoriasis associated with ulcerative colitis and Crohn’s disease. J Eur Acad Dermatol Venereol 2009; 23: 561-565 DOI: 10.1111/j.1468-3083.2008.03031.x.
• 19 Candia R, Ruiz A, Torres-Robles R. et al. Risk of non-alcoholic fatty liver disease in patients with psoriasis: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2015; 29: 656-662 DOI: 10.1111/jdv.12847.
• 20 Robinson A, Kardos M, Kimball AB. Physician Global Assessment (PGA) and Psoriasis Area and Severity Index (PASI): why do both? A systematic analysis of randomized controlled trials of biologic agents for moderate to severe plaque psoriasis. J Am Acad Dermatol 2012; 66: 369-375 DOI: 10.1016/j.jaad.2011.01.022.
• 21 Mattei PL, Corey KC, Kimball AB. Psoriasis Area Severity Index (PASI) and the Dermatology Life Quality Index (DLQI): the correlation between disease severity and psychological burden in patients treated with biological therapies. J Eur Acad Dermatol Venereol 2014; 28: 333-337 DOI: 10.1111/jdv.12106.
• 22 Mrowietz U, Kragballe K, Reich K. et al. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Arch Dermatol Res 2011; 303: 1-10 DOI: 10.1007/s00403-010-1080-1.
• 23 Reid C, Griffiths CEM. Psoriasis and Treatment: Past, Present and Future Aspects. Acta Derm Venereol 2020; 100 adv00032 DOI: 10.2340/00015555-3386.
• 24 Fritsch P, Schwarz T. Dermatologie Venerologie: Grundlagen. Klinik. Atlas. Springer-Verlag; 2018
• 25 Nast A, Altenburg A, Augustin M. et al. Deutsche S3-Leitlinie zur Therapie der Psoriasis vulgaris, adaptiert von EuroGuiDerm – Teil 1: Therapieziele und Therapieempfehlungen. J Dtsch Dermatol Ges 2021; 19: 934-951 DOI: 10.1111/ddg.14508_g.
• 26 Elmets CA, Korman NJ, Prater EF. et al. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol 2021; 84: 432-470 DOI: 10.1016/j.jaad.2020.07.087.
• 27 Hölzle E, Lehman P. Lichttherapie. In Braun-Falco’s Dermatologie, Venerologie und Allergologie. Springer; 2018: 2093-2104
• 28 Lwin SM, Snowden JA, Griffiths CEM. The promise and challenges of cell therapy for psoriasis. Br J Dermatol 2021; 185: 887-898 DOI: 10.1111/bjd.20517.