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Psoriasis

Senast uppdaterad: Senast reviderad:
Sakkunnig:
Definition:
Psoriasis är en kronisk, recidiverande, inflammatorisk hudsjukdom med välavgränsade, erytematösa och fjällande lesioner.
Förekomst:
Livstidsprevalensen är 2–4 %.
Symtom:
Hudförändringar och klåda. Ledsymtom utvecklas hos cirka 20–25 %.
Kliniska fynd:
Välavgränsade, erytematösa plack, täckta av tjocka, vita eller silverglänsande, stearinliknande, delvis fastsittande fjäll. Vanligaste lokalisationerna är hårbotten, armbågar och knän.
Diagnostik:
Inga tilläggsundersökningar behövs i regel bortsett från eventuell biopsi vid tveksamhet om diagnosen.
Behandling:
Lokalbehandling är ofta tillräckligt. Vid svåra former ges behandling med fototerapi eller systemiska immunsuppressiva läkemedel.
  1. Läkemedel vid psoriasis och psoriasisartrit: behandlingsrekommendation från Läkemedelsverket (2019) lakemedelsverket.se  
  2. Naldi L. Epidemiology of psoriasis. Curr Drug Targets Inflamm Allergy 2004; 3: 121-8. PubMed  
  3. Alinaghi F, Calov M, Kristensen LE, et al. Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol. 2019 Jan;80(1):251-265.e19. PMID: 29928910. PubMed  
  4. Shobeiri SS, Khorrami M, Sankian M. Plaque-type psoriasis inhibitors. Int Immunopharmacol. 2021 Nov 12:108326. doi: 10.1016/j.intimp.2021.108326. Epub ahead of print. PMID: 34782274 PubMed  
  5. Giardina E, Sinibaldi C, Novelli G. The psoriasis genetics as a model of complex disease. Curr Drug Targets Inflamm Allergy 2004; 3: 129-36. PubMed  
  6. Gudjonsson JE, Elder JT. Psoriasis: epidemiology. Clin Dermatol. 2007 Nov-Dec;25(6):535-46. doi: 10.1016/j.clindermatol.2007.08.007. PMID: 18021890. PubMed  
  7. 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 PubMed  
  8. Ito T, Takahashi H, Kawada A, Iizuka H, Nakagawa H; Japanese Society For Psoriasis Research. Epidemiological survey from 2009 to 2012 of psoriatic patients in Japanese Society for Psoriasis Research. J Dermatol. 2018;45(3):293-301. PMID: 29115687 PubMed  
  9. Ozawa M, Aiba S. Immunopathogenesis of psoriasis. Curr Drug Targets Inflamm Allergy 2004; 3: 137-44. PubMed  
  10. Kim WB, Jerome D, Yeung J. Diagnosis and management of psoriasis. Can Fam Physician. 2017 Apr;63(4):278-285. PMID: 28404701 PubMed  
  11. Svenska sällskapet för Dermatologi och venerologi. SSDV:s. behandlingsrekommendationer för systemisk behandling av psoriasis. Hämtad 2020-10-13 www.ssdv.se  
  12. Mease P, Goffe BS. Diagnosis and treatment of psoriatic arthritis. J Am Acad Dermatol 2005; 52: 1-19. PubMed  
  13. Gladmann DD; Antoni C, Mease P, et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005; 64: 14-7. PubMed  
  14. Chen T-L, Lee L-L, Huang H-K, et al. Association of Psoriasis With Incident Venous Thromboembolism and Peripheral Vascular Disease A Systematic Review and Meta-analysis. JAMA Dermatol 2021. pmid:34851364 PubMed  
  15. Mallbris L, Akre O, Granath F, Yin L, Lindelof B, Ekbom A, et al. Increased risk for cardiovascular mortality in psoriasis inpatients but not in outpatients. Eur J Epidemiol 2004; 19: 225-30. PubMed  
  16. Boffetta P. Cancer risk in a population-based cohort of patients hospitalised for psoriasis in Sweden. J Invest Dermatol 2001; 117: 1531-7. PubMed  
  17. Luba KM, Stulberg DL. Chronic plaque psoriasis. Am Fam Physician 2006; 73: 636-44. PubMed  
  18. Gelfand JM, Berlin J, Van Voorhees A, Margolis DJ. Lymphoma rates are low but increased in patients with psoriasis: results from a population-based cohort study in the United Kingdom. Arch Dermatol 2003; 139: 1425-9. PubMed  
  19. Al-Suwaidan SN, Feldman SR. Clearance is not a realistic expectation of psoriasis treatment. J Am Acad Dermatol 2000; 42:796-802. PubMed  
  20. Ashcroft DM, Li Wan Po A, Williams HC, Griffiths CEM. Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis. BMJ 2000; 320: 963-7. PMID: 10753146 PubMed  
  21. Douglas WS, Poulin Y, Decroix J, Ortonne JP, Mrowietz U, Gulliver W, et al. A new calcipotriol/betamethasone formulation with rapid onset of action was superior to monotherapy with betamethasone dipropionate or calcipotriol in psoriasis vulgaris. Acta Derm Venereol 2002; 82: 131-5. PubMed  
  22. Mason AR, Mason J, Cork M, Dooley G, Edwards G. Topical treatments for chronic plaque psoriasis. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD005028. doi: 10.1002/14651858.CD005028.pub2. Update in: Cochrane Database Syst Rev. 2013;3:CD005028. PMID: 19370616 PubMed  
  23. Crowley JJ, Weinberg JM, Wu JJ et al. Treatment of Nail Psoriasis. JAMA Dermatol 2015; 151(1): 87-94. pmid:25471223 PubMed  
  24. Jabbar-Lopez ZK, Wu KC, Reynolds NJ. Newer agents for psoriasis in adults. BMJ. 2014 Jul 9;349:g4026. doi: 10.1136/bmj.g4026. PMID: 25008099 PubMed  
  25. Papp KA, Guenther L, Boyden B, Larsen FG, Harvima RJ, Guilhou JJ, et al. Early onset of action and efficacy of a combination of calcipotriene and betamethasone dipropionate in the treatment of psoriasis. J Am Acad Dermatol 2003; 48: 48-54. PubMed  
  26. SBU. Ljusbehandling och systemisk behandling av psoriasis 2018. www.sbu.se  
  27. Hearn RM, Kerr AC, Rahim KF, Ferguson J, Dawe RS. Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy. Br J Dermatol. 2008 Sep;159(4):931-5. doi: 10.1111/j.1365-2133.2008.08776.x. PMID: 18834483 PubMed  
  28. Garnock-Jones KP. Secukinumab: a review in moderate to severe plaque psoriasis. Am J Clin Dermatol. 2015 Aug;16(4):323-30. PMID:26202871. PubMed  
  29. Picardi A, Abeni D. Stressful life events and skin diseases: disentangling evidence from myth. Psychother Psychosom 2001; 70: 118-36. PubMed  
  30. Dupire G, Droitcourt C, Hughes C, Le Cleach L. Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database Syst Rev. 2019 Mar 5;3(3):CD011571. doi: 10.1002/14651858.CD011571.pub2. PMID: 30835819 PubMed  
  31. Owen CM, Chalmers RJG, O`Sullivan T, Griffiths CEM. Antistreptococcal interventions for guttate and chronic plaque psoriasis. The Cochrane Library, issue 2, 2000. Last amandment January 07, 2000. PMID: 10796842 PubMed  
  32. Shah M, Al Aboud DM, Crane JS, Kumar S. Pustular Psoriasis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 10, 2020. PMID: 30725687 PubMed  
  33. Rabin F, Bhuiyan SI, Islam T, Haque MA, Islam MA. Psychiatric and psychological comorbidities in patients with psoriasis- a review. Mymensingh Med J. 2012 Oct;21(4):780-6. PMID: 23134936 PubMed  
  34. Leisner MZ, Riis JL, Schwartz BS et al. Psoriasis and Risk of Mental Disorders in Denmark. JAMA Dermatol 2019.0039 pmid:31066861. www.ncbi.nlm.nih.gov  
  35. Geale K, Henriksson M, Jokinen J, Schmitt-Egenolf M. Association of Skin Psoriasis and Somatic Comorbidity With the Development of Psychiatric Illness in a Nationwide Swedish Study published online ahead of print, 2020 Jun 3. JAMA Dermatol. 2020;10.1001/jamadermatol.2020.1398. PMID: 32492085 PubMed  
  36. Pouplard C, Brenaut E, Horreau C, et al. Risk of cancer in psoriasis: a systematic review and meta-analysis of epidemiological studies. J Eur Acad Dermatol Venereol. 2013;27(suppl 3):36-46. PMID: 23845151 PubMed  
  37. Trafford AM, Parisi R, Kontopantelis E, et al. Association of Psoriasis With the Risk of Developing or Dying of Cancer A Systematic Review and Meta-analysis. JAMA Dermatol 2019. pmid:31617868 PubMed  
  38. Li X, Andersen KM, Chang H-Y, et al. Comparative risk of serious infections among real-world users of biologics for psoriasis or psoriatic arthritis. Ann Rheum Dis 2019. pmid:31672774 PubMed  
  39. Russo PA, Ilchef R, Cooper AJ. Psychiatric morbidity in psoriasis: a review. Australas J Dermatol 2004; 45: 155-61. PubMed  
  • Tore Särnhult, överläkare, Hallandskustens hudmottagning
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet