Myths and truths. Psoriasis

Abstract

STATEMENTS

1. “There are environmental factors that can act as triggers.”

2. “Psoriasis carries no cardiovascular risk.”

3. “Psoriasis does not cause mucosal manifestations.”

RESOLUTION 1. TRUE. Various factors can trigger or aggravate psoriasis. Notable among these are harmful habits, such as alcohol and tobacco consumption. Bacterial, fungal, and viral infections can act as triggers or aggravating factors by stimulating the immune response in susceptible individuals. Bacterial infections—particularly streptococcal ones—are associated with guttate psoriasis, as they induce intense immune activation. Physical or chemical trauma can also act as triggers. The Koebner phenomenon explains the appearance of psoriatic lesions on previously healthy skin following local injury. Emotional stress, whether acute or chronic, can provoke a neuroendocrine response via the hypothalamic-pituitary-adrenal axis, triggering a state of systemic inflammation. Regarding nutrition, there is a bidirectional relationship between obesity and psoriasis. Obesity promotes systemic inflammation mediated by proinflammatory cytokines produced in adipose tissue. Exacerbating factors include various medications, such as antimalarials, beta-blockers, non-steroidal anti-inflammatory drugs (NSAIDs), interferon, angiotensin-converting enzyme (ACE) inhibitors, and gemfibrozil.

2. MYTH. In addition to atherosclerotic risk factors, the severity of skin involvement is independently associated with an increased cardiovascular risk in patients with psoriasis. Endothelial dysfunction and increased carotid intima-media thickness have been demonstrated, suggesting the presence of subclinical cardiovascular disease.

3. MYTH. In patients with acrodermatitis continua of Hallopeau and generalized pustular psoriasis, migratory erythematous annular lesions with whitish scaling and a moist appearance may occur. These lesions are most frequently located on the tongue and can mimic geographic tongue both clinically and histologically. Oral mucosal manifestations may also be observed.