Nursing Paper Example on Psoriasis

Psoriasis is a chronic autoimmune disease characterized by the rapid growth of skin cells, leading to thick, scaly patches on the skin. Affecting approximately 2–3% of the global population, psoriasis is both physically and psychologically burdensome. The condition can manifest at any age, though it most commonly develops between the ages of 15 and 35. While the exact cause of psoriasis remains unknown, a combination of genetic, environmental, and immune factors contribute to its development. Psoriasis is not just a cosmetic condition but also a systemic disease that can affect various aspects of an individual’s health, especially when associated with complications like psoriatic arthritis.

Causes and Risk Factors

Psoriasis arises from a complex interplay of genetic predisposition and environmental triggers. Genetics play a significant role, as individuals with a family history of the disease are more likely to develop it. The immune system is central to psoriasis, where overactive T-cells (a type of white blood cell) mistakenly attack healthy skin cells, causing an accelerated production of skin cells. Environmental factors such as stress, infections, and skin trauma (known as the Koebner phenomenon) can trigger or exacerbate psoriasis. Moreover, lifestyle factors like obesity, smoking, and alcohol consumption are associated with an increased risk of developing or worsening the disease.

Types of Psoriasis

Psoriasis manifests in several forms, each with distinct characteristics:

Plaque Psoriasis (Psoriasis Vulgaris): The most common type, plaque psoriasis presents as raised, red patches covered with silvery-white scales.
Guttate Psoriasis: This type often appears suddenly and is typically triggered by a bacterial infection like strep throat, presenting as small, drop-shaped lesions.
Inverse Psoriasis: Found in skin folds such as the armpits and groin, inverse psoriasis appears as smooth, red patches of skin.
Pustular Psoriasis: This severe form causes pus-filled blisters surrounded by red skin, typically affecting the hands and feet.
Erythrodermic Psoriasis: A rare, life-threatening form of psoriasis characterized by widespread inflammation, redness, and skin shedding.
Nail Psoriasis: Affects nails, causing pitting, discoloration, and abnormal nail growth.

Signs and Symptoms

The primary symptom of psoriasis is the formation of thick, scaly plaques on the skin, which can be itchy and painful. These plaques may vary in size and typically develop on the scalp, elbows, knees, and lower back. Additional symptoms include dry and cracked skin that may bleed, nail abnormalities (e.g., pitting and discoloration), and joint pain in cases of psoriatic arthritis. Psoriasis is a cyclic condition, with periods of flare-ups and remission. Beyond its physical symptoms, psoriasis can also have profound emotional effects, leading to anxiety, depression, and social isolation due to the visible nature of the lesions.

Etiology

Psoriasis is an autoimmune disorder in which the body’s immune system mistakenly identifies healthy skin cells as a threat, triggering an abnormal response. The immune system accelerates the life cycle of skin cells, causing them to multiply rapidly and accumulate on the skin’s surface. While the exact cause is not fully understood, genetic factors are believed to contribute significantly. Over 40% of individuals with psoriasis have a family history of the disease. Additionally, certain genes, particularly those associated with the immune system (e.g., HLA-Cw6), are linked to psoriasis development. Environmental triggers such as infections, certain medications (e.g., beta-blockers), and physical or emotional stress can also play a key role in the onset or exacerbation of psoriasis.

Pathophysiology

The pathophysiology of psoriasis involves an abnormal immune response that results in the overproduction of skin cells. T-cells, a type of white blood cell, become overactive and release pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-17 (IL-17), and interleukin-23 (IL-23). These cytokines trigger the rapid production of keratinocytes (skin cells) in the epidermis. Instead of the normal 28-day turnover cycle, skin cells in psoriatic lesions regenerate every 3–4 days. This rapid turnover leads to the accumulation of dead skin cells on the surface, resulting in the characteristic plaques. Chronic inflammation also plays a key role in joint damage in patients with psoriatic arthritis.

Diagnosis

Psoriasis is typically diagnosed through a physical examination of the skin, scalp, and nails. In most cases, a clinical diagnosis is sufficient, based on the appearance and distribution of lesions. For cases that are not typical, a skin biopsy may be performed to differentiate psoriasis from other skin conditions such as eczema or fungal infections. Additional diagnostic measures, such as blood tests and imaging, are used when psoriatic arthritis is suspected, helping to assess joint involvement and inflammation.

Complications

While psoriasis primarily affects the skin, it can lead to several complications:

Psoriatic Arthritis: Up to 30% of individuals with psoriasis develop psoriatic arthritis, a condition characterized by joint pain, stiffness, and swelling.
Cardiovascular Disease: Chronic inflammation associated with psoriasis increases the risk of heart disease and stroke.
Psychological Impact: The visible nature of psoriasis can significantly impact an individual’s quality of life, leading to mental health conditions such as anxiety and depression.
Metabolic Syndrome: Psoriasis is linked to an increased risk of developing metabolic syndrome, which includes obesity, hypertension, and diabetes.

(Nursing Paper Example on Psoriasis)

Treatment Options

Psoriasis treatment aims to reduce inflammation, control the rapid production of skin cells, and manage symptoms. Treatment options vary depending on the severity of the disease and may include:

Topical Therapies: These include corticosteroids, vitamin D analogs, and coal tar. These medications help reduce inflammation and slow the growth of skin cells.
Phototherapy: Phototherapy involves exposing the skin to ultraviolet (UVB) light to reduce the growth of skin cells. PUVA therapy, which combines psoralen medication with UVA light, is another option for more severe cases.
Systemic Therapies: For moderate to severe psoriasis, systemic medications such as methotrexate, cyclosporine, and retinoids may be used. These medications work throughout the body to suppress the immune response.
Biologic Therapies: Biologics target specific components of the immune system, particularly TNF-α, IL-17, and IL-23. Common biologics include etanercept, adalimumab, and ustekinumab.
Lifestyle and Alternative Therapies: Lifestyle modifications such as smoking cessation, weight management, and regular exercise can help reduce the risk of flare-ups. Alternative therapies like aloe vera and fish oil supplements may provide additional relief for some patients.

Patient Education and Lifestyle Modifications

Educating patients about psoriasis is crucial for managing the condition and improving quality of life. Patients should be informed about the chronic nature of the disease and the importance of adherence to treatment plans. Stress management techniques, such as mindfulness and relaxation exercises, can help reduce flare-ups. Patients should avoid known triggers, including smoking and excessive alcohol consumption. Additionally, regular skin care, including the use of moisturizers and gentle cleansers, is essential for minimizing dryness and irritation.

(Nursing Paper Example on Psoriasis)

Conclusion

Psoriasis is a chronic autoimmune condition with complex causes and multiple manifestations. While there is no cure for psoriasis, treatments ranging from topical medications to biologics can significantly improve the quality of life for individuals affected by this condition. Early diagnosis, patient education, and a personalized treatment plan are essential for effectively managing psoriasis and its associated complications, including psoriatic arthritis and cardiovascular disease.

(Nursing Paper Example on Psoriasis)

References

National Psoriasis Foundation. Psoriasis Overview. https://www.psoriasis.org/about-psoriasis
Mayo Clinic. Psoriasis: Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840
World Health Organization. Global Report on Psoriasis. https://www.who.int/publications/i/item/global-report-on-psoriasis
Armstrong, A. W., & Read, C. (2020). Pathophysiology, Clinical Presentation, and Treatment of Psoriasis. JAMA, 323(19), 1945–1960. https://jamanetwork.com/journals/jama/fullarticle/2767932
Lowes, M. A., Suárez-Fariñas, M., & Krueger, J. G. (2014). Immunology of Psoriasis. Annual Review of Immunology, 32, 227–255. https://www.annualreviews.org/doi/10.1146/annurev-immunol-032713-120225

Nursing Paper Example on Psoriasis