NURS 6501 Discussion Week 2 Psoriasis Post and response
NURS 6501 Discussion Week 2 Initial Post
Psoriasis is a chronic, relapsing, proliferative, inflammatory disorder that involves the skin, scalp, and nails and can occur at any age. Psoriasis affects about 1% to 4% of the population in countries north of the equator. The onset is generally established by the age of 40. A family history of psoriasis is common and the genetic mechanisms are complex. The onset of psoriasis later in life is less familial and more secondary to comorbidities, such as obesity, smoking, hypertension, and diabetes (Huether & McCance) NURS 6501 Discussion Week 2 Psoriasis Post and response.
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Psoriasis is the prototypical form of psoriasiform dermatitis, a pattern of inflammatory skin disease in which the epidermis is thickened as a result of elongation of rete ridges. In psoriatic lesions, epidermal thickening reflects excessive epidermopoiesis. This increase is reflected in shortening of the duration of the keratinocyte cell cycle and doubling of the proliferative cell populations. NURS 6501 Discussion Week 2 Psoriasis Post and response Because of these alterations, lesional skin contains up to 30 times as many keratinocytes per unit area as normal skin (Hammer & McPhee).
The turnover time for shedding the epidermis is decreased to 3 to 4 days from the normal 14 to 20 days, with many germinative cells and increased transit time through the dermis. Cell maturation and keratinization are bypassed, and the epidermis thickens and plaques form. The disease can be mild, moderate, or severe depending on the size, distribution, and inflammation of the lesions. Psoriasis is marked by remissions and exacerbations (Huether & McCance). NURS 6501 Discussion Week 2 Psoriasis Post and response.
Inflammatory Bowel Disease
The prevalence of irritable bowel disease (IBD) is about 1.6 million people in the United States with about 70,000 new cases per year. The disease is more prevalent among white populations and Ashkenazi Jews. Risk factors and theories of causation include susceptibility genes, environmental factors, alterations in epithelial cell barrier functions, and an altered immune response to intestinal microflora. NURS 6501 Discussion Week 2 Psoriasis Post and response Environmental factors or infections are thought to alter the barrier functions, and an altered immune response to intestinal microflora (Huether & McPhee).
There are two forms of chronic inflammatory bowel disease; Crohns disease and ulcerative colitis. The causes of IBD are unknown. Genetic risk and environmental factors are recognized as two key elements in the pathogenesis of IBD. Genetic factors are not the sole contributor to IBD. Many environmental factors have been found to contribute to the development of Crohns disease, including pathogenic microorganisms, indigenous intestinal microbes, dietary factors, smoking, defective immune responses, and psychosocial factors. Similar factors may contribute to the pathogenesis of ulcerative colitis, including infections, allergies to dietary components, immune responses to bacteria and self-antigens, and psychosocial factors. The features common to all forms of IBD are mucosal ulceration and inflammation of the GI tract. Accumulating evidence suggests that cytokine dysregulation may be a key factor in connecting these conditions (Hammer & McPhee) NURS 6501 Discussion Week 2 Psoriasis Post and response.
Psoriasis and IBD cluster at all genetic levels of human populations. They share the same geographic/ethnic, kindred and patient niches. Psoriasis and crohns disease also coexist in the same patient more often than expected by chance. The relative risks of psoriasis are significantly increased in both ulcerative colitis and crohns disease patients, and psoriasis patients are at increased risk of developing irritable bowel disorder Vlachos, C., Gaitanis, G., Katsanos, K., Christodoulou, D., Tsianos, E., & Bassukas, I., 2016).
According to current knowledge, both psoriasis and IBD recognize two pathogenetic moments, the first one involving innate immunity triggered by unknown stimuli and the second one involving the adaptive immunity, due to cytokines released from cells of the innate immune system, mainly dendritic cells. Cytokines subsequently influence the activity of T cells subtypes as T-helper17 and T-regs, now considered as crucial within the pathogenetic process (Skroza, N., Proietti, I., Pampena, R., LaViola, G., Bernardini, N., Nicolucci, F., & Potenza, C., 2013) NURS 6501 Discussion Week 2 Psoriasis Post and response.
The inflammatory disease involve thickening of the epidermis in psoriasis, and the mucosa with inflammatory bowel disease. This thickening or inflammation is followed by sloughing or necrosis of the thickened lesions. Psoriasis and IBD are strictly related inflammatory diseases, probably sharing immune-pathogenetic mechanisms. Skin and bowel represent, at the same time, barrier and connection between the inner and the outer sides of the body. This explains why, at these levels, immune processes play a key role in maintaining homeostasis and in sustaining pathological processes (Skroza, N., et.al.) NURS 6501 Discussion Week 2 Psoriasis Post and response.
Reference
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Hammer, G.D. & McPhee, S.J. (2014). Pathophysiology of disease: An introduction to clinical medicine. New York, NY: McGraw-Hill Medical.
Skroza, N., Proietti, I., Pampena, R., La Viola, G., Bernardini, N., Nicolucci, F., & … Potenza, C. (2013). Correlations between Psoriasis and Inflammatory Bowel Diseases. Biomed Research International, 2013983902. doi:2013/983902
Vlachos, C., Gaitanis, G., Katsanos, K., Christodoulou, D., Tsianos, E., & Bassukas, I. (2016). Psoriasis and inflammatory bowel disease: links and risks. Psoriasis : Targets And Therapy, Vol 2016, Iss Issue 1, Pp 73-92 (2016), (Issue 1), 73. NURS 6501 Discussion Week 2 Psoriasis Post and response.
RE: Discussion 1 – Week 2 response # 1
Thank you for an informational and interesting post. I did not realize that 1.) irritable bowel disease (IBD) was an umbrella term for chron’s and ulcerative colitis and 2.) there were so many similarities between psoriasis and IBD.
Innate and adaptive immunity seem to play a large role in triggering chronic inflammation in IBD, which is also common in psoriasis (another immune related disease). This leads to similar theraputic strategies in both diseases including steroids, immunomodulators, and monoclonal antibodies (Fiorino & Omodu, 2015) NURS 6501 Discussion Week 2 Psoriasis Post and response.
Lesuis, Befrits, Nyberg, & van Vollenhoven (2012) report that previous studies have shown women with IBD generally have worse scores on pain and quality of life measurements, while gender relationships remain unclear on psoriasis. They did an observational study on gender and treatment for women and men in relation to immune- mediated chronic inflammatory diseases and found that women, even though they have the same treatment as men, may be undertreated. This study an hopefully aid in the proper treatment of these painful life changing diseases.
References:
Fiorino, G., & Omodei, P.D. (2015). Psoriasis and the inflammatory bowel disease: Two sides f the same coin?. Journal of Chron’s Colitis, 9(9), 697- 698. DOI: https://doi.org/10.1093/ecco-jcc/jjv110. NURS 6501 Discussion Week 2 Psoriasis Post and response
Lesuis, N., Befrits, R., Nyberg, F., & van Vollenhaven, R. (2012). Gender and the treatment of immune- mediated chronic inflammatory diseases: rheumatoid arthritis, inflammatory bowel disease and psoriasis: an observational study. BMC Medicine, 10(1), 82. DOI: 10.1186/1741-7015-10-82. NURS 6501 Discussion Week 2 Psoriasis Post and response