After studying Module 4: Lecture Materials & Resources, discuss a dermatologic disorder and its treatment modalities.
Submission Instructions:
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
Dermatologic Disorder: Psoriasis and Its Treatment Modalities
Psoriasis is a chronic, immune-mediated inflammatory skin disorder characterized by erythematous plaques covered with silvery scales, most commonly affecting the scalp, elbows, knees, and lower back. It affects approximately 2-3% of the global population and is associated with a significant impact on quality of life due to its visible nature and associated comorbidities such as psoriatic arthritis, cardiovascular disease, and depression (Greb et al., 2016). The exact etiology of psoriasis remains unclear, but it is understood to involve genetic predisposition and environmental triggers, including infections, stress, and certain medications. Immune dysregulation, particularly the overactivation of T-helper 17 (Th17) cells and increased production of pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukin-17 (IL-17), plays a central role in the disease’s pathophysiology (Armstrong & Read, 2020).
Treatment modalities for psoriasis are determined based on disease severity, the extent of body surface area affected, patient comorbidities, and patient preference. The main categories of treatment include topical agents, phototherapy, systemic therapies, and biologic agents. Mild to moderate psoriasis is typically managed with topical therapies such as corticosteroids, vitamin D analogs (e.g., calcipotriol), coal tar, and calcineurin inhibitors. Topical corticosteroids are considered the first-line treatment due to their anti-inflammatory and immunosuppressive effects. However, long-term use is limited by potential side effects such as skin atrophy, telangiectasia, and tachyphylaxis (Menter et al., 2019).
For moderate to severe psoriasis, phototherapy and systemic treatments are considered. Narrowband ultraviolet B (NB-UVB) phototherapy is one of the most effective non-pharmacologic treatments and works by inducing T-cell apoptosis and reducing epidermal hyperproliferation. However, it requires frequent clinic visits and may be associated with long-term skin damage and an increased risk of skin cancer with prolonged use (Menter et al., 2019).
Systemic therapies include traditional agents such as methotrexate, cyclosporine, and acitretin. Methotrexate is a folate antagonist that inhibits DNA synthesis and reduces T-cell activation, while cyclosporine is a calcineurin inhibitor that suppresses the immune system. These agents are effective but carry risks of hepatotoxicity, nephrotoxicity, and immunosuppression, necessitating close monitoring of liver and renal function (Greb et al., 2016).
In recent years, biologic therapies have revolutionized the management of moderate to severe psoriasis. These agents target specific components of the immune system involved in the disease process. Examples include TNF-α inhibitors (e.g., etanercept, adalimumab), IL-12/23 inhibitors (e.g., ustekinumab), IL-17 inhibitors (e.g., secukinumab, ixekizumab), and IL-23 inhibitors (e.g., guselkumab, risankizumab). These medications have demonstrated high efficacy and favorable safety profiles, although they are costly and require monitoring for infections and other adverse events (Armstrong & Read, 2020). Biologics offer personalized therapy and have significantly improved outcomes for patients with recalcitrant or widespread psoriasis.
In conclusion, psoriasis is a complex dermatologic disorder requiring a tailored approach to management. The choice of therapy should be individualized based on the severity of the disease, patient comorbidities, lifestyle, and risk-benefit analysis. As new therapies emerge, particularly targeted biologics, the potential for improved quality of life and disease control for psoriasis patients continues to grow. Advanced practice nurses play a pivotal role in assessing disease severity, educating patients, monitoring for treatment efficacy and side effects, and coordinating interdisciplinary care.
References
Armstrong, A. W., & Read, C. (2020). Pathophysiology, clinical presentation, and treatment of psoriasis: A review. JAMA, 323(19), 1945–1960. https://doi.org/10.1001/jama.2020.4006
Greb, J. E., Goldminz, A. M., Elder, J. T., Lebwohl, M. G., Gladman, D. D., Wu, J. J., … & Krueger, J. G. (2016). Psoriasis. Nature Reviews Disease Primers, 2, 16082. https://doi.org/10.1038/nrdp.2016.82
Menter, A., Strober, B. E., Kaplan, D. H., Kivelevitch, D., Prater, E. F., Stoff, B., … & Armstrong, A. W. (2019). Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. Journal of the American Academy of Dermatology, 80(4), 1029-1072. https://doi.org/10.1016/j.jaad.2018.11.043
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