La psoriasis es un trastorno crónico con predisposición poligénica y desencadenantes ambientales, como infecciones bacterianas, traumas o drogas. La psoriasis afecta entre el 1.5 y el 2% de la población en los países occidentales. Se presenta en todo el mundo.
Expresiones clínicas serias Las lesiones típicas son pápulas y placas descamativas crónicas y recurrentes. Las erupciones pustulosas y la eritrodermia también ocurren.
La presentación clínica varía entre un individuo y otro, desde aquellos que solo tienen algunas placas circunscritas a aquellos con afectación cutánea generalizada.
- Eritrodermia psoriásica en la psoriasis que afecta toda la piel.
- La artritis psoriásica ocurre en 10 a 25% de los casos.
Tipos de psoriasis
- Psoriasis vulgaris.
- Eritrodermia psoriásica.
- Psoriasis pustular.
- Psoriasis palmoplantar.
- Acrodermatitis continua.
Factores que influyen en la selección del tratamiento de la Psoriasis
- Edad: infancia, adolescencia, edad adulta joven, edad media,> 60 años.
- Tipo de psoriasis: en gotas, placas, palmar palmar y pustular, psoriasis pustular generalizada y psoriasis eritrodérmica.
- Lugar y extensión de la afectación: circunscrito a las palmas de las manos y las plantas de los pies, el cuero cabelludo, la región ano genital, placas dispersas pero afectadas <5%; generalizado y afectado> 30%.
- Tratamiento previo: radiación ionizante, glucocorticoides sistémicos, foto o quimioterapia (PUVA), ciclosporina (CS) y metotrexato (MTX).
- Condiciones médicas concomitantes (p. Ej., Infección por VIH).
Psoriasis circunscrita
- Glucocorticoide fluorado tópico cubierto con vendaje de plástico. La cinta impregnada con glucocorticoide también es útil. Los efectos secundarios de los corticosteroides deben tenerse en cuenta.
- Un apósito hidrocoloide, que se mantiene durante 24 a 48 h, es eficaz y evita los arañazos.
- Para placas pequeñas (≤4 cm), acetónido de triamcinolona en suspensión acuosa 3 mg / ml diluido en solución isotónica que se inyecta intradermicamente en las lesiones. Debemos tener en cuenta la hipopigmentación en la piel oscura.
La antralina tópica también es efectiva, pero puede causar irritación. - Los análogos de la vitamina D ( ungüento y crema) son buenos compuestos tópicos antipsoriásicos no esteroideos, pero menos efectivos que los corticosteroides; no están acompañados de atrofia cutánea; Se pueden combinar con corticosteroides.
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