Nanotechnological approaches for the effective management of psoriasis

Figures & data

Table I. Pathological events involved in psoriasis.

Steps	Pathological events
(A) T cell activation	• Human leukocyte antigen (HLA-1, HLA-4, & HLA-6) enter the human skin and activate the antigen-presenting cells. • The activated cells reach the skin-associated lymphoid tissue and interact with T cells, resulting in their maturation, activation, and proliferation.
(B) Migration of activated T cells into skin	• The activated T cells express common leukocyte antigen (CLA), interact with E and P selection expressed by the vascular endothelium which undergoes extravasation into the skin, and migrate into the dermis and epidermis.
(C) Reactivation of T cells in dermis and epidermis	• Activated T cells undergo reactivation in the lymph nodes, resulting in the formation of memory T cells, which produce type-1 and type-2 cytokines. • Type-1 cytokines (tumor necrosis factor-α, interleukin (IL)-2, interferon-γ) and type-2 cytokines (IL-4, IL-5 and IL-10) are predominant in psoriatic plaques and are responsible for the formation of new psoriatic lesions.

Table II. Characteristics, symptoms, and causes of various types of psoriasis.

Types of psoriasis	Signs & symptoms	Causes
Plaque psoriasis: The most prevalent form of the disease. About 80–85% of those who have psoriasis have this type. It is typically found on the elbows, knees, scalp, and lower back.	The plaques are pinkish-red, round or oval, and covered with white silvery scales. The plaques itch or may be painful.	Rubbing of skin, infection, medicines, alcohol, stress, smoking, and sunlight. (Lee et al. 2012)
Flexural psoriasis: It is also known as inverse psoriasis. Inverse psoriasis is found in the armpits, groin, under the breasts, and in other skin folds around the genitals and the buttocks. About 18% of those who have psoriasis have this type.	Bright red lesions that are smooth and shiny. Irritation from rubbing and sweating.	Yeast overgrowth, high sensitivity to friction or sweating. (Syed and Khachemoune 2011)
Guttate psoriasis: Guttate psoriasis is usually triggered by a bacterial infection such as strep throat. This form of psoriasis that often starts in childhood or young adulthood. It often comes on quite suddenly. About 18% of those who have psoriasis have this type.	Itching and spots on skin. The spots may be covered with silvery, flaky skin called scales. It is marked by small water-drop-shaped sores on the trunk, arms, legs and scalp.	Streptococcal infection, bacterial or viral infections, injury to skin, e.g., cuts, burns, and insect bites, medicines, stress, sunburn, and alcohol. (Henley 2012)
Nail psoriasis: Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth, and discoloration. About 50–80% of those who have psoriasis have this type.	Change in nail color, little pits in nails, lines across nails, white area on nail plate, thickening of skin under nail, loosening of nail.	Combination of genetic, environmental, and immune causes. (Aydin et al. 2012)
Psoriatic arthritis: Psoriatic arthritis (PSA) is an inflammatory condition that affects the joints of children and adults with psoriasis. About 1/3 of psoriasis patients have this type.	Red, swollen, tender, warm, and stiff joints, stroke, arthrosclerosis, myocardial infarction.	Trauma or injury on skin, like cuts or burns, medicines, alcohol, skin irritants, smoking. (Mease 2012)
Erythrodermic psoriasis: It is a particularly inflammatory form of psoriasis that affects most of the body surface. It is characterized by periodic, widespread, fiery redness of the skin and the shedding of scales in sheets, rather than smaller flakes. About 1–6% of those who have psoriasis have this type.	Heart rate increase, fluctuating body temperature, reddening and shedding of the skin.	Use of steroid, severe sun burn, emotional stress, alcoholism, infection, allergy. (Hawilo et al. 2011)
Pustular psoriasis: Pustular psoriasis can occur in widespread patches or in smaller areas on the hands, fingertips, or feet. Less than 5% of patients who have psoriasis have this type.	Reddening of the skin, followed by formation of pustules and scaling. Severe irritation, or light sensitivity. (Viguier et al. 2012)	Overexposure to UV light, pregnancy, systemic steroids, infections, stress, and sudden withdrawal of systemic medications or potent topical steroids.

Table III. Diagnosis of psoriasis by skin biopsy and blood analysis.

Findings revealed on skin biopsy of psoriasis (18)	Findings revealed on blood analysis of psoriasis (19)
• Thickening of skin • Excess keratin formation • Formation of continuous skin • Expansion of capillaries • Infiltration of skin due to macrophages • Infiltration of skin due to lymphocytes • Large Munro abscesses	• Increased erythrocyte sedimentation rate (ESR, CED rate) • 10–20% increase in content of uric acid • Below normal amount of red blood cells in severe psoriasis • High erythrocyte sedimentation rate is noted in pustular psoriasis.

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