Guías para el diagnóstico y manejo de la psoriasis
Abstract
La psoriasis es un desorden crónico inflamatorio de la piel, que afecta a un 2.6% de la población mundial. La susceptibilidad para desarrollar la psoriasis se encuentra en la región HLA del cromosoma 6, o cerca de ella. Las citoquinas involucradas incluyen interleuquinas 1-2-4-5-7-10, FNTa, IFNy, hemopoyetinas, factor estimulante de colonias granulocito-macrófago, quimioquinas, factores de crecimiento, endotelina 1. Entre los factores precipitantes se encuentran drogas, infección, alcohol y tabaquismo.
Clínicamente se caracteriza por lesiones con bordes delimitados, superficie compuesta por escamas plateadas, debajo de las cuales la piel muestra un eritema brillante y homogéneo; signo de Auspitz y fenómeno de Koebner.
A la histopatología se puede apreciar un espesor epidérmico 3-5 veces mayor, ausencia de las papilas dérmicas, paraqueratosis, aumento en el número de mitosis, y en la dermis se observan papilas finas, alongadas y prominentes, capitales tortuosos dilatados, estroma papilar edematoso,
infiltrado inflamatorio compuesto por linfocitos, macrófagos, neutrófilos y mastocitos en la dermis papilar, y microabscesos de Munro.
El diagnóstico se hace por los hallazgos clínicos e histopatológicos. Los objetivos generales del tratamiento son lograr remisiones largas y el antenimiento del paciente con pocos efectos secundarios; para ello existen diferentes estrategias terapéuticas como monoterapia, terapia combinada, terapia rotacional, terapia secuencial y terapia continua.
Author Biography
Carolina Alejandra Palacio Valencia, Universidad Militar Nueva Granada
RII Dermatología Universidad Nueva Granada, Hospital Militar Central, Bogotá, Colombia.
References
1. Koo J, Lee E, Lee es, Lebwohl M. Psoriasis. J Am Acad Dermatol. 2004; 50(4):613-22.
https://doi.org/10.1016/j.jaad.2003.11.046
2. Koo JP population-based epidemiologic study of psoriasis with emphasis on quality of life assessment. Dermatol Clin 1996; 14(3): 485 - 96.
https://doi.org/10.1016/S0733-8635(05)70376-4
3. Leder RO, Mansbridge JN, Hallmayer J, Hodge SE. Familia! psoriasis and HLA-B: unambiguous support for linkage in 97 published families. Hum Hered 1998; 48(4): 198 - 211.
https://doi.org/10.1159/000022802
4. Elder JT, Nair RP, Henseler T, Jenisch S, Stuart P, Chia N, Christophers E, Voorhees JJ. The genetics of psoriasis 2001 > the odyssey continues. Arch Dermatol 2001; 137 (11): 1447 - 54.
https://doi.org/10.1001/archderm.137.11.1447
5. Prinz JC Psoriasis vulgaris a sterile antibacterial skin reaction mediated by cross-reactive T cell? An immunological view of pathophysiology of psoriasis. Clin Exp Dermatol 2001; 26(4): 326-32.
https://doi.org/10.1046/j.1365-2230.2001.00831.x
6. Bonifati C. Cytokines in psoriasis. lnt J Dermatol 1999; 24: 291- 5.
https://doi.org/10.1046/j.1365-4362.1999.00622.x
7. Tsankov N, Kazandjieva J, Drenovska K. Drugs in exacerbation and provocation of psoriasis. Clin Dermatol 1998; 16(3): 333-51.
https://doi.org/10.1016/S0738-081X(98)00005-4
8. Rasmussen JE. The relationship between infection with group A betta hemolitic streptococco and the development of psoriasis. Pediatr lnfect Dis J 2000; 19 (2): 153-4.
9. Higgins E. Alcohol, smoking and psoriasis. Clin Exp Dermatol 2000 25(2): 107- 10.
https://doi.org/10.1046/j.1365-2230.2000.00588.x
10. Rook. Textbook of Dermatology. Blackwell Science 6a. ed 1988; 3:1589.
11. Fitzpatrick TB, Eisen A, Wolf K, et al. Dermatology in General Medicine. USA, McGraw-Hill, 5a. ed; 2001.
12. Miller JJ.Roling D. Failure to demonstrate therapeutic tachyphylaxis to topically applied steroids in patients with psoriasis. J Am Acad Dermatol 1999; 4(4)1: 546- 9.
https://doi.org/10.1016/S0190-9622(99)80050-4
13. Katz HI, Prawer SE, Medansky RS, Krueger GG, Mooney JJ, Jones ML, Samson CR lntermitent corticosteroid maintenance treatment of psoriasis: a double-blind multicenter trial of augmented betamethasone dipropionate ointment in a pulse dose treatment regimen. Dermatológica, 1991, 183(4): 269-74.
https://doi.org/10.1159/000247698
14. Volden G. Bjornberg A, Tegner E, Pedersen NB, Arles UB, Agren S, Brolund L. Short contasct treatment at home with micanol . Acta Derm Venereol. 1992; 172, 20-2.
15. Bruce S, Epinette WW, Funicella T, lson A, Jones EL, Loss R Jr, McPhee ME, Whitmore C. Comparative study of calcipotriene ointment and fluocinonine ointment in the treatment of psoriasis. J Am Acad Dermatol 1994; 31 (5 Pt 1 ): 755-9.
https://doi.org/10.1016/S0190-9622(94)70237-3
16. Lebwohl LM, Yoles A, Lombardi K, Lou W. Calcipotriene ointment and halobetasol ointment in the long-term treatment of psoriasis : effects on the duration of improvement. J Am Acad Dermatol 1998; 39(3): 447-50.
https://doi.org/10.1016/S0190-9622(98)70323-8
17. Patel B, Siskin S, Krazmien R, Lebwohl M. Compatibility of calcipotriene with other topical medications. J Am Acad Dermatol 1998; 38(6 Pt 1 ): 1010-1.
https://doi.org/10.1016/S0190-9622(98)70171-9
18. Lebwoht M. Strategies to optimize efficacy duration of remission and safety in the treatment of plaque psoriasis by using tazarotene in combination with a corticosteroid. J Am Acad Dermatol, 2000; 43(2 Pt 3): S43-6.
https://doi.org/10.1067/mjd.2000.108319
19. Hecker D, Worsley J, Yueh G, Kuroda K, Lebwohl M. lnteractions between tazarotene and ultraviolet light. .J Am Acad Dermatol 1999; 41 (6): 927-30.
https://doi.org/10.1016/S0190-9622(99)70248-3
20. Schissel DJ, Elston DM. Topical 5 FU treatment for psoriatic trachonychia. Cutis 1998; 62 (1): 27-8.
21. Nouri K, Chartier TK, Eaglstein WH, Taylor JR. Cryoteraphy for psoriasis. Arch Dermatol 1997; 133 (12): 1608-9.
https://doi.org/10.1001/archderm.1997.03890480134028
22. Stern RS. Non-melanoma skin cancer occurring in patiens treatment with PUVA five to ten years after first treatment. J lnvest Dermatol 1988; 91: 120-4.
https://doi.org/10.1111/1523-1747.ep12464137
23. Stern RS, Laird N. The carcinogenic risk of treatment of severe psoriasis. Photochemotherapy follow-up study. Cancer 1994; 73(11 ):2759-64.
https://doi.org/10.1002/1097-0142(19940601)73:11<2759::AID-CNCR2820731118>3.0.CO;2-C
24. Walters IB, BurackLH, Coven TR, Gilleaudeau P, Krueger JG. Suberythemogenic narrow band UVB is markedly more effective than conventional UVB in treatment of psoriasis vulgaris. J Am Acad Dermatol 1999; 40(6 Pt 1 ): 893-900.
https://doi.org/10.1016/S0190-9622(99)70076-9
25. Feldman SR, Mellen BG, Housman TS, Fitzpatrick RE, Geronemus RG, Friedan PM. Efficacy of the 308 - nm excimer laser for treatment of psoriasis: results of a multicenter study. J Am Acad Dermatol 2002; 46 (6) :900- 6.
https://doi.org/10.1067/mjd.2002.120454
26. Roenigkl HH Jr, Auerbach R, Maibach H, Weinstein G, Lebwohl M. Methotrexate in psoriasis: consensus conference. J Am Acad Dermatol 1998; 38(3): 478-85.
https://doi.org/10.1016/S0190-9622(98)70508-0
27. Gutierrez S. Pancitopenia secondary to MTX therapy in AR. Arthritis Rheumatol 1996; 39: 272 - 276.
https://doi.org/10.1002/art.1780390214
28. Malatja D. MTX hepatotoxicity in psoriatic patients submited to long - term therapy. J Gastroenterol 1996; 1 O: 369 -75.
29. Roenigk HH Jr, Auerbach R, Maibach HI, Weinstein GD. Methotrexate in psoriasis: revised guidelines. J Am Acad Dermatol. 1988; 19(1 Pt 1 ): 145-56.
https://doi.org/10.1016/S0190-9622(88)80237-8
30. Lebwohl M, Ali S. Treatment of psoriasis. Part 2. Systemic therapies. J Am Acad Dermatol 2001; 45 (5): 649- 61.
https://doi.org/10.1067/mjd.2001.117047
31. Zachariae H, Steen Olsen T. Efficacy of cyclosporin A (CyA) in Psoriasis: an overview of dose/response, indications, contraindications and side-effects. Clin Nephrol 1995:43(3): 154-158.
32. Srivastava T, Zwick DL, Rothberg PG, Warady BA. Posttransplant lymphoproliferative disorder in pediatrie renal transplantation. Prediatic Nephol 1999; 13(9):748-54.
https://doi.org/10.1007/s004670050692
33. Solganic J, Tan MH. Adverse effects of systemic treatments: Cyclosporine. Psoriasis Forum 1998; 4-5.
https://doi.org/10.1177/247553039804a00104
34. Systemic tacrolimus (FK 506) is effective for the treatment of psoriasis in a double-blind, placebo-controlled study. The European FK 506 Multicentre Psoriasis Study Group ARCDermatol 1996; 132(4):419-23.
https://doi.org/10.1001/archderm.132.4.419
35. Callen JP, Krueger GG, Lebwohl M, McBurney El, Mease P, Menter A, Palier AS , Pariser DM, Weinblatt M, Zimmerman G; AAD. AAD consensus statement on psoriasis therapies. J Am Acad Dermatol. 2003; 49(5):897-9.
https://doi.org/10.1016/S0190-9622(03)01870-X
36. Lebwohl M. lnnovations in the treatment of psoriasis. J Am Acad Dermatol. 2004; 51(1 Suppl):S40-1.
37. Lebwohl M, Ali S. Treatment of psoriasis. Part 1. Topical therapy and phototherapy. J Am Acad Dermatol. 2001; 45(4):487-98; quiz 499-502.
https://doi.org/10.1067/mjd.2001.117046
https://doi.org/10.1016/j.jaad.2003.11.046
2. Koo JP population-based epidemiologic study of psoriasis with emphasis on quality of life assessment. Dermatol Clin 1996; 14(3): 485 - 96.
https://doi.org/10.1016/S0733-8635(05)70376-4
3. Leder RO, Mansbridge JN, Hallmayer J, Hodge SE. Familia! psoriasis and HLA-B: unambiguous support for linkage in 97 published families. Hum Hered 1998; 48(4): 198 - 211.
https://doi.org/10.1159/000022802
4. Elder JT, Nair RP, Henseler T, Jenisch S, Stuart P, Chia N, Christophers E, Voorhees JJ. The genetics of psoriasis 2001 > the odyssey continues. Arch Dermatol 2001; 137 (11): 1447 - 54.
https://doi.org/10.1001/archderm.137.11.1447
5. Prinz JC Psoriasis vulgaris a sterile antibacterial skin reaction mediated by cross-reactive T cell? An immunological view of pathophysiology of psoriasis. Clin Exp Dermatol 2001; 26(4): 326-32.
https://doi.org/10.1046/j.1365-2230.2001.00831.x
6. Bonifati C. Cytokines in psoriasis. lnt J Dermatol 1999; 24: 291- 5.
https://doi.org/10.1046/j.1365-4362.1999.00622.x
7. Tsankov N, Kazandjieva J, Drenovska K. Drugs in exacerbation and provocation of psoriasis. Clin Dermatol 1998; 16(3): 333-51.
https://doi.org/10.1016/S0738-081X(98)00005-4
8. Rasmussen JE. The relationship between infection with group A betta hemolitic streptococco and the development of psoriasis. Pediatr lnfect Dis J 2000; 19 (2): 153-4.
9. Higgins E. Alcohol, smoking and psoriasis. Clin Exp Dermatol 2000 25(2): 107- 10.
https://doi.org/10.1046/j.1365-2230.2000.00588.x
10. Rook. Textbook of Dermatology. Blackwell Science 6a. ed 1988; 3:1589.
11. Fitzpatrick TB, Eisen A, Wolf K, et al. Dermatology in General Medicine. USA, McGraw-Hill, 5a. ed; 2001.
12. Miller JJ.Roling D. Failure to demonstrate therapeutic tachyphylaxis to topically applied steroids in patients with psoriasis. J Am Acad Dermatol 1999; 4(4)1: 546- 9.
https://doi.org/10.1016/S0190-9622(99)80050-4
13. Katz HI, Prawer SE, Medansky RS, Krueger GG, Mooney JJ, Jones ML, Samson CR lntermitent corticosteroid maintenance treatment of psoriasis: a double-blind multicenter trial of augmented betamethasone dipropionate ointment in a pulse dose treatment regimen. Dermatológica, 1991, 183(4): 269-74.
https://doi.org/10.1159/000247698
14. Volden G. Bjornberg A, Tegner E, Pedersen NB, Arles UB, Agren S, Brolund L. Short contasct treatment at home with micanol . Acta Derm Venereol. 1992; 172, 20-2.
15. Bruce S, Epinette WW, Funicella T, lson A, Jones EL, Loss R Jr, McPhee ME, Whitmore C. Comparative study of calcipotriene ointment and fluocinonine ointment in the treatment of psoriasis. J Am Acad Dermatol 1994; 31 (5 Pt 1 ): 755-9.
https://doi.org/10.1016/S0190-9622(94)70237-3
16. Lebwohl LM, Yoles A, Lombardi K, Lou W. Calcipotriene ointment and halobetasol ointment in the long-term treatment of psoriasis : effects on the duration of improvement. J Am Acad Dermatol 1998; 39(3): 447-50.
https://doi.org/10.1016/S0190-9622(98)70323-8
17. Patel B, Siskin S, Krazmien R, Lebwohl M. Compatibility of calcipotriene with other topical medications. J Am Acad Dermatol 1998; 38(6 Pt 1 ): 1010-1.
https://doi.org/10.1016/S0190-9622(98)70171-9
18. Lebwoht M. Strategies to optimize efficacy duration of remission and safety in the treatment of plaque psoriasis by using tazarotene in combination with a corticosteroid. J Am Acad Dermatol, 2000; 43(2 Pt 3): S43-6.
https://doi.org/10.1067/mjd.2000.108319
19. Hecker D, Worsley J, Yueh G, Kuroda K, Lebwohl M. lnteractions between tazarotene and ultraviolet light. .J Am Acad Dermatol 1999; 41 (6): 927-30.
https://doi.org/10.1016/S0190-9622(99)70248-3
20. Schissel DJ, Elston DM. Topical 5 FU treatment for psoriatic trachonychia. Cutis 1998; 62 (1): 27-8.
21. Nouri K, Chartier TK, Eaglstein WH, Taylor JR. Cryoteraphy for psoriasis. Arch Dermatol 1997; 133 (12): 1608-9.
https://doi.org/10.1001/archderm.1997.03890480134028
22. Stern RS. Non-melanoma skin cancer occurring in patiens treatment with PUVA five to ten years after first treatment. J lnvest Dermatol 1988; 91: 120-4.
https://doi.org/10.1111/1523-1747.ep12464137
23. Stern RS, Laird N. The carcinogenic risk of treatment of severe psoriasis. Photochemotherapy follow-up study. Cancer 1994; 73(11 ):2759-64.
https://doi.org/10.1002/1097-0142(19940601)73:11<2759::AID-CNCR2820731118>3.0.CO;2-C
24. Walters IB, BurackLH, Coven TR, Gilleaudeau P, Krueger JG. Suberythemogenic narrow band UVB is markedly more effective than conventional UVB in treatment of psoriasis vulgaris. J Am Acad Dermatol 1999; 40(6 Pt 1 ): 893-900.
https://doi.org/10.1016/S0190-9622(99)70076-9
25. Feldman SR, Mellen BG, Housman TS, Fitzpatrick RE, Geronemus RG, Friedan PM. Efficacy of the 308 - nm excimer laser for treatment of psoriasis: results of a multicenter study. J Am Acad Dermatol 2002; 46 (6) :900- 6.
https://doi.org/10.1067/mjd.2002.120454
26. Roenigkl HH Jr, Auerbach R, Maibach H, Weinstein G, Lebwohl M. Methotrexate in psoriasis: consensus conference. J Am Acad Dermatol 1998; 38(3): 478-85.
https://doi.org/10.1016/S0190-9622(98)70508-0
27. Gutierrez S. Pancitopenia secondary to MTX therapy in AR. Arthritis Rheumatol 1996; 39: 272 - 276.
https://doi.org/10.1002/art.1780390214
28. Malatja D. MTX hepatotoxicity in psoriatic patients submited to long - term therapy. J Gastroenterol 1996; 1 O: 369 -75.
29. Roenigk HH Jr, Auerbach R, Maibach HI, Weinstein GD. Methotrexate in psoriasis: revised guidelines. J Am Acad Dermatol. 1988; 19(1 Pt 1 ): 145-56.
https://doi.org/10.1016/S0190-9622(88)80237-8
30. Lebwohl M, Ali S. Treatment of psoriasis. Part 2. Systemic therapies. J Am Acad Dermatol 2001; 45 (5): 649- 61.
https://doi.org/10.1067/mjd.2001.117047
31. Zachariae H, Steen Olsen T. Efficacy of cyclosporin A (CyA) in Psoriasis: an overview of dose/response, indications, contraindications and side-effects. Clin Nephrol 1995:43(3): 154-158.
32. Srivastava T, Zwick DL, Rothberg PG, Warady BA. Posttransplant lymphoproliferative disorder in pediatrie renal transplantation. Prediatic Nephol 1999; 13(9):748-54.
https://doi.org/10.1007/s004670050692
33. Solganic J, Tan MH. Adverse effects of systemic treatments: Cyclosporine. Psoriasis Forum 1998; 4-5.
https://doi.org/10.1177/247553039804a00104
34. Systemic tacrolimus (FK 506) is effective for the treatment of psoriasis in a double-blind, placebo-controlled study. The European FK 506 Multicentre Psoriasis Study Group ARCDermatol 1996; 132(4):419-23.
https://doi.org/10.1001/archderm.132.4.419
35. Callen JP, Krueger GG, Lebwohl M, McBurney El, Mease P, Menter A, Palier AS , Pariser DM, Weinblatt M, Zimmerman G; AAD. AAD consensus statement on psoriasis therapies. J Am Acad Dermatol. 2003; 49(5):897-9.
https://doi.org/10.1016/S0190-9622(03)01870-X
36. Lebwohl M. lnnovations in the treatment of psoriasis. J Am Acad Dermatol. 2004; 51(1 Suppl):S40-1.
37. Lebwohl M, Ali S. Treatment of psoriasis. Part 1. Topical therapy and phototherapy. J Am Acad Dermatol. 2001; 45(4):487-98; quiz 499-502.
https://doi.org/10.1067/mjd.2001.117046
How to Cite
1.
Palacio Valencia CA. Guías para el diagnóstico y manejo de la psoriasis. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2005 Dec. 1 [cited 2026 Mar. 19];13(4):287-300. Available from: https://revistaasocoldermaorgco.biteca.online/index.php/asocolderma/article/view/547
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2005-12-01
How to Cite
1.
Palacio Valencia CA. Guías para el diagnóstico y manejo de la psoriasis. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2005 Dec. 1 [cited 2026 Mar. 19];13(4):287-300. Available from: https://revistaasocoldermaorgco.biteca.online/index.php/asocolderma/article/view/547
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