Nursing Assessment, Management and Treatment of Autoimmune Diseases
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Pathophysiology Psoriasis is a complex disease that ap- pears to be influenced by genetic and im - mune-mediated facets. The exact trigger or triggers of the disease are unknown, but experts believe that triggers may in- clude an infectious episode, traumatic insult, or stressful life events. Once trig- gered, a substantial number of leukocytes gather at the dermis and epidermis, which leads to characteristic psoriatic plaques. Many patients, however, have no obvious trigger (Habashy, 2021). Possible triggers Many patients who are vulnerable to the development of psoriasis may be free of signs and symptoms for years until the disease is triggered by various environ- mental factors (Mayo clinic, 2020c). Com - mon triggers include the following (Mayo Clinic, 2020c): ● Infections such as bacterial or skin infections. ● The weather, particularly a cold, dry environment. ● Injury to the skin such as severe sunburn, lacerations, or bug bites. ● Stress. ● Smoking as well as exposure to second-hand smoke. ● Heavy alcohol consumption. ● Certain medications such as lithium, anti-hypertensive medications, and antimalarial drugs. ● Swift withdrawal of oral or systemic corticosteroids. Psoriasis can develop in anyone. An es- timated 33% of cases begin in the pedi- atric years. The following factors increase risk of psoriasis (Mayo Clinic, 2020c:. ● Family history : Having one parent with psoriasis increases risk. If both parents have psoriasis, the risk increases even higher.
● Stress : Since stress can impact the immune system, high levels of stress may increase the risk of disease development. ● Smoking : Smoking tobacco products increases risk and may also increase the severity of the disease. Smoking may even play a part in the initial development of the disease. Complications Psoriasis increases the risk of developing other diseases including the following (Mayo Clinic, 2020c): ● Eye conditions such as conjunctivitis and blepharitis. ● Obesity. ● Type 2 diabetes. ● Hypertension. ● Cardiovascular disease. ● Other autoimmune diseases such as inflammatory bowel disease. ● Mental health disorders such as depression. Pathogenesis The epidermis is infiltrated by large numbers of activated T cells. These T cells seem to be capable of causing keratino- cyte proliferation. Psoriatic plaques reveal large amounts of T cells within the psoria- sis lesions. An uncontrolled inflammatory process occurs. Important findings in the affected skin include vascular engorge- ment because of superficial blood vessel dilation and a changed epidermal cell cy- cle (Habashy, 2021). Assessment and diagnosis Patients are assessed for characteristic signs and symptoms of the disease and possible other causes of these signs and symptoms are investigated. It is important to rule out other skin conditions before making a diagnosis of psoriasis (Habashy, 2021).
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