Diagnostic Approach and Management of Psoriasis in Primary Care

Abstract

Psoriasis is a chronic, multifactorial and inflammatory disease which primarily affects skin and joints, and has a prevalence of 2% of the world population.  In the skin, the most frequently affected organ, is characterized by the production of erythematous plaques covered by scales. Psoriasis has an important genetic component, related to alterations in the major complex of histocompatibility. This entity is characterized by abnormalities in the control of innate and adaptive immunity, facilitating a chronic state of inflammation. Psoriasis manifests itself in different phenotypes including psoriasis vulgaris or plaques, guttate psoriasis, inverse psoriasis, pustular psoriasis and erythrodermic psoriasis. Most of these phenotypes have a cyclical evolution with outbreaks and relapses. Psoriasis has been associated with multiple rheumatological, cardiovascular and metabolic comorbidities that significantly impact the patient’s life. The initial approach and management of this disorder are fundamental in the practice of the family physician, the objective of generating an early reference and avoiding serious complications. This article recapitulates the most relevant aspects in the diagnosis, early recognition of comorbidities, and management of psoriasis at the Primary care level.