8/10/2019 bahan mantah kulit kelamin

1/2

Psoriasis is a hyperproliferative disorder, but the proliferationis driven by a complex cascade of inammatory mediators.Psoriasis appears to represent a mixed T-helper (Th)1 andTh17 inammatory disease. Th17 cells appear to be more proximalin the inammatory cascade. T cells and cytoines playpivotal roles in the pathophysiolo!y of psoriasis. "verexpression

of type 1 cytoines, such as #$-%, #$-&, #$-', #$-1%, #- and

T-, has been demonstrated, and overexpression of #$-'

leads to the accumulation of neutrophils. The main si!nal for

Th1 development is #$-1%, *hich promotes intracellular #-

production. #n animal models, shiftin! from Th1 to Th%responses improves psoriasis. #$-+ is capable of inducin! Th%responses and improvin! psoriasis. educed expression of theanti-inammatory cytoines #$-1 and #$-1 has been found,and polymorphisms for #$-1 !enes correlate *ith psoriasis.#$-1 is a type % cytoine *ith ma/or inuences on immunore!ulation,inhibitin! type 1 proinammatory cytoine production.Patients on established traditional therapies sho*risin! levels of #$-1 m expression, su!!estin! that #$-1may have antipsoriatic capacity.

The response to biolo!ic a!ents has demonstrated that 0%+lymphocytes, 0-11a and T-are important in the patho!enesis

of psoriasis. #$-12 tri!!ers inammatory cell recruitment,an!io!enesis, and production of inammatory cytoines,

includin! #-, T-, and #$-17, all of *hich are upre!ulated

in psoriatic lesions. The interplay is complex, but #$-17appears to be proinammatory,*hile #$-%% may serve toretard eratinocyte di3erentiation. #$-%4 stimulates survival,as *ell as proliferation of Th17 cells. 0irculatin! 5 cells arereduced in psoriasis.

6pecic tar!ets for therapy include T-, leuocyte

function-associated anti!en-1 ($-1)8intercellular adhesionmolecule-1 (#09-1) bindin!, and $-480% bindin!. n#$-12 monoclonal antibody has been sho*n to be e3ective ina mouse model of psoriasis.

Streptococci6treptococci play a role in some patients. Patients *ith psoriasisreport sore throat more often than controls. :eta-hemolyticstreptococci of $anceeld !roups , 0, and ; can cause exacerbationof chronic pla$ variationhas a si!nicant e3ect on the immune response to !roup streptococci.

Stress?arious studies have sho*n a positive correlation bet*eenstress and severity of disease. #n almost half of patients studied,stress appears to play a si!nicant role.

Drug-induced psoriasisPsoriasis may be induced by -blocers, lithium, antimalarials,

terbinane, calcium channel blocers, captopril, !lyburide,!ranulocyte colony-stimulatin! factor, interleuins, interferons,and lipid-lo*erin! dru!s. 6ystemic steroids may causerebound or pustular ares. ntimalarials are associated *itherythrodermic ares, but patients travelin! to malaria-endemicre!ions should tae appropriate prophylaxis. "ften, dru!ssuch as doxycycline or meo

8/10/2019 bahan mantah kulit kelamin

2/2

protection, it is !enerally better to tae the prophylactic dosesof a