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      Psoriasis: revisión del tema con énfasis en la inmunopatogénesis Translated title: Psoriasis: a review with emphasis on immunopathogenesis

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          Abstract

          La psoriasis es una de las enfermedades cutáneas más frecuentes pues afecta al 2-3% de la población mundial. Es autoinmune, específica de órgano, crónica y recurrente, desencadenada por factores externos en individuos con predisposición genética. En su inmunopatogénesis se ha descrito una falla en la regulación de la respuesta inmune frente a antígenos aún no bien identificados. Tiene diversas presentaciones clínicas e influye desfavorablemente en la calidad de vida de los pacientes. La comprensión de sus fundamentos inmunopatogénicos ha permitido poner en práctica nuevas estrategias de tratamiento como la terapia biológica. En este artículo se revisan los aspectos fundamentales de la inmunopatogénesis de la psoriasis y sus características epidemiológicas, clínicas e histopatológicas, así como las varias opciones terapéuticas.

          Translated abstract

          Psoriasis is one of the most frequent skin diseases. Worldwide, it affects 2 to 3% of the population. It is an organ-specific, chronic, recurrent, autoimmune disease, triggered by external factors in individuals with a genetic predisposition. In its immunopathogenesis a lack of regulation of the immune response to unidentified antigens has been described. Psoriasis has many different clinical presentations and produces an important decrease in the quality of life. Understanding its immunopathogenetic bases has led to new therapeutic strategies such as the biological approaches. This review includes basic immunopathogenetic aspects of psoriasis, as well as the epidemiological, clinical and histopathological characteristics of the disease. Therapeutic options are also included.

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          Most cited references91

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          Pathogenesis and therapy of psoriasis.

          Psoriasis is one of the most common human skin diseases and is considered to have key genetic underpinnings. It is characterized by excessive growth and aberrant differentiation of keratinocytes, but is fully reversible with appropriate therapy. The trigger of the keratinocyte response is thought to be activation of the cellular immune system, with T cells, dendritic cells and various immune-related cytokines and chemokines implicated in pathogenesis. The newest therapies for psoriasis target its immune components and may predict potential treatments for other inflammatory human diseases.
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            Th17: an effector CD4 T cell lineage with regulatory T cell ties.

            The naive CD4 T cell is a multipotential precursor with defined antigen recognition specificity but substantial plasticity for development down distinct effector or regulatory lineages, contingent upon signals from cells of the innate immune system. The range of identified effector CD4 T cell lineages has recently expanded with description of an IL-17-producing subset, called Th17, which develops via cytokine signals distinct from, and antagonized by, products of the Th1 and Th2 lineages. Remarkably, Th17 development depends on the pleiotropic cytokine TGF-beta, which is also linked to regulatory T cell development and function, providing a unique mechanism for matching CD4 T cell effector and regulatory lineage specification. Here, we review Th17 lineage development, emphasizing similarities and differences with established effector and regulatory T cell developmental programs that have important implications for immune regulation, immune pathogenesis, and host defense.
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              Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris.

              In 2,147 patients suffering from psoriasis, evaluation of the age of onset revealed two peaks, one occurring at the age of 16 years (female) or 22 years (males) and a second peak at the age of 60 years (female) or 57 years (males). Human lymphocyte antigen (HLA) tissue typing in 112 randomly assigned patients showed that HLA-Cw6, known to be at disequilibrium in psoriasis, is present in 85.3% of patients with early onset. In contrast, 14.7% patients with late onset showed this marker. Parents (father or mother) were affected in approximately half of the patients with early onset and in none belonging to the group with late onset. Furthermore, psoriasis in patients with early onset follows an irregular course and shows a strong tendency to become generalized. On the basis of clearly defined criteria (e.g., age of onset, heritability, and clinical course of disease), nonpustular psoriasis shows two distinct forms, one of which is hereditary, with early onset, and the other is sporadic and occurs in older age.
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                Author and article information

                Journal
                iat
                Iatreia
                Iatreia
                Universidad de Antioquia (Medellín, Antioquia, Colombia )
                0121-0793
                September 2009
                : 22
                : 3
                : 272-283
                Affiliations
                [02] Medellín orgnameUniversidad de Antioquia orgdiv1Facultad de Medicina orgdiv2Sección de Dermatología Colombia
                [01] Medellín orgnameUniversidad de Antioquia orgdiv1Facultad de Medicina Colombia
                Article
                S0121-07932009000300008 S0121-0793(09)02200308
                eab72fab-331c-47f6-8fe6-7dbc12e283f2

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 08 October 2008
                : 26 January 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 54, Pages: 12
                Product

                SciELO Colombia

                Categories
                Artículos de revisión

                Biological therapy,Adaptive immunity,Terapia biológica,Psoriasis,Inmunopatogénesis,Inmunidad adquirida,Innate immunity,Immunopathogenesis,Inmunidad innata

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