Annie and methotrexate
Annie was diagnosed with Psoriasis, a chronic inflammatory condition, in her late teens. Annie’s initial symptoms were brought under control with the standard therapy. Annie’s most recent psoriasis outbreak, exacerbated by a relationship breakdown, is being treated with methotrexate. The following is a review of the use of methotrexate in treating psoriasis.
Psoriasis is a common rash that affects approximately two percent of the global population. It is a chronic, incurable, non-contagious, autoimmune disease (Lowes, Bowcock, & Krueger, 2007, p. 866), (Nestle, Kaplan, & Barker, 2009, p. 496), (Berger & Gottlieb, 2007, p. 434), (Crow, 2012, pp. S50-S51). It typically presents as a well defined raised red plaque with silver scales. Many patients with psoriasis are embarrassed by the appearance of their skin. The affects on the patient can range from a minor irritation to a severe impact on quality of life (Wyndham, 2012, pp. 36-37), (Nestle, Kaplan, & Barker, 2009, p. 469), (Green, 2011, p. 49).
There are different types of psoriasis, they can occur separately, simultaneously or follow each other (Crow, 2012, p. S51). Psoriasis vulgaris or chronic plaque psoriasis is the most common and occurs in eighty to ninety percent of cases (Crow, 2012, p. S51), (Lowes, Bowcock, & Krueger, 2007, p. 866). One third of patients that have psoriasis will also get psoriatic arthritis, a condition that affects the joints (Berger & Gottlieb, 2007, p. 434), (Wyndham, 2012, p. 36). Other types are less common and include guttate, inverse/flexural, pustular and erythrodermic psoriasis (Crow, 2012, p. S50).
The etiology of psoriasis is complex, it seems genetic and environmental factors play a role. There are at least nine identified chromosomal loci with a link to psoriasis (Lowes, Bowcock, & Krueger, 2007, pp. 866, 506), and it is often associated with a family history (Green, 2011, p. 48). Environmental factors, for example skin trauma, stress or infection may also play a role in triggering psoriasis (Green, 2011, p. 48). Genetic and environmental factors cause an inappropriate response of immune system. There is an abundance of leucocytes in the affected areas of psoriasis. There is a cascade of events that cause cytokines and T cells to activate and inappropriately respond keratinocytes resulting in changes to the dermis and epidermis. This chronic inflammation changes the appearance of the skin, the increased vascularity of the epidermis causes redness, and abnormal maturing, stacking and proliferation of keratinocytes results in raised scaly, silvery plaques (Wyndham, 2012, pp. 36-37), (Nestle, Kaplan, & Barker, 2009, p. 496), (Clarke, 2011, p. 468), (Lowes, Bowcock, & Krueger, 2007, p. 866-867).
There are many validating tools used for research and assessing the severity of condition. The most common is the psoriasis area severity index (PASI). Other tools include the physician global assessment and the dermatology quality of...