The role of xenobiotics in triggering psoriasis
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REVIEW ARTICLE
The role of xenobiotics in triggering psoriasis Jasna Grželj1,2 · Marija Sollner Dolenc1 Received: 10 May 2020 / Accepted: 12 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Psoriasis is a common inflammatory skin disease affecting approximately 2% of the world population. A complex interplay of genetic predisposition and risk factors contributes to the risk of its onset. Several xenobiotics have been implicated in the pathogenesis of psoriasis. Drugs are among the most investigated trigger factors; strong association with disease induction or exacerbation has been reported for β-blockers, lithium, NSAIDs and ACE inhibitors, all of which are commonly used in the management of various comorbidities in psoriasis patients. Furthermore, inhibitors of TNF have a well-documented potential for triggering new-onset psoriasis when used for other indications (e.g. Crohn’s disease or rheumatoid arthritis), while post-marketing data have revealed the same association for ustekinumab. Several other drugs have been connected with psoriasis, but the evidence is less compelling. Smoking and alcohol have been reported to increase the risk for occurrence of psoriasis, but can also affect unfavorably the course of the disease and its response to treatment. Furthermore, exposure to secondhand smoke, especially in childhood, also mediates the risk. Emerging data now suggest that air pollution also has a detrimental effect on skin disease, including psoriasis, but this association needs further investigation. Understanding of the toxic effect of xenobiotics on the initiation and clinical course of psoriasis can contribute to its better control, as it can help with the avoidance of triggering factors and, in some cases, influence the success of pharmacological treatment. It, therefore, has an important place in the comprehensive management of psoriasis. Keywords Psoriasis risk factors · Drug-provoked psoriasis · Environmental factors · Inflammatory skin disease
Introduction Psoriasis is an immune-mediated inflammatory skin disease of chronic nature. It affects approximately 2% of the world population, although its prevalence varies by region (Parisi et al. 2013; WHO 2016; Rendon and Schäkel 2019). It is a complex condition affected by immunological, environmental and genetic factors that result in a clinically heterogeneous disease (Alwan and Nestle 2015). There are five main types of psoriasis: guttate (eruptive) psoriasis, inverse psoriasis, pustular psoriasis, erythrodermic psoriasis and plaque psoriasis. The latter, also termed psoriasis vulgaris, it by far the most common form, affecting 85–90% of psoriasis patients (Nestle et al. 2009; Alwan and Nestle 2015; * Marija Sollner Dolenc [email protected]‑lj.si 1
University of Ljubljana, Faculty of Pharmacy, Aškerčeva cesta 7, Ljubljana, Slovenia
Krka, D. D., Novo mesto, Šmarješka cesta 6, Novo mesto, Slovenia
2
Boehncke and Schön 2015). The disease varies greatly in its severity, morphology and distribution; as well as
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