**5. Summary**

Considering all the many facets of PsA and the different diagnostic and therapeutic strategies is the art of modern medicine and good clinical practice. We need to understand the context of inflammatory skin, joint, and spine manifestations with mental health, extra articular problems and economical considerations. This can only be accomplished by good cooperation between dermatologist and rheumatologist in addition to the comprehensive care by the general practitioner, internist, and psychological disciplines (figure 8).

Fig. 8. Interdisciplinary, holistic view of Ps and PsA.

#### **6. References**

74 Psoriasis

Fig. 7. Flow chart of possible cooperation among the medical disciplines. In the case of suspected psoriatic manifestation or in the case of suboptimal treatment response of Ps by systemic therapy the rheumatologist confers the patient to the dermatologist for further

Considering all the many facets of PsA and the different diagnostic and therapeutic strategies is the art of modern medicine and good clinical practice. We need to understand the context of inflammatory skin, joint, and spine manifestations with mental health, extra articular problems and economical considerations. This can only be accomplished by good cooperation between dermatologist and rheumatologist in addition to the comprehensive

care by the general practitioner, internist, and psychological disciplines (figure 8).

evaluation.

**5. Summary** 


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**6** 

*Italy* 

**Head and Neck Psoriasis** 

*2Dept. of Pathology, San Donato Hospital, Arezzo 3ENT Dept., University of Messina, Messina 4ENT Dept., Hospital of Milazzo, Milazzo 5ENT Dept, University of Genova, Genova* 

Sebastiano Bucolo1, Valerio Torre2, Giuseppe Romano3,

Carmelo Quattrocchi4, Maura Filidoro5 and Claudio Caldarelli1 *1ENT-Maxillofacial Surgery Dept., San Giovanni Bosco Hospital, Turin* 

Psoriasis is an immuno-mediated condition whose pathogenesis is still unclear and that in head and neck area presents six specific aspects that justify the title of this chapter: 1) visibility of the lesions and their impact on quality of life (QOL); 2) the very common involvement of the scalp; 3) the difficulty of the treatment; 4) the aberrant epidermalmesenchymal interactions theory; 5) the rare mucous occurrence and the PPP-tonsil-related disease; 6) the significantly increased risk of head and neck cancer in men with Psoriasis.

Visibility of head and neck Psoriasis has a considerable impact on patients' QOL. The differential diagnosis for pustular skin disorders is extensive but facial Psoriasis more commonly affects eyebrows, the skin between the nose and the upper lip, the upper forehead and the hairline. Scalp Psoriasis is very common. Multiple instruments have been used to determine the severity of scalp Psoriasis and tools for patient self-assessment have also been developed (Psoriasis Area and Severity Index or PASI, Psoriasis Scalp Severity Index or PSSI, Body Surface Area or BSA, Physicians' Global Assessment or PGA, Lattice Physician Global Assessment or LS-PGA, and Self-assessed Psoriasis Area and Severity Index or SAPASI) but none of the severity scores used for Psoriasis meets all of the validation criteria required for an ideal score. However the PASI score is the most

While head represents only 10% of the whole body's surface, consequences of scalp Psoriasis are disproportionate to its extension as it can be seriously debilitating inducing important

Although it is unclear why initial scalp involvement is so common, scalp tissue has unique features that may promote its vulnerability to psoriatic lesions. For example, its high follicular density provides a dark, warm and moist environment that reduces environmental UV exposure which normally would limit lesion development. In addition, inflammation-

**1. Introduction** 

**2. Visibility and the impact on quality of life** 

extensively studied (Puzenat & al, 2010).

social and emotional distress.

Vasey, F. E., L.R. (1984). Psoriatic arthropathy. Orlando, Grune & Stratton.

