الفهرس 
Mutual Impacts of Psoriasis and LiverOnly 14 pages are availabe for public view
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Abstract
New measures in the field of management of psoriasis are wide and discrete , but the review focuses on dealing with psoriatic patients with liver affection or using drugs or certain maneuvers to prevent or minimize impact of psoriatic disease on liver and impact of liver diseases on psoriatic patients vice versa .
Liver plays a central role in transforming and clearing chemicals and is susceptible to the toxicity from these agents.The liver is the most important target for toxicity caused by drugs.
Psoriasis is a common, chronic, inflammatory skin disorder affecting 1-3% of the world population. Although psoriasis is considered as a dermatological disorder and its management is usually done by the dermatologists , it is now known that it is associated with many systemic manifestations that affects the quality of patients `life .
Liver affection in psoriatic patients is considered as a big problem not only to psoriatic patients , but also to dermatologists or physicians who deal with this condition . On the other hand , it was found that also hepatic patients may have a risk for flaring or inducing psoriasis ,it may be a problem facing hepatologists . So impacts of psoriasis and liver is mutual and complexed .
Psoraitic patients are more suscectabile to catch infections as HCV due to presence of crakes and fissures in psoriatic skin .
It was found that certain systemic medications used in management of psoriasis in certain doses or, in susectabile patients or in associations with other comorbidities may predispose to liver affection .
The insult of medications are not the only cause of liver affection in psoriatic patients, medical conditions or certain habits when accompany psoriasis make patients more prone to hepatic complications .
Inspite of the large development of the ara of diagnosis and management of medical disorders , herbs are sill used today . Herbs are widely used in dermatological diseases worldwide . Uncontrolled herbal use in psoriasis is sometimes leads to hepatotoxicity . The most important clue for herbal hepatoxicity is the temporal relationship between initiation of the herbal product and the appearance of liver injury; of equal importance is the resolution of the injury following withdrawal of the herbal product.
Signs of liver affection in psoriatic patients may takes a variable shapes ranging from slight to severe elevations of liver enzymes or functions , or jaundice , or steatosis or fibrosis up to cirrhosis . Also symptoms are variables ranging from just malaise or anorexia , right abdominal pain , change of colour of urine , yellowish sclera or skin up to disturbance of awareness and other symptoms of end stage liver disease .
Drug induced hepatotoxicity is a problem limiting the use of certain drugs up to withdrawal of some types from the market . Although common hepatotoxic manifestations may be represented with all drugs , every drug has its hallmark . Age , gender ,nutrition , alcohol abuse ,dose of the drug ,other concominant drugs , association with hepatitis C, B and genetic variations are multiple factors affecting hepatotoxicity .
Diagnosis and management of drug induced hepatotoxicity needs special care from the physician focusing on early symptoms and signs of liver injury and also on given patient awareness of key symptoms to report and systematic monitoring of the liver by established standards of care for various drugs .
Management of such a case needs withdrawal of the drug , general supportive therapy , symptomatic relieve and then specific therapy .
Drug induced liver injury may be severe and fatal enough to indicate liver transplantation . Liver transplantation is performed in more than 50% of patients with idiosyncratic drug-induced acute liver failure because the survival rate in this setting without transplantation is less than 20%. Liver –assist devices decrease the hepatotoxic insult of the drug and also may be used until transplantation is possible .
Continous monitoring by liver functions , radiological techniques , immunological tests even liver biopsy keep the physicians awake for early changes that reflect liver damage induced by the used drug . The drug use may be stopped if the complications exceeds the benefits from its use or combines it with another drug to increase its benefit and decreases its side effects .
Detoxification of psoriatic patients is a challenge . Various methods for detoxification are done by herbs , dialysis and apharesis .
Vaccinations of psoriatic patients also are considerd as patients with immune-mediated inflammatory diseases , are at increased risk of infection , partially because of the disease itself , but mostly because of treatment with immunomodulatory or immunosuppressive drugs . Inactivated vaccines for hepatitis B disease can be administered safely to these patients