Psoriasis and anesthetic considerations

Psoriasis can be extremely debilitating for the patient due to the fact that it can affect the whole integument, and, because of its chronic nature, can afflict the individual for most of his/her life. In some cases such as erythrodermic psoriasis, the disease can even be fatal due to complications such as high-output congestive heart failure. The anesthesiologist must take many factors into consideration such as the severity of the disease, where to place regional anesthesia, and the anesthetic complications associated with certain types of psoriatic medications. Although certain mechanisms such as differentiating keratinocytes while impeding their proliferation, immunosuppressive therapy, regulating transcription via steroids and the use of extra-cellular oxygen radicals have been used to manage psoriasis, no "miracle" cure exists. Even though psoriasis is usually treated by dermatologists, anesthesiologists must be careful and prepared because the disease is chronic, variable, and patients must be carefully handled in the operating room.