Psoriasis is a condition that causes red, scaly, and keratinized rashes covered in silvery-white scales to appear on the skin.
Typically these rashes appear on the elbows, knees, scalp and lower back, but can occur in any other places. Most people have minor rashes. In some cases, they may be itchy or painful.
In our country, about 1% of the population suffers from psoriasis; pityriasis versicolor is often found among the indigenous people of the north. Men and women get sick equally often. The first symptoms of psoriasis often appear before the age of 30, but later onset of psoriasis is not uncommon. The severity of psoriasis varies greatly from person to person. For some people, psoriasis is just a little annoying, while for other people, psoriasis makes it difficult to lead a normal life.
Psoriasis is a chronic disease that usually has periods of remission—no or mild symptoms—followed by periods of flare-up when symptoms become more severe.
Psoriasis occurs when the body speeds up the process of reproduction of skin cells. Skin cells are usually produced and replaced every 3-4 months, but with psoriasis this process is shortened to 3-7 days. As a result, a build-up of skin cells occurs, which leads to the appearance of characteristic changes on the body.
The causes of psoriasis are not entirely clear; it is believed that increased production of skin cells is associated with disorders of the immune system. The immune system is the body's natural defense against infection and disease, but in people with psoriasis it mistakenly attacks healthy skin cells.
Psoriasis can be inherited, and therefore it is believed that there is a genetic factor to this disease. However, it is still unclear exactly what role genetics plays in the occurrence of psoriasis.
Symptoms of psoriasis
In most cases, psoriasis occurs cyclically: every few weeks or months the disease worsens, and then the symptoms become less noticeable or disappear, and remission occurs.
There are several different types of psoriasis. Many suffer from only one form of psoriasis, although it is possible to have two different types at the same time. One type can turn into another type or get worse. If you suspect psoriasis, you should consult a doctor.
Common types of psoriasis
Ordinary (plaque-like) psoriasis.This is the most common form of psoriasis, accounting for about 90% of all cases. Symptoms are dry red skin formations, so-called plaques, covered with silvery-white scales. They usually appear on your elbows, knees, scalp and lower back, but can appear anywhere else. The plaques may be itchy and/or painful. In severe cases, the skin on the joints may crack and bleed.
Psoriasis of the scalp (seborrheic psoriasis)may occur on the scalp or adjacent areas of the skin, as well as on the back and chest. Causes reddish rashes covered with dense silvery-white scales. For some people, this type of psoriasis causes severe itching, while for others it causes no discomfort. In the most severe cases, it can lead to hair loss, most often temporary.
Nail psoriasis.In about half of people with psoriasis, the disease spreads to the nails. With psoriasis, your nails may develop small pits or depressions and may lose color and shape. Often, nails can become loose and pull away from the nail bed in which they are located. In severe cases, nails may crumble.
For guttate psoriasissmall (less than 1 cm) plaques appear in the form of a drop on the chest, arms, legs and under the hair on the head. Guttate psoriasis is likely to go away completely within a few weeks, but in some people it turns into regular psoriasis. This type of psoriasis sometimes occurs after a streptococcal throat infection and is more common in children and teenagers.
Psoriasis of the folds- folds of skin are affected, for example, under the arms, in the groin, between the buttocks or under the mammary glands. Large, smooth rashes may appear in some or all of these areas. Symptoms are aggravated by friction and sweating, so they can be especially uncomfortable in hot weather.
Pustular psoriasis
A rarer type of psoriasis in which pustules (blisters containing pus) appear on your skin. Different types of pustular psoriasis affect different parts of the body.
Generalized pustular psoriasis (von Zumbusch psoriasis).Pustules occur over a large surface area of the skin and develop very quickly. Pus consists of white blood cells and its appearance is not always directly related to infection. The pustules may cyclically reappear every few days or weeks. At the beginning of these cycles, von Zumbusch psoriasis can cause fever, chills, weight loss, and chronic fatigue.
Palmoplantar psoriasis.Pustules appear on the palms and soles of the feet. Gradually, the pustules turn into round, brown plaques with scales, which then separate from the skin. The pustules may reappear every few days or weeks.
Pustular acrodermatitis (acropustulosis).Pustules appear on your fingers and toes. The pustules then burst, leaving behind bright red areas that may ooze fluid or become scaly. May lead to painful nail deformities.
Erythrodermic psoriasis (psoriatic erythroderma)
Erythrodermic psoriasis is a rare form of psoriasis that affects almost the entire surface of the skin. This causes severe itching or burning. Due to erythrodermic psoriasis, your body may lose proteins and fluid. This can lead to other complications such as infection, dehydration, heart failure, hypothermia and exhaustion.
Causes of psoriasis
Psoriasis occurs when skin cells divide and turn over faster than usual. The causes of psoriasis are not completely clear. The body produces new cells in the deepest layer of the skin. These cells gradually move upward. Once they reach the surface, they die and peel off. This process normally occurs gradually and unnoticed by us. Skin cells are renewed every 3-4 weeks.
For people with psoriasis, this process lasts only 3-7 days. As a result, not yet fully formed cells quickly accumulate on the surface of the skin, causing red, flaky and keratinized rashes covered with silvery-white scales. It is believed that in people with psoriasis, skin cells change faster due to a compromised immune system.
The immune system is the body's defense that helps it fight infection. One of the main types of cells that the immune system uses is called T lymphocytes.
T cells typically travel throughout the body, find and fight infections. In people with psoriasis, they mistakenly attack healthy skin cells. This causes the immune system to produce more T cells and also reproduce new skin cells faster than usual.
It is not entirely clear what exactly causes the immune system to become compromised, although certain genes and environmental factors may play a role.
Triggers of psoriasis
For many people, psoriasis symptoms appear or worsen after a specific event, called a trigger. Knowing your triggers can help you avoid worsening symptoms. Examples of common triggers:
- a skin injury such as a cut, scrape, insect bite, or sunburn (called Koebner phenomenon);
- alcohol abuse;
- smoking;
- stress;
- hormonal changes, especially in women (for example, during puberty and menopause);
- certain medicines, such as lithium, some antimalarials, anti-inflammatory drugs including ibuprofen, ACE inhibitors (to treat high blood pressure) and beta blockers (to treat congestive heart failure);
- Throat infections - some people, especially children and young adults, develop a form of psoriasis called guttate psoriasis after a streptococcal throat infection, although most people do not develop psoriasis after a streptococcal throat infection.
- other immune system disorders, such as HIV, that cause or worsen psoriasis.
Psoriasis is not contagious and therefore cannot be transmitted from one person to another.
Diagnosis of psoriasis
As a rule, an external examination of the skin is sufficient to diagnose psoriasis.
In rarer cases, a biopsy (a small sample of skin) may be taken, which is then sent to a laboratory to be examined under a microscope. This will help identify the specific type of psoriasis and rule out other skin conditions such as seborrheic dermatitis, lichen planus, lichen simplex chronicus and lichen rosea.
As a rule, diagnosis and treatment of psoriasis is carried out under the supervision of a dermatologist - a specialist in skin diseases. If your doctor suspects you have psoriatic arthritis, which sometimes occurs as a complication of psoriasis, you may be referred to a rheumatologist. A rheumatologist is a doctor who specializes in arthritis.
You may have blood tests to rule out other conditions, such as rheumatoid arthritis, and x-rays of affected joints.
Treatment of psoriasis
It is not possible to completely cure psoriasis, however, with the help of treatment it is possible to reduce the severity and frequency of its exacerbations. Usually, treatment of psoriasis is carried out under the supervision of a dermatologist; if the joints are involved in the process, a consultation with a rheumatologist is prescribed. If the symptoms of psoriasis are severe and do not respond well to treatment, your doctor may refer you to hospital admission to the dermatology department.
Each treatment method is used depending on the type and severity of psoriasis and the area of skin affected by the disease. If the symptoms of psoriasis are moderate and do not increase, the doctor may limit himself to prescribing external remedies, for example, in the form of a cream. At the acute stage, more serious treatment is usually prescribed with medications taken orally.
There are a wide range of treatments for psoriasis, but it can be difficult to determine which treatment is most effective. Talk to your doctor if you feel that your treatment is not helping or if you experience side effects that are bothersome.
Treatment methods are divided into 3 categories:
- local treatment - creams and ointments are applied to the skin;
- phototherapy - your skin is exposed to a certain type of ultraviolet rays;
- systemic - ingestion or injection of drugs that have a therapeutic effect on the entire body.
Often different treatment methods are combined. Since patients with psoriasis require long-term treatment, it makes sense to draw up a written plan for medicinal procedures that need to be done daily. Your doctor should regularly monitor your condition and, if necessary, adjust your treatment plan.
Local treatment of psoriasis
Typically, for mild to moderate psoriasis, local treatment is first prescribed. In this treatment, creams and ointments are applied to the skin. For some people, this is enough to control the disease. If you have scalp psoriasis, you may be a candidate for a shampoo and ointment combination.
Topical corticosteroidsoften used to treat mild to moderate psoriasis of various locations on the body. Corticosteroids help relieve inflammation. This slows down the division of skin cells and relieves itching. Topical corticosteroids are graded in strength from mild to very strong. There are various corticosteroids that differ from each other in the strength of their effect on the body.
Use topical corticosteroids only with your doctor's approval. Stronger topical corticosteroids are available by prescription and should only be used on small areas of skin or particularly dense plaques. Excessive use of topical corticosteroids can cause thinning of the skin.
Vitamin D analoguesin cream form are often used with or instead of topical corticosteroids for mild to moderate psoriasis on the extremities, body and scalp. They slow down the reproduction of skin cells. They also have anti-inflammatory effects. Vitamin D analogues include, for example, substances such as calcipotriol and calcitriol. If you do not exceed the recommended dosage, they have almost no side effects.
Calcineurin inhibitors,such as tacrolimus and pimecrolimus are medications that reduce the activity of the immune system and help relieve inflammation. They are sometimes used to treat psoriasis on sensitive areas of the skin (scalp, genitals, and skin folds) when topical corticosteroids have not been effective.
These medications may cause skin irritation or a burning or itching sensation when you start taking it, but this usually goes away within a week.
Coal taris a thick, viscous oil that is probably the oldest treatment for psoriasis. The mechanism of action is not entirely clear, but it helps relieve flaking, inflammation and itching. The resin can be used for psoriasis of the extremities, body and scalp if other topical agents have been ineffective.
Coal tar can stain clothing and bedding and has a strong odor. It can be used in combination with phototherapy (see below).
Substancehydroxyanthronehas been used to treat psoriasis for 50 years. It effectively suppresses the reproduction of skin cells and has almost no side effects. However, in too concentrated form it can cause burns.
It is usually used for short-term treatment of psoriasis of the extremities or body under medical supervision, as it leaves marks on anything it comes into contact with, including skin, clothing and fixtures. It is applied to the skin (with gloved hands) and left for 10-60 minutes and then washed off. Dithranol may be used in combination with phototherapy (see below).
Phototherapy for psoriasis
Phototherapy uses natural or artificial light to treat psoriasis. Artificial light therapy can be performed in hospitals and some specialized centers, usually under the supervision of a dermatologist. Phototherapy is not the same as tanning.
Phototherapy with UVB rays.Ultraviolet B (UVB) phototherapy uses light at wavelengths visible to the human eye. Light slows down the reproduction of skin cells and is an effective treatment for some types of psoriasis that do not respond to topical treatments. Each session lasts a few minutes, but you may need to go to the hospital 2-3 times a week for 6-8 weeks.
PUVA therapy- this is a combined effect of ultraviolet rays with photosensitizers (substances that increase the skin's sensitivity to light). With this treatment, you will first be prescribed a furocoumarin drug (such as ammifurin) in the form of a tablet or cream. The skin is then exposed to ultraviolet A. This radiation penetrates deeper into the skin than ultraviolet B.
PUVA therapy may be used for severe psoriasis that does not respond to other treatments. Side effects: nausea, headache, burning and itching. You may need to wear special glasses for 24 hours after treatment to prevent cataracts from appearing. It is not recommended to use this treatment for a long time as it increases the risk of skin cancer.
Combined phototherapy.Combining phototherapy with other treatment methods often increases its effectiveness. Some doctors use UVB phototherapy in combination with coal tar because the tar makes the skin more sensitive to light. Combining phototherapy with dithranol cream may also be effective (this is called Ingram treatment).
Systemic non-biological agents for psoriasis
If you have severe psoriasis or other treatments have not been effective, your dermatologist may prescribe systemic treatments, which are products taken orally or injected. These treatments can be very effective, but each has potentially dangerous side effects that must be weighed before starting therapy.
There are 2 main types of systemic treatments, called non-biological (usually in the form of tablets or capsules) and biological (usually in the form of injections). They are described in detail below.
An antimetabolite drug may help control psoriasis by slowing skin cell production and suppressing inflammation. May cause nausea and affect blood cell production. Long-term use may cause liver dysfunction. It should not be taken by people with kidney disease and alcohol should not be consumed while taking it.
May be very harmful to the developing fetus, so women should use contraception while taking this drug and up to 3 months after finishing the course. May also affect the development of sperm cells, so men should not be involved in conceiving a child during treatment and for 3 weeks after the end of the course.
An immunosuppressant is a medicine that suppresses the immune system. It was originally used to prevent organ transplant rejection, but has also proven effective in treating all types of psoriasis. Increases the likelihood of kidney disease and high blood pressure.
Biological drugs for psoriasis
Biologic drugs reduce inflammation by targeting overactive cells in the immune system. These drugs are usually used to treat severe psoriasis that does not respond to other drugs, or when other treatments are contraindicated.
Solution with the active ingredient etanerceptadministered by subcutaneous injection. They will show you how to do this. If psoriasis does not begin to improve after 12 weeks of treatment, treatment will be stopped. The main side effect of etanercept is rash at the injection site. Since etanercept affects the entire immune system, there is a risk of dangerous side effects, including severe infections. If you have had TB in the past, there is a risk that it will come back. During the course of treatment, the specialist will monitor for possible side effects.
Solution with adalimumab substanceadministered by subcutaneous injection. If psoriasis symptoms do not begin to improve after 16 weeks of treatment, treatment will be stopped. Adalimumab may be harmful to the developing fetus, so women should use birth control while taking this drug and for 5 months after finishing treatment.
The main side effects of adalimumab are headache, rash at the injection site and nausea. Because adalimumab affects the entire immune system, there is a risk of dangerous side effects, including severe infections. During the course of treatment, the specialist will monitor for possible side effects.
Substance infliximabgiven through an intravenous drip in the hospital. If your psoriasis does not improve after 10 weeks of treatment, treatment will be stopped. The main side effect of infliximab is headache. Because infliximab affects the entire immune system, there is a risk of dangerous side effects, including severe infections. During the course of treatment, the specialist will monitor for possible side effects.
Substance ustekinumabadministered by injection. If no effect is observed after 16 weeks of starting treatment, treatment will be stopped. The main side effects of this substance are throat infections and rash at the injection site. Because ustekinumab affects the entire immune system, there is a risk of dangerous side effects, including severe infections. During the course of treatment, the specialist will monitor for possible side effects.
Lifestyle with psoriasis
For some people, psoriasis is only a minor problem, but it can have a significant impact on their quality of life. If you have psoriasis, the following tips may be helpful for you.
People with chronic illnesses can benefit greatly from self-care. They will be able to live longer, experience less pain, anxiety, depression and fatigue, lead more fulfilling lives and be more active and independent. A treatment plan will help you organize your treatment to fit your lifestyle.
During treatment, it is important to follow all the doctor’s instructions, even when the psoriasis is already going away. Consistent treatment can help prevent recurrent flare-ups. Talk to your doctor or other health care providers if you have any questions or concerns about the medications you are taking or their side effects.
In most cases, psoriasis is a chronic condition, so you may need to communicate regularly with your healthcare professionals. Discuss your symptoms or concerns with them, the more they know, the better they can help you.
People with psoriasis have a slightly increased risk of diabetes and heart disease, although the reasons for this are unknown. Regular exercise and a healthy diet are recommended for everyone, not just people with psoriasis, as they help prevent many diseases. A healthy, balanced diet and regular exercise relieve stress, which improves psoriasis symptoms.
Psoriasis can make the skin look unattractive, which is why sufferers often develop low self-esteem and anxiety. This can lead to depression, especially if psoriasis symptoms worsen. Your doctor understands the impact psoriasis has on your mental and emotional well-being, so talk to them about what's worrying or bothering you. If necessary, he can suggest appropriate treatment options.
10–20% of people with psoriasis develop psoriatic arthritis, which is characterized by pain, swelling and stiffness in the joints. Most often, psoriatic arthritis affects the joints of the fingers and toes. In some cases - the lumbar and cervical spine and knees. For most people, psoriatic arthritis appears after a skin attack of psoriasis, but in about 20% it occurs before the skin changes of psoriasis.
Psoriasis does not affect fertility, and women with psoriasis can become pregnant and give birth to healthy children. For some women, psoriasis goes away during pregnancy, for others it worsens.
Which doctor should I contact?
Using our service you can find a dermatologist. A full examination and treatment can be completed at dermatological clinics, a list of which, as well as reviews and other information about them, can be found here.