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Psoriasis: What is psoriasis?, symptoms, causes

by Josephine Andrews
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Psoriasis

Psoriasis is an inflammatory, non-contagious skin disease. The disposition to do so is inherited. Typical symptoms are sharply defined red spots with silvery scales and severe itching. Psoriasis occurs in phases. It is not yet curable but often easily treatable. Read more here about what causes psoriasis, how it manifests itself, and what you can do about it.

ICD codes for this disease: L41 | M07 | L40

Quick Overview

  • Description: inflammatory, non-contagious, almost always chronic skin disease with an intermittent course, severe scaling of the skin, irregular course
  • Symptoms: areas of skin covered with silvery scales, sharply demarcated, reddened, severe itching
  • Causes: genetic predisposition, an autoimmune reaction in the skin, possible relapse triggers are stress, infections, hormonal changes, skin irritation, and damage
  • Treatment: medication (anti-inflammatory ointments and creams with urea and salicylic acid, immunomodulators, TNF-alpha inhibitors, interleukin inhibitors), diet adjustment, relaxation techniques
  • Nutrition: Mediterranean diet – lots of fish, little meat, lots of vegetables, edible oils containing omega-3, vitamins; abstinence from alcohol
  • Prognosis: not curable; However, the number, duration, and severity of relapses can be significantly reduced with the proper treatment; complete freedom from symptoms is rare.

 

Psoriasis: causes and triggers

Psoriasis Vulgaris is an inflammatory, non-contagious, almost always chronic skin disease that occurs in episodes. Its exact cause is still unclear, but various factors are known that play a role in the development of the disease.

genetic predisposition

People with psoriasis have a genetic predisposition to skin disease. Therefore, children whose parents have psoriasis have a much higher risk of developing the disease. But not everyone who has the risk genes gets psoriasis. The disease often only breaks out when a trigger factor is added. But there are also cases where symptoms appear without a specific trigger recognizable.

Misdirected immune system

The leading actor in the onset of the disease is the immune system. The immune cells react to an attack of psoriasis exactly as to a skin injury: they trigger inflammatory reactions in the skin and accelerate skin renewal processes. This is why an excessive number of new skin cells are constantly being formed. Typically, the epidermis regenerates within four weeks. In patients with psoriasis, it is just 3 to 4 days.

Psoriasis trigger

A whole range of factors can trigger psoriasis or provoke a new flare-up of the disease.

Infections: In the course of a disease, the immune system turns against the pathogens and the healthy skin. In principle, any infection can lead to a psoriasis flare – for example, a condition with streptococci (bacteria that can cause pneumonia and urinary tract infections, among other things), measles, a common cold, an HIV infection, or a chronic inflammation.

Stress: In some cases, the disease breaks out at times of more significant mental tension, for example, after the death of a relative, during school stress, or when you lose your job.

Hormonal changes: Psoriasis often occurs for the first time when the hormonal balance is disturbed. This can be during puberty, pregnancy, or menopause.

Skin injuries: cuts, abrasions, burns, and sunburn can provoke an attack.

Mechanical irritation: pressure, Scratching, for example, from a tight belt, and chafing clothing are further possible triggers.

Medications: It is known that some medications can also trigger psoriasis flare-ups. These include, among others:

  • Antihypertensives (ACE inhibitors, beta-blockers)
  • cholesterol-lowering drugs (statins)
  • Painkillers (ASA, Ibuprofen , Diclofenac )
  • interferon
  • antimalarial and antirheumatic drugs
  • some antibiotics (e.g., tetracyclines)

Psoriasis treatment

There is currently no cure for psoriasis. However, modern treatment approaches can significantly reduce the severity and number of flare-ups. The treatment is successful if the symptoms improve by at least 75 percent.

Skincare as a basis

The basis of every psoriasis therapy is proper care. The skin of psoriatic sufferers is dry. Products containing oil and moisturizing are, therefore, the right choice. There are also creams and ointments with urea or salicylic acid. They support the skin in storing moisture.

Drugs slow down the immune system.

If care products are not sufficient, anti-inflammatory creams and ointments can help. They contain, for example, cortisone or dithranol as an active ingredient.

In the case of moderate and severe courses of psoriasis, the skin is not only treated directly but the excessive activity of the immune system is also curbed with tablets or injections. These contain immune modulators such as acitretin, ciclosporin, or methotrexate (MTX).

The most delinquent generation of therapeutics are genetically engineered antibodies. They are aimed specifically at certain messenger substances that fuel the activity of the immune system. These include various TNF-alpha inhibitors and interleukin antibodies. They are costly and are only prescribed when other treatment options are insufficient.

Light and bath treatments

The skin of people with psoriasis also benefits from exposure to sunlight. Therefore, light therapy (phototherapy) with appropriate radiation can help.

Salt water also relieves the symptoms, especially brine. Light and spa treatments are often combined into balneophototherapy: the salt water makes the skin more sensitive to light rays.

relaxation techniques and psychotherapy

Stress is one of the primary triggers of psoriasis flare-ups. Psoriasis patients, therefore, benefit from relaxation techniques such as autogenic training or progressive muscle relaxation.

Psoriasis can be very distressing. Many patients feel unattractive and inhibited, and other people often meet them with disgust and rejection – many people who are not affected do not know that psoriasis is not contagious. Psychotherapy can help patients to deal with the psychological stress of the disease.

Would you like more detailed information about the treatment options for psoriasis? Then read the article Psoriasis – treatment.

Read more about the therapies.

Read more about therapies that can help here:

Psoriasis – nutrition

Excessive inflammatory reactions in the body cause the symptoms of psoriasis. People with psoriasis should avoid food and beverages that fuel such inflammatory processes. These include, above all:

  • alcohol
  • Foods high in arachidonic acids, such as meat and sausages

But some foods have an anti-inflammatory effect. This includes:

  • Fruits and vegetables that scavenge aggressive oxygen molecules
  • Fish, especially oily sea fish, provides plenty of anti-inflammatory omega-3 fatty acids
  • Edible oils with omega-3 fatty acids such as linseed oil or grape seed oil

Many people living with psoriasis report that cutting out certain foods, such as citrus fruits or hot spices, improves their skin. What these are, however, varies from patient to patient. So you have to find out what is good for your skin. A food diary can help you with this.

Reduce excess weight

Adipose tissue, especially fat deposits in the abdomen, constantly produces inflammatory messengers. Overweight psoriasis patients can significantly improve their symptoms if they lose weight. The above dietary advice will help shed excess weight. Ask your doctor or a nutritionist for advice.

If you want to learn more about psoriasis nutrition, read the post Psoriasis – Nutrition.

“Don’t rub dandruff with a towel.”

Three questions to

  • Is psoriasis dependent on cortisone for life?
  • No – cortisone is not a long-term therapy. In the treatment of psoriasis, it is only one building block. Others include light therapy or vitamin D3 analogues. For severe cases, active ingredients can also be taken by mouth and work throughout the body. Unfortunately, psoriasis as a genetic disease cannot be cured. It would help if you prevented possible triggers such as alcohol, nicotine, or certain medications to avoid relapses.
  • Does stress promote psoriasis?
  • Stress is one of the most potent triggers, and avoiding it is particularly difficult. Because stress is everything that people find unpleasant. What you can prevent, however, is mechanical or chemical “stress” on irritated skin. Because the plaques can worsen if they are rubbed off with brushes or a towel, this phenomenon even has its own name: the Köbner phenomenon.
  • As an expert, do you have any particular advice for those affected?
  • Go to a specialist and get help there! Because psoriasis is a systemic disease and often goes hand in hand with other conditions, such as the heart. If left untreated, it not only reduces the quality of life but can even reduce life expectancy. Nowadays, however, specialists can treat psoriasis well and effectively.

Psoriasis: symptoms

Most psoriasis patients suffer from psoriasis Vulgaris. Typical of this form of psoriasis are sharply demarcated, reddened, and slightly raised spots on the skin. They are covered with silver-white scales called plaques. The affected areas of skin are sometimes small and punctiform but can also be more extensive. They can also be very itchy.

The surface scales can be easily scraped off. On the other hand, the deeper ones sit more firmly on a young, thin layer of skin. Minor, punctate skin bleeding occurs if this layer of scales is removed (Auspitz phenomenon).

The plaques tend to appear in the following parts of the body:

  • elbow
  • Knee
  • sacral region
  • hairy head
  • gluteal crease
  • the area behind the ears
  • belly button region

In severe cases, inflamed skin changes are not limited to specific regions but appear extensively on large parts of the body’s skin.

Special forms of psoriasis

In addition to psoriasis Vulgaris, many other forms of psoriasis cause different symptoms. The most important ones are explained below:

guttate psoriasis

This common form of psoriasis occurs mainly after previous streptococcal (tonsil) infections and manifests itself in the form of numerous small spots. Guttate psoriasis is often accompanied by severe itching.

After the infection can go away again or turn into chronic psoriasis Vulgaris. Then the spots are usually not as numerous but more significant.

Eruptive exanthematous psoriasis

An eruptive-exanthematous psoriasis is a form of guttate psoriasis. It also occurs mainly after infections and can be the first form of a new disease (initial manifestation) with psoriasis.

Within a few weeks, small, often very itchy spots appear on parts of the body where “common psoriasis” (psoriasis Vulgaris) does not occur. Eruptive-exanthematous psoriasis can heal on its own or become chronic.

Exudative psoriasis

Exudative psoriasis is a highly inflammatory form of psoriasis. It usually begins with symptoms of eruptive exanthematous psoriasis. The affected areas then become red and develop an inflamed “hem.” Here, wound secretion comes to the surface, which covers the psoriasis foci in the form of yellowish crusts.

Pustular psoriasis

Pustular psoriasis is a relatively rare particular form of psoriasis. Typical here are pus-filled blisters (pustules) on reddened skin. This form of psoriasis usually occurs on the hands and feet, especially on the palms of the hands and the soles of the feet. But there is also a generalized form in which the whole body is affected.

Psoriatic erythroderma

A psoriatic erythroderma is a rare form of psoriasis in which the entire skin becomes red and thickened. This makes it more rigid and can tear over the joints and form so-called fissures. The scaling is less pronounced in this form. As a result of the extensive skin inflammation, patients usually also develop general symptoms such as fever, exhaustion, and a feeling of illness.

Psoriatic erythroderma usually occurs after solid UV radiation, aggressive topical therapy, or a viral or bacterial disease.

Inverse psoriasis

Psoriasis inversa mainly occurs in body regions where skin surfaces rub against each other, for example under the armpits or breasts, in the abdominal and anal folds, and at the back of the knees. In psoriasis inversa, the scaly coating is missing because the friction of the skin detaches it.

psoriasis of the scalp

Psoriasis also affects the scalp in more than two-thirds of patients. The plaques often extend beyond the hairline and are visible on the forehead or the back of the neck. This is particularly stressful for those affected since the skin changes here are difficult to conceal.

The treatment is carried out with the same active ingredients as on the rest of the body, except that no creams are used on the fuzzy head but appropriate shampoos. For these to take effect, the scales must first be loosened and removed if possible. There are also special shampoos for this.

If external treatment is not enough, a medication that slows down the activity of the immune system can also help with scalp psoriasis.

You can read more about this form of psoriasis in Psoriasis – Scalp.

psoriatic arthritis

About every fifth psoriasis patient develops psoriatic arthritis as the disease progresses: the inflammation spreads to the joints (arthritis = joint inflammation). But it usually takes a few years until then. However, psoriatic arthritis can occur before skin symptoms appear. In individual cases, the skin even remains completely symptom-free.

Psoriasis arthritis can affect the synovial membrane, bones, periosteum, and the attachments of joint capsules, tendons, or ligaments. The following joints are affected:

  • The joints of the fingers or toes often become inflamed. They then hurt and swell. These symptoms are often confused with rheumatism or gout.
  • Some patients are particularly troubled by the larger joints, symmetrically from the collarbone to the ankle.
  • The complaints rarely occur in the spine or the sacroiliac joints of the pelvis (sacroiliac joints). The joints can stiffen as a result. This form is often confused with Bechterew’s disease.

diagnosis and treatment

The diagnosis of psoriatic arthritis is often only made when the characteristic skin and nail changes are present, and the so-called rheumatoid factor cannot be detected in the blood.

In milder cases, psoriatic arthritis is treated with non-steroidal anti-inflammatory drugs intended to curb inflammation. Physiotherapy can also help. In more severe cases, the patient is given more vital medicines that suppress the immune system.

You can find more detailed information about this form of psoriasis in the Psoriatic Arthritis article.

nail psoriasis

Psoriasis often changes the fingernails and toenails (in up to 50 percent of all psoriasis patients and up to 70 percent of all patients with psoriatic arthritis). Usually, not only one nail is affected, but several are affected simultaneously.

Various characteristic spot patterns on the nails are typical. The nails also often lose their strength – porous or even crumbly. An affected nail can also fall off entirely, for example, if the nail bed becomes inflamed or the skin under the nail is severely flaky.

diagnosis and treatment

Diagnosis is difficult when nail psoriasis develops before the skin symptoms of psoriasis are visible. Then there is a risk of confusion with fungal infections or eczema.

Nail psoriasis should be treated as soon as possible so that the condition of the nails does not deteriorate further. However, it often takes months for the treatment to take effect, and since nails grow slowly, the changes remain visible for a long time.

Preparations are available for treatment applied to the diseased nail, such as unique nail polishes or ointments. They contain, for example, cortisone or urea as active ingredients. Some patients receive other therapies, such as PUVA or internal (systemic) treatment with tablets, injections, or IV fluids.

For more information on this specific aspect of psoriasis, see Nail Psoriasis.

Psoriasis: investigations and diagnosis

The doctor recognizes psoriasis through typical skin changes that usually occur on distinct body regions such as elbows, knees, buttock folds, and fuzzy heads.

A simple skin test also provides a clear indication: It is typical for psoriasis that punctate skin bleeding occurs when the last layer of scales is removed from an affected area.

The nails also change frequently with psoriasis: blotchy, yellowish, and brittle. Such nail changes can strengthen the suspicion of psoriasis.

If the diagnosis is unclear, the doctor can take a skin sample ( biopsy ) to rule out other diseases with similar symptoms. This includes:

  • fungal diseases
  • skin lichen
  • syphilis
  • neurodermatitis

Psoriasis: course of the disease and prognosis

Psoriasis can occur at any age. However, it often breaks out for the first time in young adulthood. In Germany, about two percent of the population suffers more or less from psoriasis.

The disease is currently not curable. It occurs in phases, which means relatively symptom-free times alternate with phases of severe psoriasis symptoms. In some patients, the symptoms disappear entirely for a long time or do not return.

Psoriasis progresses very differently from person to person about:

  • Severity and type of skin symptoms
  • Localization (place) of the skin symptoms
  • duration of flare-ups
  • Frequency and severity of relapses
  • Time of (relatively) symptom-free periods

prevent flare-ups

With an appropriate lifestyle, psoriasis patients can help themselves to make flare-ups less frequent and less severe. This includes, in particular, the ability to deal with stress and avoid unnecessary strain, an anti-inflammatory diet, reducing excess weight, and avoiding alcohol and cigarettes.

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