What are the clinical manifestations of psoriasis?
Due to inflammation skin cells reproduce in 3-6 days instead of the normal 28 days, leading to the typical rough redness of the scaly plaques anywhere in the torso, limbs and hairy sections of the scalp. The clinical image of psoriasis varies among patients with similar psoriasis-characteristic features.
Psoriasis may appear in a form of many small guttates in sizes ranging from droplets to coins - psoriasis guttata et nummularis (at first dissemination), chronically stationary and charted plaque in typical locations above the limb joints (elbows, knees), abdomen and lower back plaque - psoriasis vulgaris, and also confluent with a transition to a severe, generalized form affecting the entire skin - psoriatic erythroderma. It is pink-red, stiff to the touch, inflammatory
and relatively well-defined, with silvery scales on the surface. Usually, there is no itching. Some patients have scalp psoriasis, localized only in hairy part of the scalp - psoriasis capillitii, where it forms a red, scaly plaque and the hair does not fall out. Some patients have inverse psoriasis localized at skin folds (sweaty areas), namely the armpits, groin, under the breasts, the genital area and sometimes around the eyes - psoriasis inversa. Here the psoriasis
is red, inflammatory and often without scales on the surface. Another localized form is psoriasis palmoplantaris,
where pustular psoriasis is located on the palms and soles and is often associated with disability and typical nail deformities - psoriasis unguium. A specific severe acute form is psoriasis pustulosa generalisata von Zumbush (generalized von Zumbish pustular psoriasis), which extensively disseminates, merges and is characterized,
in addition to redness, by numerous whitest yellow sterile pustules. Impetigo herpetiformis is a generalized pustular psoriasis that appears in the second half of pregnancy, with severe constitutional symptoms.
A diagnosis can be unambiguously confirmed by histological examination of skin samples.
What causes psoriasis?
The cause of psoriasis is considered to be a genetically determined disorder in the functioning and dysregulation of the immune system, which causes disproportionately accelerated production and insufficient maturation of skin cells. The subsequent buildup is reflected in local inflammation and flaking of the skin. It is a genetic disease that can remain for a long time in a latent form. This means there are no outward signs, though the disease may break out under the influence of internal or external factors. This may include, for instance contact with streptococcal infection (angina), which is a common trigger for psoriasis in children. Stress is one of the most important factors influencing the first outbreak of psoriasis and negatively effects the course of the disease. Triggers can also be the taking of medication for other conditions (ACE inhibitors, beta-blockers, antimalarials, lithium, non-steroidal anti-inflammatory drugs and others). A worsening factor in the development of psoriasis may be an unrecognized focal infection (chronic tonsillitis, untreated teeth) or another concurrent disease. There is a greater risk of occurrence with an unhealthy lifestyle, obesity or excessive consumption of cigarettes and alcohol. External factors can also be mechanical, such as clothes rubbing on skin, or psoriasis may flare up due to a seasonal change in the weather.
What is psoriatic arthritis?
Psoriatic arthritis is a chronic inflammatory rheumatoid disease with inflammation of the joints and is associated with psoriasis-stricken skin. However, not every patient with psoriasis has musculoskeletal disorders, and psoriatic arthritis often appears years after the onset of skin symptoms, and in only one quarter of patients. Both psoriasis and arthritis most frequently start at the same time, and it only rarely does inflammation of the joints lead to psoriatic skin manifestations. Psoriatic arthritis without psoriasis is quite exceptional. The disease begins with a dull pain and swelling of one or more small joints in the arms, knees, elbows and/or tendon-bone insertions, or inflammatory back pain. A properly chosen anti-psoriatic therapy, properly chosen in cooperation with a rheumatologist, may have a favorable effect on the course of the disease. In addition to these signs, an untreated severe form of psoriasis can affect the function of other internal organs, namely elevated levels of inflammatory factors, so any extensive form of psoriasis should be completely treated.
Psoriasis and quality of life
Psoriasis is a condition that adversely affects not only the physical health of a patient, but can also have a significant psychological influence on the patient. Patients often suffer from depression because psoriasis limits their emotional and sexual life and their partnerships. Employment opportunities for people with psoriasis are limited, not only due to the disease itself and treatment, but also because of local prejudices.
What are possible treatments for psoriasis?
MModern dermatology offers a wide range of effective treatments that can alleviate the symptoms of psoriasis and keep them under control. However, no medical product exists that can completely cure psoriasis. Not every treatment works equally with any patient, and likewise a response to treatment may also change over time.In general, the treatment of psoriasis is divided into 4 major groups of therapies that can be employed depending on the degree of disability:
1. Topical (local) treatment - medicines administered directly on the skin of the affected area, anti-inflammatory external treatment, topical corticosteroids, vitamin D derivatives, retinoids, topical immunomodulators, salicylic acid, tar, ichthammol, pix and others.
2. Phototherapy - treatment using ultraviolet light such as UVB and PUVA.
3. Oral systemic treatment (retinoids, methotrexate, cyclosporin A) - medical products in the form of tablets or injections that act on the whole body, suppress immunity and are to be taken over a long period, while clinical monitoring is necessary.
4. Biological treatment (infliximab, adalimumab, ustekimumab, etanercept) - new products that act selectively in the body’s biological response, intervening in the course of disease reactions in the body. The high selectivity of their effects is particularly reflected in better tolerability, allowing them to be administered long-term and for symptoms of psoriasis to be continually controlled. Biological treatment is intended for patients with moderate or severe psoriasis whose prior systemic therapy or phototherapy have failed due to lack of efficacy or adverse events.
Because psoriasis is a chronic disease and in every way adversely affects a patient’s quality of life, it has to be treated. The availability of high-quality treatment, the correct combination of global and local therapy and rotational therapy under the guidance of a dermatologist lets patients achieve long-term remission.
Can psoriasis be affected by diet and lifestyle?
Numerous studies of psoriasis have not yet ascertained a relationship to diet and to liver or kidney disease. The efficacy of certain diets are rather attributed to a radical change in what is eaten, not their particular form. We can only recommend to patients with psoriasis to observe generally known principles of a healthy diet, involving a lower percentage of carbohydrates and fats, increased omega-3 fatty acids, no smoking and alcohol, and a proper regimen. In such a regimen, a short shower is more fit than a long bath, while salt in seawater and suitable emollients after a bath have a beneficial impact. Spa stays with mud, salt, sulfur dioxide or silicon water treatments or holidaying by the sea are appropriate, too.
Taking an individual approach to the disease and accepting it has a noteworthy impact on its course. An active approach to the disease, daily skin care and preventive action are positive. An effective preventive measure is to maintain risk factors at the desired level. An adequate diet, restful sleep and vitamin preparations keep your body in balance and with a good immune level. It is important to avoid immunodepressive situations, such as stress, streptococcal and viral infections, injuries, sunburn or excessively long exposure to sunlight. It is advisable for people suffering from psoriasis not to enter occupations that can worsen the situation, for example where the risk of quick-drying hands or inflamed nail beds rises, such as hairdressers, mechanics, butchers, construction workers, etc.
What about psoriasis and pregnancy?
In general, psoriasis-related conditions improve during pregnancy and after childbirth and deteriorate during breastfeeding. If you are or planning to become pregnant, it is important to tell your doctor right away, especially if you are undergoing global treatment. Systemically administered medicines and also some ointments administered over large areas of the body can have an impact on fetal development. It is almost impossible to predict whether children will have psoriasis as the type of inheritance is far less straightforward than for other illnesses. If you have psoriasis, your children will be at increased risk of developing this disease and have a “positive family history”. However, they may never contract psoriasis, but the children of your children may.