Psoriasis is a chronic skin condition that affects millions of people worldwide. Its main feature is the excessive proliferation of skin cells in the upper layer of the epidermis (keratinocytes). The result of this process is the formation of hard plaques that cause itching and shed from the body as “flakes”. Psoriasis is mainly located on the knees, elbows, trunk, lower back, palms, soles, and scalp.
Psoriasis is not contagious, but it can be painful. Treatments are available to help manage symptoms. This is very important, as the disease can have a serious impact on patients’ lives, significantly burdening their psychological state.
What is psoriasis?
Psoriasis is a chronic inflammatory autoimmune skin disease that affects approximately 2% of the population, with men and women being affected equally often. The characteristic appearance of psoriasis is an erythematous plaque with intense hyperkeratosis (thickening of the epidermis), due to the excessive proliferation of skin cells. Under normal conditions, cells renew themselves every 28–30 days. In areas with psoriasis, however, the cells renew themselves every 4–6 days.
Psoriasis usually goes through cycles of flare-ups and remissions. It mainly develops on the elbows, knees, scalp, and genital area. Psoriasis can also affect the joints, causing what is known as psoriatic arthritis, as well as the nails, creating an additional psychological burden for the individual.
What are the causes of psoriasis?
Although psoriasis is closely linked to heredity, other factors may trigger it or worsen it — for example, streptococcal infections, certain medications, stress, smoking, and alcohol.
More specifically, the causes of psoriasis include:
- Heredity: Individuals with a family history of psoriasis are at greater risk of developing the disease. Specific genes, such as those related to the immune system, play a decisive role in its development. Of course, this does not mean that people with this predisposition will necessarily exhibit symptoms.
- Environmental factors: Environmental factors can trigger or worsen psoriasis symptoms. Common triggers include stress, infections, cold weather, and skin injuries. Smoking and excessive alcohol consumption have also been linked to an increased risk of developing psoriasis.
- Immune dysfunction: Psoriasis is primarily an autoimmune disorder. This means that the immune system mistakenly attacks healthy skin cells, resulting in an accelerated cycle of skin cell growth that leads to the characteristic symptoms of psoriasis. Understanding this immune dysfunction is essential for developing targeted treatments that address the underlying cause of the disease.
What are the symptoms of psoriasis?
Seeking medical assistance and psychological support is very important for those suffering from psoriasis, as visible lesions, particularly on the hands and face, can affect interpersonal relationships, harm self-image, and lead to anxiety and depression.
The symptoms of psoriasis include:
- Red patches on the skin: One of the most common and recognisable symptoms of psoriasis is the appearance of red, inflamed patches on the skin. These patches, called plaques, usually appear on the elbows, knees, scalp, and lower back, but can also appear anywhere else.
- Itching: Itching is a characteristic symptom of psoriasis and can range from mild to very intense. Scratching affected areas can worsen the condition and lead to the development of more plaques or even infection.
- Nail changes: Psoriasis can also affect the nails, causing pitting, discolouration, and swelling. Nail psoriasis can be especially troublesome and may affect the appearance and function of the nails. Early recognition of these changes can help with prompt treatment.
- Joint pain and stiffness: In some cases, psoriasis can lead to a condition called psoriatic arthritis, which affects the joints. This can cause pain, stiffness, and swelling, making everyday tasks difficult.
What are the types of psoriasis?
Psoriasis comes in various forms, each with its own unique characteristics. However, two types stand out as the main ones:
Type I: Early onset, usually during adolescence, with a more severe prognosis and a positive family history.
Type II: Late onset, with a milder clinical picture and no positive family history.
How is psoriasis diagnosed?
An accurate diagnosis is the first step toward effective management of psoriasis. Dermatologists use various methods to diagnose psoriasis, such as:
Clinical examination
A thorough clinical examination by a dermatologist can reveal indicative signs of psoriasis, such as red plaques and “flakes”. A detailed assessment helps determine the type and severity of the psoriasis.
Biopsy
In some cases, a skin biopsy may be needed to confirm the diagnosis. During a biopsy, a small skin sample is taken and examined under a microscope to look for the characteristic changes associated with psoriasis.
Blood tests
Blood tests may be performed to rule out other medical conditions that may mimic the symptoms of psoriasis, such as fungal infections or rheumatoid arthritis. These tests can help ensure an accurate diagnosis.
What does psoriasis treatment include?
Among the indices for measuring the severity of psoriasis, in addition to the body surface area affected (BSA) and the Psoriasis Area and Severity Index (PASI), the inclusion of the Dermatology Life Quality Index (DLQI) of patients was also decided. All of these are critical in determining treatment.
Importantly, treatment options for psoriasis are now broader and can significantly improve patients’ daily lives. Management of psoriasis involves a combination of lifestyle changes and medical treatments. Treatment options include:
- Medication (topical): Topical medicated creams are often the first treatment option for mild to moderate psoriasis. They can help reduce inflammation, itching, and scaling.
- Phototherapy: Phototherapy, through exposing the skin to a controlled spectrum of light, can help manage psoriasis by slowing skin cell growth and reducing inflammation.
- Systemic treatment: For more severe cases of psoriasis, oral medication may be required. These drugs work throughout the body to suppress the overactivity of the immune system.
What should home care include?
In addition to medication, disease management plays a crucial role. Daily skincare is important.
Be careful in the bath
When bathing, you should wash the skin gently and avoid scrubbing it. Use lukewarm water and gentle soaps that contain added oils.
Keep your skin moisturised
Apply a moisturiser daily. After bathing, gently dry your skin and apply your preferred product while your skin is still damp. For very dry skin, oils or deeply hydrating creams may be preferable.
Cover the affected area at night
Before going to bed, apply a moisturiser to the affected skin and wrap it with plastic film. When you wake up, remove the plastic and rinse the skin.
Avoid scratching
If you have scalp psoriasis, try a medicated shampoo. Keep your nails trimmed so they do not damage your skin. Wear soft fabrics that do not aggravate itching.
Avoid skin irritants
Notice what triggers your psoriasis and take steps to prevent or avoid it. Infections, skin injuries, smoking, and intense sun exposure can worsen psoriasis.
Try to maintain a healthy lifestyle
Exercise, a good diet, limiting or avoiding alcohol, maintaining a healthy weight, and avoiding things that cause stress are vital in the effort to manage psoriasis.
Conclusions
Psoriasis is a complex skin condition caused by genetic, environmental, and immunological factors. Understanding the causes and symptoms of psoriasis plays an important role in early diagnosis and effective management.
If you suspect you have psoriasis or have already been diagnosed, seeking care from a specialised dermatologist is essential. Early intervention and a personalised treatment plan can significantly improve a patient’s quality of life. Do not hesitate to consult a dermatologist for information on the best treatment options for your case.