Psoriasis

Introduction and Cause

psoriasis_plaque.jpg

Psoriasis is a chronic, recurring skin disease.
Its scope can vary considerably; from mild outbreaks, to severe cases
In principle, people of all ages can get psoriasis,
early-onset: mostly seen in 16 to 22-year-olds
late-onset: 50 - 60.

Runs in families
exposure to certain stimuli (such as a streptococcal infection in the throat, alcohol, medicines and local irritation) or damage to the skin, may cause an outbreak of psoriasis in persons who have this genetic predisposition.

Types: psoriasis vulgaris (plaque psoriasis) and psoriasis pustulosa (pustular psoriasis).
The different types of psoriasis can be divided into subgroups according to severity, duration, location on the body and appearance of the lesions.

6 per cent of the people who have psoriasis also get psoriatic arthritis in the joints.
Psoriatic arthritis primarily occurs in fingers and toes, but is also quite common in the back bone.

Symptoms

distribution.jpg
  • red spots or patches.
  • the patches grow bigger and become scaly.
  • the upper scales fall off in large quantities, while the lower layers of scales are firmly fixed.
  • when the scales are scraped off, a number of small, bleeding points can be seen underneath.
  • psoriasis of the nail often manifests itself as small indentures in the nails. The outbreak can be so severe that the nail thickens and crumbles away.
  • flexural psoriasis occurs in skin folds (flexures). Red, itchy plaques appear in the armpits, under the breasts, on the stomach, in the groin or on the buttocks. The plaques are often infected by the yeast-like fungus candida albicans.
  • guttate psoriasis is a special variant which primarily occurs acutely in children and young people due to a streptococcal infection of the throat. Drop-like, scaly patches appear on the entire body. In many cases, the condition disappears by itself after a few weeks or months.

Pustular Psoriasis
Pustular psoriasis is a rare variant where the inflammation is so severe that, in addition to the usual lesions, blisters or pustules containing fluid appear on the skin.
The severity of the condition varies.

Treatment

The treatment, which should be carried out in close collaboration between the patient and the GP or the dermatologist, consists of various local and systemic treatments. It depends on the patient's age, state of health and on the nature of the psoriasis.

Local treatments
creams and ointmen containing tar,
dithranol, salicylic acid or vitamin D-related compounds (calcipotriol (Dovonex),
calcitriol (Silkis) or tacalcitol (Curatoderm)).
Occasionally, corticosteroid-containing ointments are used for a short time.
Combining a corticosteroid with another topical treatment, either as separate products used at different times of day, or as a combination product, eg Dovobet (calcipotriol and betamethasone) or Alphosyl HC (coal tar and hydrocortisone), may be beneficial for chronic psoriasis vulgaris. Special lotions are available for scalp treatment. These often contain salicylic acid, coal tar, sulphur or corticosteroids.

Phototherapy (ultraviolet B, UVB) and photochemotherapy (psoralent ultraviolet A, PUVA) are both used for widespread psoriasis. Many patients find that natural sunlight also helps.

Oral treatment with immunosuppressants such as ciclosporin (Neoral), or methotrexate (eg Maxtrex) or the vitamin A derivative acitretin (Neotigason) may be used for patients with severe, widespread or unresponsive psoriasis.

Intensive research is being carried out to find better treatments for psoriasis and new treatments are regularly introduced which improve the condition in some patients.

Patient Counselling

  • People who have family members with psoriasis, especially if they are exposed to stress, alcoholism, infections, medical treatment, or events such as divorce, bereavement or moving house.
  • It is important to accept that psoriasis is a chronic, long-lasting condition. The disease is usually characterised by alternate good periods and periods with outbreaks.
  • If you discover that certain things make your psoriasis worse, try to avoid them.
  • It should be noted that all degrees of psoriasis can be treated effectively. The treatment is not a cure, but it will ensure a better quality of life.

Pictures

skinpathology
Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License