Psoriasis

Psoriasis

Description

Psoriasis is a chronic inflammatory, hereditarily acquired, non-contagious skin disease, which can spread to the joints (psoriatic arthritis) and other organs (e.g. nails, ligaments). The strain of psoriasis can also adversely affect the blood vessels, heart, liver and metabolism, but above all the psychosomatic problems of psoriasis sufferers must be kept in mind when treating patients.

The most common form of the disease, psoriasis vulgaris, is classified into two different types depending on when it first appears: Type I manifests before 40 years of age, whereas Type II manifests later. The first outbreak of the disease often occurs between the ages of 20 and 30 (i.e. Type I).

Psoriasis cannot be completely cured: all treatment measures are aimed at alleviating the existing symptoms or effects of the disease.

Symptoms

Typical of psoriasis are shiny, sharply defined, hard scaly patches on the skin, reddened and inflamed due to increased blood flow to those areas. Primarily affected are the elbows, shin area, scalp or eyebrows, as well as the buttocks, chest, back and coccyx, the armpits, navel or genitals, on which the skin can also become infected.

Causes and Risks

The etiology of the disease is not entirely clear, however the causes are thought to be genetic (hereditary disposition) or autoimmune (immune system dysfunction). The symptoms are consequences of accelerated, hyperkeratotic and premature renewal of the epidermis.

A number of factors may promote or trigger the disease, for example streptococci infections, HIV or sexually transmitted diseases. In addition injuries, sunburn, continuous mechanical irritation of the skin, metabolic disorders, ingestion of certain drugs (for example, beta-blockers), emotional stress or alcohol and nicotine abuse can provoke the onset of the disease.

In severe cases the disease may lead to a life-threatening infection of the entire skin surface (erythroderma).

Examination and Diagnosis

Diagnosing psoriasis requires first an in-depth examination of the skin. The following characteristics ("psoriasis phenomena") are specific to the disease: cautious scraping away of the relatively loosely adhering scales leaves behind a thin membrane, after which removal a point-like bleeding (also called "bloody dew") generally occurs.

Further diagnostic measures should be conducted to rule out other diseases (eczema or fungal infections) with similar symptoms. Blood tests, swabs and - if necessary - the removal of tissue samples serve in the final clarification of the diagnosis. If the joints are affected, the changes that have already taken place should be detectable using magnetic resonance imaging (MRI) and X-rays.

Treatment

Therapeutic measures are aimed, above all, at relief from the symptoms and prevention of relapses. The spectrum of techniques ranges from externally acting ones (creams, ointments and lotions) to treatment with preparations for internal use with severe diseases, such as retinoids which normalize cell growth and are anti-inflammatory, or immunosuppressive therapy using e.g. methotrexate or cyclosporine. In recent years, anti-inflammatory biotechnologically produced medications, called biologics, have been approved for psoriasis treatment.

For external use, bath products and shampoos are also available which remove scales or are anti-inflammatory. With psoriasis, proper skin care is also very important.

 Course and Prognosis

The course psoriasis takes is individual to each patient and may evolve differently: in some the disease occurs only once during their life and heals without a trace, in others there may be phases of increased, decreased or a complete lack of psoriasis activity.

Not to be underestimated are the physical and psychological stresses to which those affected are frequently exposed in their daily lives, or the side effects of the medications. Patients suffering from psoriasis often fall into a vicious circle, where living with the disease becomes a daily challenge. The external manifestations of the disease often lead to serious, stress-inducing complexes emerging in those affected, which in turn can worsen the appearance of the skin. Patients react with ill humour or depression, social isolation or alcohol abuse, leading to serious problems in their partnership or family. Sexual problems are common in those with psoriasis.