Clinical Dermatology
Psoriasis
Information on Psoriasis
Psoriasis is a chronic, non-transmissible autoimmune disease that affects the skin and joints, usually causing redness, scaly patches appearing on the epidermis. These scaly spots, caused by psoriasis, are called psoriatic plaques. The skin quickly accumulates in these spots and gets a silver-white tint. Most commonly they appear on the elbows and knees, but they can affect every part of the body, including the scalp and genitalia. Unlike eczema, psoriasis is more likely to occur on the inner side of the joints.

Psoriasis affects equally men and women and can occur at any age. Psoriasis is never completely cured, but it may be chronic in recession with proper treatment without affecting the life of the individual.
 
The two types of psoriasis are:
  • Type I: refers to young adults who may have a relative who also suffers from psoriasis (positive family history). This type usually has a more severe clinical manifestation of psoriasis.
  • Type II: refers mainly to older people aged 50-60, without a positive family history with milder and less extensive psoriasis.
Which Are The Basic Types Of Psoriasis?
Like all autoimmune skin diseases, psoriasis can be distinguished in different types and forms depending on its manifestation.
  • Plaque Psoriasis: It is the most common type of psoriasis, as it occurs in about 80% of patients. It is characterized by plates consisting of thick, silver scales that do not have a particular itch. Multiple psoriasis usually affects the elbows, knees, and head.
  • Guttate psoriasis: It is a very rare type of psoriasis and occurs usually in children or adolescents who have just experienced streptococcal infection. The plates are small and diffuse distribution. The prognosis of this psoriasis is very positive, with high rates of complete healing.
  • Inverse Psoriasis: Appears mainly in older ages and affects body folds, such as between buttocks and armpits. It is characterized by clearly-defined erythematous plaques with little or no lepidopteran.
  • Pustular psoriasis: This type of psoriasis, which may be localized or generalized, is characterized by blemishes with pus in the skin. The localized form is lighter as it only affects the palms and soles. On the contrary, the generalized form can attack the whole body, have an acute and thunderous outburst and progression, while the patient should contact the dermatologist directly to avoid the risk of his life.
  • Erythrodermic Psoriasis: This type is the most dangerous manifestation of psoriasis. It is characterized by redness of all skin, and there may be systemic symptoms such as fever and malaise. The patient should contact a dermatologist immediately and require hospitalization and support to avoid complications.
  • Nail Psoriasis: It is a type of psoriasis that occurs in 25% of patients already suffering from psoriasis. There are changes in nail colour and nail dystrophy. Usually more than one nail is affected.
  • Psoriatic arthritis: Appears in about 30% of patients already suffering from some type of psoriasis. This is a seronegative arthritis that affects both sexes equally and occurs more often at older ages above 40 and type I psoriasis.
What Are The Stages Of Psoriasis?
Psoriasis is not transient, but is a chronic disease characterized by bouts and recessions. It is not a simple rash with an unpleasant look, but a manifestation of systemic inflammation. Psoriasis may go through the following stages, not necessarily in the same order.
  • Actively evolving psoriasis that quickly occupies the entire body.
  • Chronic progressive psoriasis that takes up the skin slowly, making it delicate.
  • Chronic stable psoriasis that stays stationary in size and color.
  • Chronic declining psoriasis resulting from treatment. Symptoms recede and gradually fade.
What Causes Psoriasis?
Psoriasis is a multifactorial disease not due to just one cause, but it is the result of many factors. The exact reasons of psoriasis have not been elucidated and remain unknown.

According to the latest scientific data, psoriasis is the result of a disorder of the body's immune system and is therefore characterized as an autoimmune disease. The body itself identifies the cells as its enemy and attacks them.

Thepsoriatic skin is replaced much faster than normal skin. Thus, renewing skin keratinocytes instead of taking 28 days lasts for 4 days, resulting in thickening of the epidermis.

And in this case, as with most autoimmune diseases, family history appears to play a major role in the appearance of psoriasis, although there are cases where one shows psoriasis without any congenital sufferer in the family, or the children of a parent with psoriasis, never to experience psoriasis.

There are also several environmental factors that can cause psoriasis or favor its appearance, such as:
  • Streptococcal infection: Many children or adolescents suffer from phlebotomy psoriasis following pharyngugalmitis.
  • Hormonal disorders: TIntensification of psoriasis at the beginning of one’s period, menopause or pregnancy is often observed.
  • Medicines: Some medicines, such as antidepressants or antihypertensives, appear to exacerbate or promote psoriasis. However, the patient should not stop taking it himself, but after consultation with his doctor.
  • Anxiety: It seems that anxiety increases psoriasis or favours its appearance.
  • Smoking and alcohol: They are not responsible for the appearance of psoriasis, but greatly affect their appearance and development.
The most important thing to stress about psoriasis is that, despite its various forms and severity, it is a disease that is not contagious.

How Does Psoriasis Affect Psychology?
Psoriasis does not only affect the skin, but also the psychology of the person, especially when it occurs in visible parts of the body such as the face and hands. It is now established that psoriasis affects many aspects of the quality of life, making it difficult for everyday functioning, interpersonal relationships and professional careers. The most important impact could be social stigma and patient isolation. In many patients, the symptoms of the disease are revived in particularly sensitive and anxious periods of their lives, which adversely affects their psychology, creating a vicious circle of anxiety and illness. That is why in many cases of psoriasis, dermatologists recommend to the patient a kind of psychological treatment and support so that they can cope with their problem.

How Is Psoriasis Treated?
Although psoriasis is a chronic illness, there are different therapies that can limit and suppress it.
  • Local treatment with
  • creams containing cortisone of different strength to reduce skin inflammation. Prolonged use is recommended to be avoided due to local and systemic side effects such as tachyphylaxis, skin atrophy, or spider veins.
  • Vitamin D in the form of cream or emulsion and they act by inhibiting the rapid proliferation of keratinocytes.
  • Tazarotene, a vitamin A retinoid derivative that acts to regulate cell proliferation and differentiation. It is a preparation that is contraindicated during pregnancy as it is teratogenic.
  • Systemic oral therapy with cyclosporine, methotrexate and retinoids. Systemic oral therapy, due to its many different side effects, is recommended for cases of severe psoriasis with exacerbations, as for psoriasis in the face and hands that significantly affect the patient's psychology. The most common side effects of medicines used in systemic therapy are renal and hepatic damage, hypertension, dry skin and mucous membranes and hair loss. Some of the drugs have been accused of teratogenicity and therefore their taking should be closely monitored by the doctor.
  • Phototherapy with ultraviolet light for therapeutic purposes.
  • UVB Phototherapy: The advantage of UVB phototherapy is that it can be applied to children and pregnant women with psoriasis. Restrictions on phototherapy include the risk of burns, photoluminescence and photocarcinogenesis.
  • Photochemotherapy: This treatment combines UVA rays with psoralen. Possible side effects are nausea, headache and gastrointestinal pain from psoralen, and the risk of burns and photoaging. It needs eye protection from the light for 24 hours after treatment with special glasses.
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