Diagnosis
As a rule, the diagnosis of psoriasis is made on the basis of the examination and inspection by the doctor. The typical reddish and thickened skin areas on certain parts of the body strongly indicate the presence of psoriasis. The patient also indicates the annoying itching, possibly also the familial occurrence and possibly other risk factors.
All these components substantiate the diagnosis of psoriasis. Scratch marks and bloody dried skin abrasions also indicate the clinical picture of psoriasis. In addition to the inspection, the doctor will also carefully remove a flake of skin.
If it is indeed psoriasis, a thin layer of skin will appear under the detached scale, which is typical for this disease. This is also known as the “last layer of skin” and can also be removed by the doctor. A small bleeding caused by this would also be characteristic of psoriasis.
The small bleeding is also known as “bloody dew” or “pointed phenomenon”.Also typical for psoriasis is the so-called “Koebner phenomenon”: Here, experimental irritation of the skin leads to psoriasis-typical changes. Sellotape strips, for example, can be used as stimuli, which are stuck to unaffected skin and quickly removed. When diagnosing psoriasis, it is also important to exclude other similarly acting diseases. To do this successfully, diagnostic procedures such as skin swabs and blood samples are used.
Symptoms of psoriasis
The symptoms of psoriasis are usually caused by a very fast and uncontrolled growth of the epidermis, which leads to the classic keratinizing structure of the skin. Almost 7-8 times faster than in a person with healthy skin, the skin cells begin to settle to the surface. For this reason, psoriasis first becomes noticeable by whitish shiny skin scales on certain parts of the body.
The extensor sides of the forearms are most often affected. The legs (here especially the shin), scalp or back can also often be affected by psoriasis. Also in the face, on the forehead and eyebrows, in the area of the abdomen around the navel, at the hairline and on the hands, the classic form can also be affected.
The affected skin areas can very often itch slightly to moderately, the skin scales can be lifted slightly with the fingernails. The classic shape and distribution of affected skin areas can resemble a map. Since simple psoriasis only affects the skin, other organs and body parts are not affected – with the exception of the joints.
These can also be affected relatively frequently (in about 10-20% of psoriasis patients), which then leads to movement-dependent pain, swelling and redness in the affected joints. In some cases, in addition to the skin, certain joints are also affected by psoriasis. The disease is then referred to as psoriatic arthritis and is included in the rheumatological form.
In psoriatic arthritis, an exuberant reaction of the immune system leads to inflammatory changes in certain joints as well as to the changes in the skin typical of psoriasis. Sometimes it can also happen that the joints are affected by psoriatic arthritis, but not the skin. It is also possible that joint pain and skin changes do not occur at the same time, but only at a different time.
The joints sometimes appear reddened and swollen in psoriatic arthritis. Pressure pain is also reported by patients. In addition, habitual movements in the affected joints often cannot be performed without pain.
In some cases, only the scalp is affected by psoriasis. Mostly, however, the scalp is also affected by psoriasis in combination with other skin areas. An infestation of psoriasis on the scalp is clearly indicated by reddish and itchy small skin changes between the hair roots.
The skin is very scaly and dandruff is also visible in the hair area. There may be individual episodes of psoriasis on the scalp, in which the inflammatory skin changes become more prominent. Often, however, a latent redness and scaling of the skin is permanently present.
A spontaneous healing practically does not occur. In the case of psoriasis it is important to irritate the scalp as little as possible. Thus, scratching and loosening of the scaly skin parts should not occur.
Furthermore, gentle shampoos and washing lotions for the skin should be used. Furthermore, no perms should be twisted into the hair and no hot blow-drying should be used. This would put more stress on the hair attachment points and thus lead to a reduced healing of the inflammatory skin areas.
Psoriasis is treated by applying special lotions to the scalp. Psoriasis of the nails occurs relatively frequently. It occurs in many patients parallel to the typical skin changes on the body.
Often the toenails are affected, which are then altered in appearance and shape. The combination of psoriatic arthritis and psoriasis of the nails is particularly common. Almost 2/3 of all patients who have psoriatic arthritis also suffer from nail infestation of the hands or feet.
In psoriasis patients, where only the skin is affected, only about 5% suffer from nail infestation. The nail affected by psoriasis is typically altered and shows some small indentations on the nail surface.Therefore this changed nail is also called spot nail. Sometimes psoriasis infestation of the nails also leads to inflammation of the nail bed, which can cause parts of the nail to turn yellowish on some parts.
This type of changes is also called oil stained nails. With the so-called crumb nails, the surface of the nail is so damaged that the nail surface is no longer smooth but rough and crumbly. Also there are nails under whose surface a scaling appears.
This leads to the fact that the nail then sooner or later loosens and lifts. In many cases it then also falls off. Often not only single but several nails of the hand or feet are affected.
The diagnosis is usually made by the doctor as a gaze diagnosis. Psoriasis may also be present on the face. The appearance is similar to psoriasis on other parts of the body.
However, since the face is not covered by clothing, it is also more exposed to wind, water and other external influences. Due to the constant irritation, the skin changes may also be more pronounced. In addition, treatment measures may not work as quickly as in protected skin areas.
If the face is affected by psoriasis, it is usually the areas around the eyebrows or around the mouth and around the nasal fold that are affected. Since the skin on the face is much thinner than on other parts of the body, medicines in the form of lotions or gels are absorbed more quickly and have a more intensive effect. The skin in or around the ear can also be affected.
Here, too, affected skin areas show reddish and inflammatory changes and show a clear scaling. The ear can itch sensitively or even hurt. The treatment of psoriasis of the ear corresponds to that of the other skin on the body. However, the skin irritation can be more severe on the ear than on other parts of the body, as the ear is usually exposed to wind and sun and other influences without protection.
