Psoriasis diagnosis | Psoriasis

Psoriasis diagnosis

During the examination by the doctor, one of the scales is carefully scraped off. The following psoriasis phenomena appear one after the other: Under the microscope, the typical cornifications and inflammatory cells can be seen in one incision.

  • “candle dropping phenomenon” by scratching a lamellar scaling appears
  • “phenomenon of the last cuticle” at the base of the scale a thin, easily tearable cuticle can be seen
  • “Phenomenon of bloody dew” further scratching leads to spot bleeding

Course of psoriasis

Psoriasis is a life-long condition with varying degrees of severity. It is not uncommon for the appearance of the skin to be impaired, with psychosocial consequences. The disease is difficult to process and problems arise in interpersonal relationships and at the workplace, for example.

Especially psoriasis that affects the face contributes to feelings of discomfort. Psoriasis usually begins acutely generalized (suddenly and everywhere) or primarily chronic (slowly and with individual foci). But also mixed forms occur and are quite common.

Psoriasis usually occurs in relapses, but there are rarely completely symptom-free intervals. The manifestation (external signs) can be treated or reduced or even disappear completely. However, the disposition remains and is not curable. The psoriasis will therefore always return.

Complications of psoriasis

The complications of psoriasis are the following:

  • Psoriasis arthropathica It affects about 5% of psoriasis patients. Inflammation of the distal joints (joints located at the ends of the extremities, e.g. toe joints, finger joints). This leads to swelling.

    Individual fingers can also be affected. Osteolytic (bone-dissolving) forms are also known. The axial type is much less common.

    This leads to a stiffening of the spine and the pelvic joints.

  • Psoriatic erythroderma Excessive irritation of the skin can lead to redness and scaling. This redness occurs on the entire skin.

Psoriatic arthritis is an inflammatory joint disease caused by antibodies directed against the body, which has many similarities to rheumatoid arthritis. What makes it special is that psoriatic arthritis only occurs in some patients who suffer from psoriasis.

The exact causes and processes that lead to the development of psoriatic arthritis are relatively poorly understood. However, a component caused by a misdirected immune system is safe. To develop psoriatic arthritis, the underlying disease psoriasis must be present.

However, the severity of psoriasis does not allow a risk assessment as to whether one is suffering from arthritis. The leading symptom are diseases of joints. Theoretically, all joints can be affected, but typically, individual toe or finger end joints are inflamed, and often all three joints of a single finger are inflamed (infestation in the beam).

This pattern of distribution is important because it allows psoriatic arthritis to be distinguished from the rheumatoid form. Here, the basic joints of the fingers and toes are usually affected, but never the terminal joints. The skin over the joint is reddened and swollen, the patient complains of pain in the joint at rest and especially during movement.

Most courses of the disease are limited to this, but in severe cases there is joint destruction and malpositioning of fingers or toes. Relatively often, large joints such as the knee, hip and spine are also inflamed as part of psoriatic arthritis. In addition to the bony parts, ligaments and tendons are also affected, which is expressed by pain in movement.

The physician diagnoses psoriatic arthritis on the basis of the medical history (psoriasis) and the typical characteristics of the inflamed joints. An X-ray can reveal possible bone damage. A blood test for typical changes in rheumatism excludes this diagnosis.

In the end, a score according to Fournié is formed from all findings, in which the diagnosis is considered confirmed from 11 points upwards. The therapy of psoriasis arthritis depends on the severity of the symptoms. Cortisone treatments are possible. Sulfasalazine can be given in case of light infestation and methotrexate in case of severe infestation.New substances such as Infliximab or Etanercept, which act more specifically, are currently being tested.