Heavily scaling and inflammatory reddened skin as well as itching are typical symptoms of psoriasis. Nails and joints can also be affected by the skin disease. The extensive and clearly visible skin changes mean that people with psoriasis – as it is also called – are often ostracized and shunned. However, there is no reason for this, because the disease is not contagious. But what are the causes of psoriasis, what can be done to treat the disease, and is it curable? We clarify all questions around this widespread disease.
What is psoriasis?
Psoriasis is called psoriasis in the technical jargon. Psoriasis is a chronic inflammatory skin disease. In addition to inflammation, the skin’s horny cells (keratinocytes) multiply more than normal. Normally, skin cells renew themselves every 28 days, but in people with psoriasis this phase is often shortened to four to seven days. This causes the top layer of skin to thicken and flake off more. Women and men are affected equally often. Recognize psoriasis: these pictures help!
Psoriasis: causes and development
Many different factors play a role in the development of psoriasis. Genes that regulate the immune system are important, as it is believed that an immune response of the body triggers the inflammation of the skin and stimulates the formation of horny cells for skin renewal. Such an immune reaction would normally occur, for example, when the skin is injured. It is also discussed whether psoriasis is an autoimmune disease. However, the exact mechanism of its development has not yet been conclusively researched. In addition, certain stimuli such as infections, medications, stress or skin irritations can cause or intensify an episode of the disease. Psoriasis is not contagious.
Possible triggers of a psoriasis flare-up
An episode, or the new appearance of foci of psoriasis, can be triggered by various so-called trigger factors. These triggers vary from person to person. In addition to drug treatment, it is important to eliminate and/or avoid these factors. Trigger factors may include:
- Stress
- Alcohol
- Nicotine
- Bacterial or viral infections
- Medication
- Mechanical irritation (scratching, spraying, sunburn, …).
However, these trigger factors are only triggers of psoriasis. They are not causative for the disease. This means that relapses or new foci of psoriasis can be triggered by the above factors only in people who already suffer from psoriasis, but not in healthy people. The cause of psoriasis is genetic changes, which can also be inherited.
Consequences for those affected
People with psoriasis often experience social exclusion and stigmatization due to their clearly visible disease. Their suffering is usually further exacerbated as a result. There are also diseases that occur more frequently in people with psoriasis than in the rest of the population, which is attributed partly to genetic changes and partly to their greater susceptibility to inflammation. These diseases include:
- Cardiovascular disease (for example, coronary heart disease).
- Diabetes mellitus
- Metabolic syndrome
- Inflammatory bowel disease
What are the typical symptoms of psoriasis?
There are different forms of psoriasis, which can also be manifested by different symptoms. The most common form is psoriasis vulgaris. It manifests itself by skin flaking, especially on the extensor sides of the arms and legs. However, the skin changes (efflorescences) can also occur on the scalp, face and external auditory canal, as well as on the hands, feet and genitals. Underneath the desquamations are clearly demarcated red patches caused by inflammation. Unlike eczema, the desquamation is usually more extensive. The reddened spots with the overlying desquamation are also called plaques. Very often, those affected suffer from itching. If the affected person scratches, the mechanical irritation of the skin causes the skin changes to persist or to develop again later in previously unaffected areas of the skin. This is known as the Köbner phenomenon.On the hand and foot, psoriasis can also cause painful tearing of the skin (rhagades). If the nail bed suffers from psoriasis, nail changes such as spotted nails (small indentations of the nail), oil spots (round, yellow-brown spots on the nail) or detachment of the nail may also occur. The joints can also be affected by a condition called psoriatic arthritis.
To the dermatologist – how is the diagnosis of psoriasis made?
The symptoms of psoriasis are very characteristic. Here, the dermatologist or dermatologist pays attention to four particular signs:
- Candle drop phenomenon: the scales can be lifted off the skin as a whole.
- Last skin phenomenon: when all the layers of scales are lifted off, a thin skin can be removed at the last.
- Auspitz phenomenon: When the last cuticle is removed, small “dewdrop” bleeding occurs.
- Köbner phenomenon: In the patient interview, the doctor clarifies whether a mechanical irritation such as scratching, sunburn or tattoo pricking triggers a psoriasis flare.
In most cases, no sampling of tissue (biopsy) is necessary to confirm the diagnosis. If it comes to the examination of a sample, show under the microscope changes in the skin stratification and the interlocking of the epidermis and dermis. The supplying small blood vessels (capillaries) are also changed in psoriasis. They are more tortuous and more permeable to inflammatory cells. If the doctor is sure that it is psoriasis, it must be clarified whether other diseases exist, which often occur in connection with psoriasis. Recognize skin diseases – with these pictures it succeeds!
What to do about psoriasis?
Unfortunately, psoriasis is not curable. However, there are various remedies available for psoriasis to alleviate the symptoms and to produce a skin appearance that is as normal as possible. In principle, good and gentle skin care is important for psoriasis, even if there are no foci of psoriasis at the time. For this purpose, gentle shower gels as well as fat-containing and moisturizing creams (for example, creams with urea) should be used.
Nutrition for psoriasis
From a scientific point of view, diet does not play a major role in psoriasis. Nevertheless, certain foods such as coffee, preservatives and hot spices can aggravate skin inflammation. In addition, many animal products such as sausage, butter and eggs contain a large amount of arachidonic acid. This arachidonic acid stimulates the body to produce pro-inflammatory substances (eicosanoids). Avoiding the above-mentioned foods can therefore help to reduce the inflammation of the skin – and also of the joints in the context of psoriatic arthritis. Omega-3 fatty acids, i.e. unsaturated fatty acids, counteract inflammation. These are found in particular in fish dishes (salmon, herring, mackerel). Overall, a balanced diet and a healthy lifestyle are always recommended. They not only prevent diseases that can accompany psoriasis (diabetes mellitus, coronary heart disease), but also help to maintain or achieve a normal weight. Indeed, obesity also plays a role in psoriasis and can promote it. Alcohol also has negative effects on psoriasis scales and should rather be avoided.
Which creams help with psoriasis?
A common therapeutic approach is to treat sufferers only locally, that is, at the site where the skin is visibly changed. On the one hand, one tries to loosen the scales with the help of creams containing salicylic acid or urea, i.e. urea. An oil bath can also help. There are also shampoos containing salicylic acid and urea for people whose scalp is also affected. Against the inflammation and dandruff creams and lotions with various active ingredients are used, which are prescribed by the attending physician:
- Vitamin D3 analogues are the main drug for long-term therapy at home. They slow down the proliferation of horny cells of the skin and affect the immune system.
- Glucocorticoids can be combined with vitamin D. They have an anti-inflammatory effect, but alone do not lead to complete healing of skin damage.
- Dithranol probably causes the death of the horn cells.It is usually used only in the context of hospital treatment because of its coloring and skin irritating effect.
Light therapy – when creams no longer help
In addition to local therapy, sufferers can do light therapy. There are different forms of light therapy:
- First, UV-B radiation and topical creams can be combined.
- On the other hand, there is the so-called photochemotherapy (PUVA), in which the skin is first made more photosensitive with the active ingredient psoralen and then irradiated with UV-A radiation.
In addition, there are other methods of therapy, such as electrotherapy, in which the affected areas of skin are exposed to light alternating current in tubs filled with water. Balneo-photo therapy combines bath therapy, often performed with brine water, with light therapy.
Systemic treatment with medications
If psoriasis continues to not respond to therapy, there is the option of using systemic treatment. Here, the drugs are no longer applied externally in the form of ointments or creams to the affected skin areas, but are taken in the form of tablets or similar. The following list provides an overview of the most important active ingredients:
- Acitretin works very well, especially in the pustular form. In other forms, it is useful to combine acitretin with, for example, light therapy. In no case should acitretin be taken during pregnancy!
- Methotrexate helps with severe forms of psoriasis and psoriatic arthritis, but can have severe side effects. Therefore, during the intake, controls (for example, the liver and bone marrow values) must be carried out and attention must be paid to the correct dose.
- Ciclosporin A is an immunosuppressant and is also used for severe forms of psoriasis.
- Apremilast has an anti-inflammatory effect.
- Biologics such as etanercept and Adalimum suppress certain substances (interleukins, tumor necrosis factor and the like) that otherwise participate in the inflammatory response caused by the immune system.
Home remedies for psoriasis?
Various home remedies are said to help relieve the symptoms of psoriasis. These include baths with sea salt or taking fish oil or apple cider vinegar. However, the effect of such home remedies has not been scientifically proven.
Psoriatic arthritis – what is it?
The changes in the immune system in the context of psoriasis can also lead to arthritis – inflammation of the joints. Presumably, an immune reaction causes the joint fluid to change. New vessels and connective tissue cells form in the joint space, which causes the inflammation. Here, too, however, the exact mechanism of origin is not yet known. Psoriatic arthritis occurs in about one third of people with psoriasis. Which joints are affected varies greatly. However, it usually only shows up in a few joints and occurs insidiously. The signs of arthritis are:
- Swelling
- Heat
- Pressure pain
- Change in the shape of the joint (if the arthritis is long).
- Symptoms of soft tissue rheumatism (pain around the joint, foot pain, tendonitis, …).
The signs of soft tissue rheumatism distinguish psoriatic arthritis from rheumatoid arthritis (“rheumatism”). Anti-inflammatory drugs are usually sufficient to treat psoriatic arthritis. However, a cure is not possible.
Classification of psoriasis: forms
A distinction is made between type I psoriasis, which begins before the age of 40, and type II psoriasis, which has a later onset. The latter usually runs a somewhat milder course. In addition, different types of progression and manifestation are distinguished. The most common form is psoriasis vulgaris. All other forms are partly considered in the literature as special forms of this variant. The most common skin pattern is plaque-type psoriasis, in which the skin changes described above are seen.
Psoriasis guttata
Instead of psoriasis guttata, the name eruptive-exanthematous psoriasis is also used. This form is caused mainly by infection with streptococci, which often affects children and adolescents. Drop-shaped skin changes are noticeable on the skin, which can also affect the face significantly more frequently than in psoriasis vulgaris.A transition into psoriasis vulgaris is possible, as is healing after a few weeks.
Psoriasis inversa
This is a less scaly form of psoriasis that mainly affects the flexor side of the arms and legs.
Psoriasis capitis (psoriasis capillitii).
In this type, psoriasis affects only or also the scalp. Classically, the pathological skin changes stop sharply at the hairline.
Psoriasis cum pustulatione
In an episode of psoriasis vulgaris, pustules may also appear in the plaques. Usually, such a change is triggered by trigger factors such as infections or hormonal fluctuations. The skin appearance is similar to pustular psoriasis, but the course is much milder.
Pustular psoriasis
In the case of pustular psoriasis, research is currently being conducted to determine whether it is actually a form of psoriasis or whether it is not much more a disease in its own right. A distinction is made in the pustular type between a rare generalized form and a localized form:
- In the generalized form (pustular psoriasis generalisata), white plaques appear on the oral mucosa. In addition, erythroderma, or redness of the entire skin surface, develops, as well as white, confluent pustules all over the body. For those affected, there is a danger to life.
- The localized form (psoriasis pustulosa palmoplantaris) affects the hands and feet of the sufferers. Here, too, pustules are found on reddened skin. It is not life-threatening and often occurs in smokers and smokers.
Rare forms of psoriasis
Other rare forms of psoriasis include:
- Seborrhiasis: in regions with many sebaceous glands, more oily than scaling.
- Psoriasis intertriginosa: mainly affects skin folds and can be confused with skin fungi.
- Erythrodermic psoriasis: redness of the entire skin often occurring without scaling, can be fatal
- Acrodermatitis suppurativa: pustular form of the fingertips and nails.
