Brief overview
- Symptoms: Sharply defined, reddened areas of skin covered with silvery scales, severe itching
- Causes and risk factors: Genetic predisposition, autoimmune reaction in the skin, possible relapse triggers are stress, infections, hormonal changes, skin irritation and damage
- Diagnostics: Physical examination, skin sample if necessary
- Treatment: Medication, for example anti-inflammatory ointments and creams with urea and salicylic acid, immunomodulators, TNF-alpha inhibitors, interleukin inhibitors and relaxation techniques
- Progression and prognosis: Psoriasis cannot be cured. The number, duration and severity of flare-ups can be significantly reduced with the right treatment; complete freedom from symptoms is rare
- Prevention: stress reduction, change of diet, avoidance of alcohol and nicotine
What is psoriasis?
Psoriasis is an inflammatory, non-contagious skin disease. It is almost always chronic with a relapsing course. A typical sign is severe scaling of the skin.
How does psoriasis start?
In appearance, the affected areas of skin are sometimes small and punctiform, but sometimes larger. They are also often very itchy. Occasionally psoriasis also occurs without itching.
Superficial scales are easy to scrape off. The deeper scales, on the other hand, sit more firmly on a young, thin layer of skin. If this layer of scales is removed, small, punctiform skin hemorrhages appear (pinpoint phenomenon).
The plaques tend to appear on the following areas of the body:
- elbows
- knees
- Sacrum area
- Hairy head
- Buttocks and gluteal fold
- Area behind the ears
- Belly button area
In some cases, the feet and soles of the feet, hands, fingers and fingertips are affected. Psoriasis also occurs on the face, for example on the nose, forehead, mouth or eyes and eyelids.
In some sufferers, psoriasis also appears in the genital area: in women on the mons pubis and vagina, in men psoriasis occurs on the genitals such as the penis, glans or scrotum.
In severe cases, the inflamed skin changes are not limited to certain regions, but extend over large areas of the body skin.
Special forms of psoriasis
In addition to psoriasis vulgaris, there are many other forms of psoriasis that cause different symptoms. The most important ones are explained below:
Psoriasis guttata
Once the infection has been overcome, it usually regresses – or turns into chronic psoriasis vulgaris. In this case, the patches are usually not as numerous, but larger. They mainly appear on the trunk, arms and legs.
Eruptive-exanthematic psoriasis
Eruptive-exanthematic psoriasis is a form of guttate psoriasis. It also occurs mainly after infections, but also occurs as the first form of a new disease (initial manifestation) with psoriasis.
Within a few weeks, small, often very itchy foci appear on areas of the body where “normal psoriasis” (psoriasis vulgaris) does not occur. Eruptive-exanthematic psoriasis heals on its own or becomes chronic.
Psoriasis exudativa
Psoriasis exudativa is a highly inflammatory form of psoriasis. It usually begins with symptoms of eruptive-exanthematic psoriasis. The affected areas then become very red and subsequently develop an inflamed “seam”. Wound secretions come to the surface, covering the psoriasis lesions in the form of yellowish crusts.
Pustular psoriasis
Psoriatic erythroderma
Psoriatic erythroderma is a rare form of psoriasis in which the entire skin becomes red and thickened. This makes it more rigid and occasionally tears over the joints, forming so-called fissures. The scaling is less pronounced in this form. Due to the extensive skin inflammation, patients usually develop general symptoms such as fever, fatigue and a feeling of illness.
Psoriatic erythroderma usually occurs after strong UV radiation, aggressive local therapy or a viral or bacterial disease.
Psoriasis inversa
Psoriasis inversa mainly occurs in areas of the body where skin surfaces rub against each other, for example under the armpits or breasts, in the abdominal and anal folds on the buttocks and at the back of the knees. In the case of psoriasis inversa, the scaly coating is missing as it is detached by the friction of the skin.
Psoriasis of the scalp
In the majority of patients, psoriasis also affects the scalp. The plaques often extend beyond the hairline and are clearly visible on the forehead or neck. This is particularly distressing for those affected, as the skin changes here are difficult to conceal.
You can read more about this form of psoriasis in the article Psoriasis – scalp.
Psoriatic arthritis
You can find more detailed information on this form of psoriasis in the article Psoriatic arthritis.
Nail psoriasis
Psoriasis often also affects the fingernails and toenails. In most cases, not just one nail is affected, but several. Various characteristic stain patterns on the nails are typical. The nails also often lose their strength – they become porous or even crumbly.
You can find more information on this particular aspect of psoriasis in the text Nail psoriasis.
Psoriasis in babies and children
The signs of psoriasis in children sometimes differ from those of adults. For example, small children often only show small patches on the face and on the flexor sides of the joints. In babies with psoriasis, there is a rash in the diaper area and in the groin region.
A possible indication of psoriasis is that the typical care products and treatments for diaper dermatitis do not improve the clinical picture.
What is the cause of psoriasis?
The exact cause of psoriasis (psoriasis vulgaris) is still unclear. However, doctors are now aware of various factors that play a role in the development of the disease.
Genetic predisposition
Misdirected immune system
The main player in the outbreak of the disease is the immune system. The immune cells react to a psoriasis flare-up as they would to a skin injury: they trigger inflammatory reactions in the skin and accelerate skin renewal processes. This is why an excessive number of new skin cells are constantly being formed. Normally, the epidermis renews itself within four weeks. In patients with psoriasis, it takes three to four days.
Psoriasis triggers
There are a whole range of factors that trigger psoriasis or provoke a new flare-up:
Infections
During an infection, the immune system not only turns against the pathogens, but also against the healthy skin. In principle, it is possible for any infection to trigger a psoriasis flare-up – for example an infection with streptococci (bacteria that cause pneumonia and urinary tract infections, among other things), measles, a flu-like infection, an HIV infection or chronic inflammation.
Stress
In some psoriasis patients, the disease breaks out in times of major emotional stress, for example after the death of relatives, school stress or job loss.
Hormonal changes
Skin injuries
Cuts and abrasions, burns and even sunburn sometimes provoke a flare-up.
Mechanical irritation
Scratching, pressure, for example from a tight belt or chafing clothing, are other possible triggers.
Medication
Some medications are also known to trigger psoriasis flare-ups in some cases. These include, among others:
- Antihypertensives (ACE inhibitors, beta blockers)
- Cholesterol-lowering drugs (statins)
- Painkillers (ASS, ibuprofen, diclofenac)
- interferon
- Malaria and rheumatism medication
- Some antibiotics (e.g. tetracyclines)
How is psoriasis diagnosed?
The doctor recognizes psoriasis by the typical skin changes that usually occur on characteristic areas of the body such as the elbows, knees, gluteal folds and hairy head.
A simple skin test provides a clear indication: it is typical for psoriasis that punctiform skin bleeding occurs when the last layer of scales is removed from an affected area.
The nails also often change with psoriasis: they are blotchy, yellowish and brittle. Such changes to the nails strengthen the suspicion of psoriasis.
If the diagnosis is unclear, the doctor will take a skin sample (biopsy) to rule out other diseases with similar symptoms. These include
- Fungal diseases
- skin lichen
- syphilis
- neurodermatitis
How is psoriasis treated?
There is currently no cure for psoriasis. However, the severity and number of flare-ups can be significantly reduced with treatment approaches such as medication or relaxation techniques.
Would you like to find out more about the treatment options for psoriasis? Then read the article Psoriasis – treatment!
How does psoriasis progress?
Psoriasis occurs at any age. However, it often breaks out for the first time in young adulthood.
The disease is currently incurable. It progresses in phases, i.e. relatively symptom-free periods alternate with phases of severe psoriasis symptoms. In some patients, the symptoms disappear completely for a longer period of time or do not return at all.
The course of psoriasis varies greatly from person to person:
- Severity and type of skin symptoms
- Localization (location) of the skin symptoms
- Duration of the flare-ups
- Frequency and severity of flare-ups
- Duration of (relatively) symptom-free periods
How can psoriasis be prevented?
There are many factors that trigger psoriasis. Not all of them can be influenced. However, by adopting an appropriate lifestyle, psoriasis patients can help to reduce the frequency and severity of flare-ups.
You can read about the role nutrition plays in psoriasis in the article on psoriasis – nutrition.