Psoriasis – Symptoms

Psoriasis is a common, autoimmune, chronic, recurrent condition characterized by clearly defined red patches, covered with silvery-white scales. Lesions can occur on any part of the skin, ranging from very small to generalized shapes. Psoriasis has phases of remission, when the lesions disappear and phases of exacerbation. Although many treatment modalities are available today, people suffering from psoriasis most often have a social problem due to the appearance of their skin.

What are the causes of psoriasis?

Psoriasis is a disease with a clear genetic predisposition, but the type of inheritance has not yet been fully established. The most common provoking factors that can trigger the hereditary mechanism are: psychological stress, viral and bacterial infections, surgical interventions, some drugs such as beta-blockers and antimalarial drugs. Mechanical injuries, alcohol, smoking are also considered to be the triggers of this disease. Psoriasis is an autoimmune inflammatory process where basal skin cells grow ten times more rapidly, and accumulate excessively in the surface layers. Clearly defined red areas are formed, and T lymphocytes accumulate in the deeper layers of the skin, encouraging further inflammation.
Skin - Atopic dermatitis
eczema atopic dermatitis symptom skin texture

At what age psoriasis most often occur?

Psoriasis can occur at any age, it is more common around the age of 30 and after the age of 50. Hereditary and environmental factors are involved in the development of psoriasis, but a specific genetic deficiency has not been proven yet. The probability that a child of one parent with psoriasis will develop the condition is 20%, if both parents are affected, it is 50%. One third of patients may have joint problems – arthritis.

How does psoriasis manifest itself?

Classic Plaque Psoriasis (Psoriasis vulgaris) is the most common type, occurring in about 80% of patients. Patches of skin are clearly defined, dark red, and have silvery-white flakes, called scales. They usually show up on knees, elbows, scalp, and lower back. The lesions may have different appearance, they can be round like coins, ring-shaped, or like a geographical map. The severity of the clinical picture depends on the affected skin surface: mild form – less than 3% of the skin, moderately severe form – 3-10% and severe psoriasis – more than 10%. In addition to classic plaque psoriasis, other types can be observed: * Guttate psoriasis (Psoriasis guttata) is characterized by small lesions resembling red dots on the trunk and limbs. They usually appear suddenly in younger people after a strep throat, flu or measles. This type responds well to therapy. * Erythrodermic or exfoliative psoriasis (Psoriasis erythrodermica) is the most severe form of this condition that affects the skin of the entire body, face and nails. The skin is red, swollen, and scales are present, along with fever and poor general condition requiring urgent hospitalization of the patient. * Pustular psoriasis (Psoriasis pustulosa) causes red, swollen patches of skin with pus-filled bumps (called pustules), most often on the hands and feet. There is also a generalized form of pustular psoriasis that is very severe and affects the entire skin. * Inverse psoriasis (Psoriasis inversa) affects the skin folds: groin, armpits, folds of the abdomen, under the breasts. The lesions are bright red with a shiny smooth surface, without scales. * Nail psoriasis occurs in 30-50% of patients with psoriasis, in the form of tiny dents on the nails, oil spots, thickening of the nails or complete loss of nail plates. * Psoriatic arthritis can occur years before skin lesions appear or at the same time. The small joints of the hands or the hip joints are most often affected.

How is psoriasis treated?

Depending on the type of psoriasis and the percentage of the affected area, topical and systemic therapy can be prescribed. The use of emollient and moisturizing preparations for psoriasis reduces surface scales and prevents skin from cracking, so it can be used in all types of therapy. Topical therapy consists of:corticosteroid creams and ointments that lead to rapid withdrawal of inflammation, but their use is limited due to side effects. For use on the scalp, corticosteroids can be in the form of gels and lotions. – topical retinoids – Tazarotene gel is used for classic plaque psoriasis, the achieved effects are maintained for 12 weeks after end of the treatment. – calcipotriol – a vitamin D analog, reduces redness and scales, it should not be applied in lager quantity than 100 g per week due to the risk of hypercalcemia. -immunomodulators– calcineurin inhibitors are particularly suitable for the treatment of lesions on the face and skin folds. – salicylic acid is used in preparations of 1-5% for the body and up to 10% for the scalp and leads to rapid elimination of scales and thickened skin in psoriasis. Systemic therapy is prescribed in severe generalized forms of psoriasis: – Retinoids reduce the accelerated production of skin cells in psoriasis. They are reserved for pustular and erythrodermic psoriasis. Having a teratogenic effect, women are not allowed to become pregnant for 2 years after the end of use of these drugs. – Biological therapy acts on autoimmune process in the psoriasis development. It is performed according to the strict protocols, once a month as a subcutaneous injection, it is reserved for severe forms of psoriasis. – Cyclosporine is an immunosuppressant that reduces the reaction of the immune system, and the appearance of psoriatic lesions. It can be nephrotoxic and it increases blood pressure. It can be nephrotoxic and it increases blood pressure. – Methotrexate is a cytotoxic drug used in psoriatic arthritis. – Phototherapy – PUVA consists of skin exposure to special UVA radiation, with the prior use of photoactive substances that enhance its effect.
Svetlana Đurišić specijalista dermatovenerologije

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