About Psoriasis

Hand scratching itchy skin with red bumpy spots

In life nowadays, people struggle with a lot of stress, and if that was not enough, things like pollution, diet, weather, and other factors could damage your skin with severity. You can decide to ignore certain signs for a while, but the symptoms can worsen and worse as time goes by. If your skin is getting drier, with lesions that tend to scale, last for some time; with red itchy spots that get worse day by day, you can have psoriasis. Psoriasis? What is psoriasis? You may be wondering – but instead of settling with a vague answer, this article has a research for you. The more you learn about it, the more you can prevent it from ruining your life.

Psoriasis is known to be a chronic, non-contagious inflammatory skin disease that tends to follow a course of remissions and exacerbations. It presents symptoms that disappear and reappear periodically. Psoriasis cause is still unknown, but it is known that it can be related to the unique immune system interactions with the environment and its genetic susceptibility.


woman-touching-skin
Woman touching skin

How psoriasis develops?

It is believed that psoriasis develops when the T lymphocytes (cells responsible for the body’s defense) release inflammatory and vessel-forming substances. 

Immunological responses are then initiated which include dilation of the blood vessels of the skin and infiltration of the skin with defense cells called neutrophils, as the skin cells are being attacked, their production increases, leading to an abnormal speed of their evolutionary cycle, with consequent mass production of scales due to the immaturity of the cells.   

This cycle doesn’t allow dead cells to be eliminated efficiently and starts forming thick and scaly psoriasis spots on the skin. 

The most common Psoriasis lesion is distinct by ‘plaques,’ characterized by grey or pink color and with a silver overlay – like scaly skin. 

They will also cause localized hyper-pigmentation.

Psoriasis symptoms can develop at any period of life; still, they are more prone to develop at the beginning of adulthood or later in life, in the 50s or 60s.

This disease is very common and is not contagious, direct contact with patients doesn’t need to have special protection.  

It is often associated with psoriatic arthritis, cardiometabolic diseases, gastrointestinal diseases, various types of cancers, and mood disorders. 

The pathogenesis of comorbidities in patients with psoriasis remains unknown.

However, there are hypotheses that common inflammatory pathways, cellular mediators, and genetic susceptibility are involved.



Psoriasis signs and symptoms.

Psoriasis signs and symptoms may vary from patient to patient, depending on the type of disease.

Manifestations can be mild, moderate, or severe, depending on the extent of the affected skin area.

The mild psoriasis forms correspond to a commitment of less than 3%, the moderate ones between 3% and 10%, and the severe ones are those in which more than 10% of the skin is affected.

Fortunately, the mild form is the most common (80% of cases).

sunblock-heart-in-skin

However, even this can have a very negative impact on the quality of life, especially when it appears on the palms of the hands or the soles of the feet.

The symptoms of this disease depend on its type and location. As a rule, a patient presents only one type of psoriasis at a time.

The plaque psoriasis type is the most frequent one, accounting for about 80% of the total affected population, causes itching and when scratched, plaques become thicker.

The nails may also become fragile and brittle.

There are other psoriasis types such as:

  • guttate (small individualized red spots);
  • the inverse (occurs mainly in the skin folds);
  • pustular (formation of pus blisters surrounded by reddened skin);
  • erythrodermic (more intense inflammation of the skin, resembling a burn;

    it reaches large areas of skin and is accompanied by intense itching, pain and acceleration of heart rhythm), requiring urgent medical observation.

Psoriasis Symptoms may include:

  • Red spots with dry whitish or silvery scales;
  • Small white or dark residual stains after injuries;
  • Dry and cracked skin; sometimes with bleeding;
  • Itching, burning, and pain;
  • Thick, grooved, detached nails with punctiform depressions;
  • Swelling and stiffness in joints.

Ignoring these symptoms for a long time may result in serious lesions that can lead to severe consequences. 

Lesions in psoriasis are clear to identify from traditional dry skin symptoms. They are also identified as Xerosis; specialists classify them as Erythmato-Squamous, i.e., both deeper layers of skin and blood vessels in the epidermis are affected.

Anomalies in the cellular regeneration level cause the plaques as we know.

Skin sample with plaque psoriasis.

The repercussions of these anomalies are:

  • inflammation in the deeper area of the dermis and upper area of the epidermis,
  • a high rate of keratinocyte turnover (in the epidermis, this is the predominant cell type),
  • a decreased skin cell maturity period and an abnormal peeling process (peeling is the process where the external covering of the skin is eliminated).

Moderated psoriasis cases may only cause a slight discomfort. Still, it can be unpleasant in more critical cases and can cause changes that significantly impact the patient’s quality of life and self-esteem.

Therefore, the ideal is to seek treatment as soon as possible.


Psoriasis Factors

In addition, some factors can increase the chances of acquiring the disease or worsen the existing clinical profile, among them are:

Family history – between 30% and 40% of psoriasis patients have a family history of the disease.

Stress – people with high levels of stress have a weakened immune system.

Obesity – overweight can increase the risk of developing a type of psoriasis, like the inverted type, it is most common in black and HIV-positive individuals.

Cold weather – as the skin becomes drier; psoriasis tends to improve with sun exposure.

Alcool – Frequent consumption of alcoholic beverages leads to consequent aggravation.

Smoking: Smoking not only increases the chances of developing the disease but also the severity of psoriasis when it manifests itself.


Psoriasis Types (detailed)

Five psoriasis types are recognized officially.

Psoriasis in plaques or Vulgaris: This most common manifestation of psoriasis forms dry, reddish plaques with silvery or whitish scales.

These plaques scratch and sometimes hurt and can reach all parts of the body, including the genitals.

Red, raised and inflamed lesions are typical of plaque psoriasis. Hand with psoriasis lesion.

In worse cases, the skin in the joints cracks and bleeds.

Guttate parapsoriasis: usually is triggered by bacterial infections, such as throat infections. It is characterized by small, drop-shaped wounds on the legs, arms, trunk, and scalp.

Some wounds are covered with fine scale, different from typical thick plaques of psoriasis.

This type affects more children and young people before the age of 30.

Inverted psoriasis: affects mainly moist areas like the buttocks, bellow the breasts, groin, and armpits.

They become inflamed and red spots.

The condition can worsen in obese people or when there is excessive sweating and friction in the region.

Psoriasis appears in different forms with different characteristics. Elbow with psoriasis signs.

Pustular psoriasis: in this psoriasis’ form, spots, blisters, or pustules (a small blister that appears to contain pus) can occur on all parts of the body or in smaller spots such as feet, hands, or fingers (called palmoplantar psoriasis).

It usually develops rapidly, with pus blisters appearing a few hours after the skin turns red. Blisters lesions end up drying but can reappear after a while.

Pustular psoriasis, in general form, can cause chills, fever, intense itching, and tiredness.

Erythrodermic psoriasis: Is known to be the uncommon psoriasis type.

It affects the whole body with red patches that can scratch or burn strongly, leading to systemic manifestations.

It is triggered with critical burns, untimely treatments (such as use or abrupt withdrawal of corticosteroids), infections, or by a different kind of uncontrolled psoriasis.


In some very specific cases, some variants can occur which can be identified by the following characteristics.

Arthropathic psoriasis: in attachment to skin inflammation and scaling, psoriatic arthritis, also causes severe joint pain.

It most commonly affects the joints of the toes and hands, spine, hip joints and can cause progressive stiffness and even permanent deformities.

It is often associated with any clinical psoriasis’ type.

Ungual parapsoriasis: affects the fingernails and toenails.

It causes the nail to develop abnormally, scale, thicken, get a different color and even distort.

Some situations cause the nail to go off from its ungueal bed.

Scalp psoriasis: reddish areas with thick silver-white scales appear, mainly after scratching.

The patient may notice the flakes of dead skin on their hair or shoulders, especially after scratching the scalp. It resembles dandruff.


Psoriasis Causes

Although its origin is still poorly understood, there seems to be a set of conditions that trigger its reaction in the human body.

Genetics

Some studies reveal that most of the disease’ cases are inherited through genetic descendence. Some genes may be connected to Psoriasis conditions, but the exact process is still not fully understood.

It is thought that certain inherited genes may be linked to psoriasis, but the specific process in which occurs is still unknown.

Psoriasis can be transmitted from parent to child.

Infections

Psoriasis symptoms are develop through the formation of infections.

Streptococci, which is a well-known bacteria, is in most of the time, the responsible pathogen connected to guttate psoriasis.

The HIV (Human immunodeficiency virus) infection isn’t directly connected to Psoriasis but also increases the chances to develop severe Psoriasis if there is already a genetic predisposition.

Stress

Nowadays, stress has become a crucial factor in triggering Psoriasis; people often react differently to random stimuli, which may be enough to start a psoriasis crisis.

Avoid stress, as it can trigger psoriasis symptoms.

Medication

Drugs like beta-blockers, antimalarials, and lithium have a heavy role in triggering Psoriasis.

Stopping a treatment with strong oral corticosteroids or topical applications can cause ‘repercussive’ symptoms. It often results in erythroderma, or worse, it can generalize itself in pustular psoriasis.

In general, psoriasis depends on the existence of a genetic predisposition associated with an external stimulus.


Psoriasis Diagnosis Importance

There are several diseases with signs similar to those of psoriasis and therefore the diagnosis should always be established in clinical observation by a dermatologist.

In some cases, confirmation with skin biopsy may be necessary.

The doctor should also try to know the patient’s family history and better understand their daily activities, in order to identify the triggering factors.

Psoriasis Diagnosis

For an accurate diagnosis sometimes is necessary to deepen the detail and quality of psoriasis exams. Those can include:

Physical assessment

Physical exploration. The diagnosis of psoriasis is made mainly by physical examination of the patient.

The skin is explored without clothing, since the lesions may appear in places not very visible as genitals, axillary folds, groin or intergluteal fold, soles of feet or scalp.

In doubtful cases, it may be necessary to perform a skin biopsy.

Female doctor exploring a man’s knee

Complete joint exploration.

If the patient presents joint pain, him/her must be assessed by a rheumatologist to carry out a complete joint exploration.

Tests to diagnose Psoriasis

Physical exploration. – The diagnosis of psoriasis is based on the detection of lesions on skin and nails so a physical examination of the patient should be done.

The shape of the lesions and their location determine the type and severity of psoriasis.

There are several scales of assessment of psoriasis’ strictness; they are useful to evaluate the evolution and response to the treatment.

Skin biopsy. – Some cases of psoriasis may raise questions to professionals and present features similar to other skin diseases, so they may require a skin biopsy.

Skin biopsy examined under a microscope

Analytical. – Although there is no blood test to make the diagnosis of psoriasis, you can do a blood test if you consider opting for a systemic treatment, that way it is possible to check that there are no contraindications.

It can be done alongside treatment to ensure that there are no adverse effects to the recommended medication.

Blood extraction tube

Psoriasis Treatments

Each type and severity of psoriasis may respond better to a different type of treatment (or a mixture of therapies).

What works well for one person will not necessarily work for another, so psoriasis treatment is individualized.

Today, with the various therapeutic options available, it is already possible to have a decent life regardless of psoriasis’ austerity.

But a watchful medical monitoring is essential to maintain a satisfactory life.

In mild cases, moisturizing the skin, applying topical medication only in the area of the lesions and daily exposure to the sun at appropriate and safe times can be sufficient to improve the clinical picture and promote the disappearance of symptoms.

Girl with summer hat

In moderate psoriasis cases, when only the above measures do not improve the symptoms, treatment with exposure to ultraviolet light A (PUVA) or ultraviolet B (narrowband) in cabins is necessary.

This therapeutic modality uses a blend of drugs that increase the sensitivity of the skin to light, the psoralenes (P), with ultraviolet light A (UVA), usually in a light-emitting chamber. 

The Puvatherapy session takes a few minutes and the dose of UVA is gradually increased, depending on the type of skin and the individual response of each patient to therapy.

The psoriasis treatment can be done with narrow-band UVB, with fewer adverse effects, and may even be indicated for pregnant women.

In serious cases, it is necessary to start treatments with oral or injectable medication.

Most common treatment types:

There are many therapeutic options.

Treatments should be distinct since the skin presents various characteristics throughout the different body parts.

Topical treatment: medicines in creams and ointments, applied directly to the skin.

They can be used in conjunction with other therapies or alone, in cases of mild psoriasis.  

Systemic treatments: medication in pills or injections, generally indicated for patients with moderate to severe psoriasis and/or psoriatic arthritis.

Biological treatments: injectable drugs, indicated for the treatment of patients with moderate to severe psoriasis.

There are several classes of biological treatments for psoriasis already approved: the so-called anti-TNFs (such as adalimumab, etanercept, and infliximab), anti-interleukin 12 and 23 (ustekinumab), or anti-interleukin 17 (secukinumab).

Phototherapy: consists of exposing the skin to ultraviolet light consistently and with medical supervision.

The treatment needs to be done by specialized professionals.

Psoriasis condition is serious and can have a significant impact on the patient’s life, thus that, psychological follow-up is indicated in some cases.

Other factors that drive improvement and even the disappearance of symptoms are a balanced diet and the practice of physical activity. 

The patient should never interrupt the prescribed treatment without the doctor’s authorization.

This attitude can make psoriasis worse and aggravate even more the psoriasis situation.

Topical therapy treatments

Emollients like corticosteroids, moisturizers, and keratolytic agents are the main constituents of the topical therapies used in patients with psoriasis

These can be very beneficial while in the middle stages of Psoriasis or in case of remission. 

The benevolent keratolytic agents have an important role in the initial phase of psoriasis formation; emollients and moisturizing creams are used in conjunction with it for better appliance and results.

Topical corticosteroids per se are stronger and, consequently, more effective. Still, one should not use them for too long; it is wise to save them for exacerbations (psoriasis flares).

Stratum corneum can become more flexible with fewer scales when emollients are used on its behalf. In dermatology, they constitute a good part of products in treatments for psoriasis.

They act by reducing the quantity of evaporated loss water of the skin, allowing the surface of the skin (stratum corneum) stay properly hydrated.

The psoriasis skin must remain hydrated. The use of additional moisturizers is recommended.

The moisturizers are emollients refined with natural hydration factors (FHN).

FHN also increases the hydration of the stratum corneum, as well as FHN, bind the attracted water. 

Advanced moisturizers contain active substances like Gluco-Glycerol, enhancing the lower hydration areas in the epidermal skin layer, activating the skin’s own hydration network, which provides hydration to the skin layers.

The most advanced moisturizers contain actives that increase hydration.

It is important to use regularly moisturizers and emollients. Both should be maintained during a crisis or psoriasis remission.

Lighter lotions are composed by more occlusive and thicker ointments and creams; they are preferable this way because it has been proved to be more effective.

Keratolytic agents proved more efficient when it comes to reducing Psoriasis’ plate scales because they break the keratolytic material.

Corticosteroids application in elbow

One of the most known effective keratolytic compounds is Salicylic acid when used in scaly Psoriasis plaques it has confirmed very beneficial results.

Another common keratolytic agent is Urea; it is present in the constitution of many moisturizers. It is very effective in binding water to the skin layer.

Topical therapies with keratolytic agents moisturizers and have an essential part in Psoriasis’ treatments.

They are very efficient in supporting any drug in a systemic therapy.

Many properties such as anti-inflammatory are only possible thanks to topical corticosteroids, with their action psoriasis plaque irritation and formation is greatly reduced. 

Correct amount of skin product in leg

Topical corticosteroids’ moderate strength is frequently used for face psoriasis, genital organs, or areas requiring stretching or bending by combining its efficiency with emollients and moisturizers.

Typical chronic psoriasis is also treated very often with the use of Vitamin D analogs, it is usually the first topical choice for treatment.


How to prevent Psoriasis?

There is no way to prevent this disease, but it is possible to reduce the number of outbreaks, keeping the skin dry and cared for, avoiding stress, anxiety, and the drugs that can trigger it. 

It is also useful to reduce the consumption of alcohol and tobacco since it can increase the severity of psoriasis outbreaks.

woman-eyes-closed

A healthy lifestyle can help to decrease the progression or improvement of psoriasis, but people who have a family history of the disease should pay extra attention to possible symptoms. 

It is important to be aware of the signs. If you notice any of the psoriasis symptoms, see your dermatologist immediately. The earlier the diagnosis, the easier is the psoriasis treatment. 

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