Psoriasis is a chronic inflammatory skin disease which can also affect the joints (psoriasis arthritis). Psoriasis is an autoimmune disease. The body’s own immune system attacks its own cells for reasons still unknown. Silver-white, scaly and itchy nodes on the skin are the characteristic clinical picture of psoriasis. The disease typically proceeds in episodes.
Psoriasis at a glance
Psoriasis is a chronic, non-contagious skin condition. It is caused by a malfunction of the immune system. This autoimmune disease results in an acceleration of the life cycle of skin cells and, consequently, an accumulation of cells on the skin surface. Usually, skin regenerates about once a month, but in those with psoriasis, this process takes place within a few days, leading to the typical silvery white flakes and red, often itchy or painful patches.
Forms of psoriasis
Plaque psoriasis
The most common form of psoriasis is characterised by dry, raised, red skin patches (plaques) covered in silver flakes. These plaques may be itchy or painful and are commonly found on the elbows, knees, scalp and lower back.
Guttate psoriasis
This form of psoriasis is often a response to bacterial infections and is characterised by small, drop-shaped lesions on the trunk, arms, legs and scalp. Guttate psoriasis often occurs suddenly and is particularly common in children and young adults.
Pustular psoriasis
A rarer form of psoriasis characterised by white, non-infectious pustules (consisting of white blood cells) surrounded by reddened skin. Pustular psoriasis may occur in specific places such as the hands and feet or all over the body.
Nail psoriasis
This form affects the nails on the hands and feet and causes changes such as thickening, colour changes (yellow-brown spots), pitting on the nail surface and detachment of the nail from the nail bed (onycholysis). Nail psoriasis can be cosmetically disturbing and painful, affecting the ability to use the hands and feet.
Causes of psoriasis
The causes of psoriasis are complex and include genetic, immunological and environmental factors. The exact cause of psoriasis is not fully understood. However, it is known to be linked to an overactive immune system that produces more skin cells.
Genetics play an important role in the development of psoriasis. People with a family history of the disease have an increased risk of developing it themselves. Certain genes that affect the immune system are associated with psoriasis, making the disease an autoimmune disease. However, the disease does not occur in all those with a genetic predisposition, which suggests that environmental factors and triggers also play a role.
Risk factors
Various risk factors and triggers may favour the onset of psoriasis or exacerbate existing symptoms:
Stress
Emotional stress is a known trigger of psoriasis flare-ups and can make existing symptoms worse.
Certain medicines
Some medicines, including lithium, beta-blockers, antimalarials and certain anti-inflammatory medicines, can trigger or worsen psoriasis.
Infections
Certain infections, in particular streptococcal infections, may cause psoriasis, in particular guttate psoriasis.
Lifestyle factors
Smoking, excessive alcohol consumption and being overweight are associated with an increased risk of developing or worsening psoriasis.
Frequency and age
Psoriasis can occur at any age, but typically occurs at two peaks: between 15 and 25 years and between 50 and 60 years. Men and women are equally affected. The prevalence of psoriasis varies globally, but it is estimated that it affects about 2–3% of the global population. The incidence and severity of psoriasis may vary according to genetic predisposition, geographical location and lifestyle factors.
Understanding these factors is critical for the development of effective treatment strategies and for advising people at increased risk of developing psoriasis.
Symptoms
Symptoms of psoriasis may vary depending on the type and severity of the disease, but there are some general signs and symptoms that indicate this skin condition. Psoriasis is characterised by relapses and remissions, i.e. symptoms may be severe for a time, but then subside or disappear altogether.
The following symptoms may occur:
- Red, raised, inflamed skin areas: These are often covered with silvery-white flakes and can occur on different parts of the body, e.g. elbows, knees, scalp and back.
- Dry skin that can tear and bleed: Particularly in cold and dry climates, the skin can become extremely dry.
- Itching, burning or pain: These symptoms may occur mainly during active flare-ups of the disease.
- Thickened, spotted or discoloured nails: Nail psoriasis can cause changes to the colour and texture of the nails, including indentation or detachment of the nail from the nail bed.
- Swollen and stiff joints: Some people develop psoriatic arthritis, which causes pain, stiffness and swelling in the joints.
Disease progression
The course of psoriasis varies greatly from one person to the next. It can range from mild, barely noticeable symptoms to severe relapses that affect a person’s entire life. Some people only experience small-scale skin rashes occasionally, while others have large-scale, persistent skin problems. The course of the disease is often unpredictable, with periods of improvement followed by periods of deterioration.
While psoriasis is a chronic disease with no cure, its symptoms can often be well managed with treatment and lifestyle changes. Treatment is aimed at relieving symptoms, promoting skin healing and preventing new flare-ups.
Diagnosis
The diagnosis is based primarily on a physical examination of the skin, nails and occasionally the joints by the dermatologist. Typical skin changes often allow for a direct diagnosis. In unclear cases, confirmation may be required through a skin biopsy, involving a small skin sample being taken and examined under a microscope for the characteristic features of psoriasis.
Early detection and treatment is essential to alleviate symptoms, influence the course of the disease and improve the quality of life of those affected. It is also important for preventing complications such as psoriatic arthritis or mitigating their effects. If psoriatic arthritis is suspected, additional examinations such as X-rays, MRIs or ultrasounds are often required to make an accurate diagnosis and initiate appropriate treatment.
Treatment
Home remedies for psoriasis
There are several measures that those affected can take themselves to alleviate the symptoms of psoriasis and minimise relapses:
- Skin care: Applying moisturisers regularly can help to keep the skin supple and reduce flaking and cracks.
- Gentle skin cleansing: Use mild soaps and shower gels that do not dry out the skin.
- Avoid triggers: Identify and avoid personal triggers such as certain foods, stress or skin injuries.
Medical and medicinal treatment
The medicinal treatment of psoriasis varies according to the severity and nature of the disease:
- Topical treatments: Creams and ointments applied directly to the skin to reduce inflammation and slow down cell production.
- Light therapy: Use of natural or artificial UV light to slow down the excess production of skin cells.
- Systemic medicines: Oral or injected medicines that affect the immune system and are used to treat moderate to severe psoriasis.
- Biologicals: Targeted therapies that block certain parts of the immune system to reduce inflammation and are often effective in severe psoriasis or psoriatic arthritis.
Prevention of psoriasis
Although psoriasis cannot be completely prevented, some measures can be taken to help minimise relapses and keep symptoms under control:
- Skin care: Applying moisturisers regularly keeps the skin supple.
- A healthy diet: A balanced diet packed with anti-inflammatory foods can help alleviate symptoms.
- Stress management: Techniques such as meditation, yoga or regular exercise can help reduce stress, which is known to trigger psoriasis attacks.
- Avoidance of risk factors: Reducing alcohol consumption, not smoking and maintaining a healthy weight can reduce the risk of psoriasis flare-ups.
A proactive approach to managing psoriasis, including lifestyle adjustments and medical treatment, can help to manage the disease effectively and improve quality of life.
