Psoriasis

Cause

Normally, the skin is gradually renewed. Old skin cells are released at the outside and new skin cells grow at the underside of the epidermis. In case of psoriasis, the skin growth is accelerated and the surplus of cell layers is not disposed. This causes skin slices with a thick layer of immature skin cells that are difficult to flake off. The cause of this disturbed skin production is genetic in nature.
Symptoms can begin or worsen due to skin damage (cutting wound, abrasion), burning of the skin, stress or infections. Psoriasis can possibly slightly worsen when using certain medicines, for example lithium, beta blockers, malaria pills and certain painkillers, such as ibuprofen and diclofenac. The condition is more common in people who regularly smoke or drink alcohol. Psoriasis is not contagious.

Symptoms

The signs and symptoms of psoriasis are as follows:

• Suffering from some small spots or extensive redness with flaking. The flakes are whitish or silver-gray and easily let go.
• The spots itch, especially when they have just emerged. Sometimes there are nail defects: small dents in the nails. Joint problems sometimes occur too, especially at fingers and toes.
• Psoriasis is common at the elbow and knee, on the head and the lower back. The spots are sometimes in the body folds, for example in the groin, armpits, anal cleft or under the breasts. Psoriasis is rarely found in the face.
• The spots can range in size from one to several centimeters and can also merge.
• The spots can remain for a few weeks. Sometimes they stay for life. If they disappear, the skin can temporarily remain slightly lighter or just darker.
• Sometimes, psoriasis is only made up of several round spots of up to one centimeter, especially on the torso, upper arms and upper legs. This is called guttate psoriasis and occurs mainly in children and adolescents.

Psoriasis is a disease that can have a strong effect on self-image and self-confidence of those concerned. These psychological effects influence the quality of life as patients experience.

Diagnosis

The diagnosis of psoriasis can usually be made on the characteristic defects. In some cases, a piece of skin (biopsy) will be removed under local anesthesia for microscopic examination.

Treatment

The treatment of psoriasis is often very difficult. The following types of therapy can be effective:

• Local therapy. A doctor will always prefer to treat psoriasis locally as this has the fewest side effects. Local therapy is, as the term implies, applied only to the areas of the skin disorder. This is in the form of a cream or ointment. Commonly used agents for local treatment of psoriasis are vitamin D3 derivatives, corticosteroids and salicylic acid.
• Light therapy. Here, psoriasis is treated with ultraviolet light (UV-B or PUVA). This is sometimes done in combination with medication.
• Systemic therapy. This therapy can have an effect on the entire body, on the whole system. In this type of therapy, drugs are orally taken or injected into the skin. Examples of these agents are biologicals.

Prognosis

Psoriasis is incurable, but treatable. The treatment of psoriasis is customised, not every therapy helps as well in everyone. Following lifestyle advice and the correct application of the above-mentioned therapies can reduce symptoms significantly, but they are no guarantee.

Considerations

• Avoid burning of the skin.
• Prevent skin damage (bruising, scraping or scratching).
• Keep nails short.
• Don’t bath or shower too hot or for too long. This dries out the skin.
• Use little or no soap.
• Those who smoke or regularly drink alcohol, can stop for a while and see if there are fewer symptoms.
• Write down the situations where the symptoms reduce or get worse. Then the patient may recognize what factors have influence.
• Sunlight can reduce the symptoms. Don’t directly lie down in the sun for a long time, but build it up gradually. The skin shouldn’t burn. Whether sunlight in combination with sea water works better than sunlight only, is not clear.
• Many people with severe psoriasis feel ashamed. For example, they prefer not to swim, sport or have a haircut because the spots are visible then. If this causes problems, it’s good to talk about it. It may well help to discuss insecurities, fears, shame or depression with a trusted person, with the general practitioner or, for example, a psychologist.

Facts

• The term ‘psoriasis’ is derived from the Greek word psõra (scabies). However, the disease has nothing to do with scabies.
• The prevalence of psoriasis is 2%.
• The condition can occur at any age, but is most common in adults.