Psoriasis is a common skin disease in which skin cells multiply up to 10 times faster than normal. It affects both women and men and usually develops between the ages 15-35 but it can appear at any age, even in newborns. We don’t know the exact cause of psoriasis but we do know that genetics and the immune system are involved in its pathogenesis. Psoriasis is a chronic disease that often recurs. There is no cure for psoriasis, but treatments to control the symptoms and improve the quality of life.
What are the symptoms of psoriasis?
Symptoms vary depending on the type of psoriasis. The most common form is the plaque psoriasis. It appears as red, raised plaques covered with silver scales. Sometimes these plaques "crack" and bleed and may be itchy or painful. They can be found on small surfaces, usually on elbows and knees, or they can cover almost the entire surface of the body. The nails become 'thick', usually yellow and can be pitted or ridged. They also harden and in some cases detach and "fall". Red plaques with scales also appear on the scalp.
What other forms of psoriasis are there?
• Guttate psoriasis. It appears with small, circular or oval lesions, 2-10 mm in diameter.
• Inverse psoriasis. It mainly affects the skin in the armpits, in the groin, under the breasts and around the genitals.
• Erythrodermic psoriasis. The disease affects almost the entire surface of the skin. It is red, peels off and can itch or burn intensely.
• Pustular psoriasis can affect the entire body or only the palms and soles. It appears as white- yellow pustules (blisters of noninfectious liquid). The liquid consists of white blood cells and it is not infectious.
• Psoriatic arthritis. In some cases in addition to skin lesions arthritis might appear and causes swollen, painful joints. Sometimes the joint symptoms are the first or only manifestation of psoriasis.
What causes psoriasis?
We do not know what exactly causes psoriasis but it's thought to be related to an immune system problem due to genetics which leads to excess skin cells proliferation. Normally, skin cells are replaced every 10 to 30 days. In psoriasis, new cells grow every 3 to 4 days. Psoriasis often comes and goes. Factors that favor its appearance are:
• Infections, such as strep throat or skin infections.
• Injury to the skin, such as a cut, a bug bite, a severe sunburn, a surgical trauma.
• Stress.
• Smoking.
• Heavy alcohol consumption.
• Vitamin D deficiency.
• Certain medications such as lithium, high blood pressure medications (beta blockers), antimalarial drugs, e.t.c.
How is psoriasis diagnosed?
In most cases is easy by physical exam and medical history. In more difficult cases, we perform a diagnostic biopsy.
Is psoriasis a contagious disease?
It isn’t contagious or infectious disease.
What is the treatment?
Psoriasis treatments aim to reduce the inflammation and "clean" the skin. They are divided into:
Topical treatments
• Topical corticosteroids.
• Derivatives of vitamin D. Calcipotriene.
• Anthralin.
• Topical retinoids. These are vitamin A derivatives.
• Calcineurin inhibitors. - tacrolimus and pimecrolimus.
•Salicylic acid.
• Coal tar derivatives
• Moisturizers in the form of ointment.
Phototherapy
• Narrow-band UVB
• PUVA: combination of UVA with drugs (psoralens).
Oral or injected medications
In severe cases of psoriasis or in those that do not respond to the mild to moderate treatments, we use oral or injectable medications. These include oral retinoids, cyclosporine, methotrexate, and biological agents.
Is it associated with other diseases?
Psoriasis is more common in obese people, those suffering from type B diabetes, cardiovascular diseases, hypertension, other autoimmune diseases, metabolic syndrome, depression, kidney diseases, Parkinson's disease.
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