What is psoriasis?
Psoriasis is a relatively common dermatological condition that mainly affects the upper layer of the skin but also the middle layer. It is usually characterized by psoriatic plaques, which are red lesions with scales, often appearing more frequently on friction-prone surfaces such as knees and elbows, with psoriasis on the hands being relatively common, but mainly on the legs and the scalp. Fortunately, psoriasis on the scalp rarely appears on the face. There are other forms of psoriasis with variations in appearance and affected areas. It should also be noted that there is psoriasis of the nails and it can affect both nails and joints. Psoriasis on the joints can even lead to permanent damage and should be recognized early.
What causes it?
Unfortunately, we do not have a clear answer to how this common condition is caused. We know that certain genetic factors play a role as they create a predisposition for its appearance, and to some extent, this predisposition can be inherited. It is important to clarify that psoriasis is not contagious and is a personal matter for the patient. There are some medications, e.g., a category of antihypertensives, that can cause the appearance of psoriatic-like rashes or even psoriasis. Also, in psoriasis, there is the Koebner phenomenon where even minor trauma or friction can lead to the appearance of a psoriatic plaque at the site. Finally, the appearance of psoriasis, especially the guttate form, may follow a streptococcal infection of the upper respiratory tract, as it seems to trigger a sequence of immune changes triggering the appearance of psoriasis.
What triggers the symptoms?
It is crucial to avoid friction and scratching of the lesions as this will lead to exacerbation and extension of psoriasis. Additionally, an unhealthy diet with smoking and alcohol consumption can worsen the condition. Finally, reduced exposure to sunlight usually worsens psoriasis, as does the intake of certain medications. The intake of oral cortisone can destabilize psoriasis and especially upon discontinuation, it can lead to a significant exacerbation.
Where does it appear?
Psoriasis appears more frequently in areas of friction with reduced exposure to sunlight. For this reason, the knees and elbows are classic sites of appearance. It appears more frequently on the legs than on the hands, while on the scalp, it mainly appears in the hair, possibly because the usually beneficial effect of the sun protects the face.
Types of psoriasis
Common psoriasis
This is the most classic form of psoriasis, with plaques on knees, elbows, head, and areas such as around the navel. These red plaques are characterized by thick scales and may cover these limited areas or almost the entire body.
Guttate psoriasis
In this form of psoriasis, which is more common in children and young people after streptococcal infections, there is a sudden appearance of multiple lesions. These lesions have a smaller extent, resemble drops, and have less scaling. This form can evolve into common psoriasis.
Localized psoriasis
Sometimes psoriasis appears only in a specific area. This can be an early stage of the disease that may spread, and it is important to treat it correctly from the beginning. The most common area of appearance is the scalp, but other areas may be the palms, soles, and genitals.
Inverse psoriasis
In this rarer form, psoriatic plaques appear on the flexural surfaces of the extremities. Friction and sweat slightly alter the appearance, reducing scaling, and for this reason, the correct diagnosis is often not made and it is mistakenly treated as dermatitis or fungal infection.
Nail psoriasis
Nails, as an extension of the skin, can sometimes be affected by psoriasis. This can happen either in association with skin lesions or, more rarely, maybe the only finding. In these cases, while the skin does not show plaques and scales, the nails may have specific findings, such as small depressions, onycholysis, or dystrophy. In such a case, an examination for psoriatic arthritis should be performed.
Erythroderma
Erythroderma is a rare but dangerous condition in which the majority of the skin (over 90%) becomes inflamed and red. This leads to disturbances in thermoregulation and electrolytes, among other things, and for this reason, it requires hospitalization. Erythroderma can be caused by various diseases, but psoriasis is the most common. The most common cause is the incorrect treatment of psoriasis, leading to its destabilization and extension.
Pathogenesis of psoriasis and treatment
The pathogenesis of psoriasis is a field of research, and there is a constant effort to find new treatments. In summary, we can refer to the heredity, the role of the body's T cells and their messengers, in the multiplication of epidermal cells, and the increased number of blood vessels. These cells constitute increasingly specific targets for treatments with biological agents.
More specifically, it has been found that a subset of our body's immune T cells, for some reason deviate from their normal function and through a cocktail of messengers they secrete, fuel the pathogenesis of psoriasis, playing an instrumental role in this process. Under the influence of these cells, but also interacting with them, skin cells increase their proliferation rate vertically, in a 'makeshift' way, causing thickening of the epidermis and the formation of scales. At the same time, growth factors lead to increased angiogenesis and the creation of a plethora of blood vessels under the skin.
Heredity seems to play a role, but it is a complex picture, clearly polygenic and multifactorial. Thus, certainly, some environmental factors are crucial for the manifestation of the disease, both in terms of the intake of drugs that may cause or maintain psoriasis, as well as in terms of stimuli such as friction and injury that fuel the disease through the Koebner phenomenon. Finally, certain lifestyle habits are also important, such as alcohol intake and smoking, while often some specific changes in these, especially in diet, can have extremely beneficial effects and reduce the required drug therapy.
This is because psoriasis can be included in the context of a metabolic syndrome, where the proper functioning or dysfunction of the liver (hepatitis) is crucial.
However, beyond diet, there is a plethora of treatments that can be given, but we consider it important to emphasize the avoidance of cortisone preparations. Unfortunately, cortisone creams, while initially seeming to help, eventually lead to the phenomenon of rebound, i.e., the reappearance of damage, with the gradual extension of the damage, while in the end, after years of use, their initial apparent effectiveness decreases.
Beyond local treatments, there are also systematic treatments with both old and tried and newer biological agents that are now highly targeted drugs that affect very specific pathways of the immune system that lead to psoriasis. Even these new drugs have been on the Greek market for over 10-15 years now, and there is a great deal of experience regarding their safety as well as their effectiveness, while constantly evolving and new ones appearing. The use of these biological agents has revolutionized the treatment of psoriasis, with patients clearing from psoriatic plaques faster and easier than ever before, with very good maintenance of their results. They also help both in nail psoriasis and psoriatic arthritis.
Why trust the experts of TotalSkin
Taking all this into account, we consider the issue of diet crucial in the treatment of Psoriasis. At the same time, prioritizing the safety of the patient, we choose systematic treatment, where required, with the primary criterion being tested and having stable results, without causing sudden worsening (rebound) upon discontinuation. As a local treatment, we avoid the use of cortisone and prefer other 'alternative' preparations. Finally, in the clinic, depending on the case, we choose to treat psoriasis either with classical dermatology or with a treatment that may be compatible with some homeopathic treatment that some patients follow with another doctor.
