What does it look like
The classic plaque form occurs in most patients: well-defined red spots raised above the skin, covered with silvery-white scales. Typical localization is the extensor surfaces of the elbows and knees, scalp, lower back, and navel area.
- Plaques with silvery peeling; when scraped, the scales come off like stearin
- Itching is not necessary, but occurs in most people
- Nail damage: pinpoint “thimble” impressions, yellowish spots, peeling
- The appearance of rashes at the site of injuries and scratches (Köbner phenomenon)
- Drop-shaped - small rashes all over the body after a sore throat, more often in teenagers
- Inverse form - smooth red spots in folds without peeling
Why does it occur and what causes it?
It is based on a hereditary predisposition plus a malfunction of the immune system: T-lymphocytes attack their own skin cells. The disease itself is not transmitted, only the predisposition to it is transmitted.
- Stress is the most common trigger of exacerbations
- Streptococcal infection, especially sore throat (triggers guttate psoriasis)
- Skin injuries and irritation, sunburn
- Smoking and alcohol
- Some drugs: beta blockers, lithium, antimalarials
- Abrupt withdrawal of systemic glucocorticosteroids
- Obesity and metabolic syndrome
Psoriasis is not just the skin
About one in three patients develop psoriatic arthritis, and the joints may be affected before the skin. It cannot be missed: without treatment, it leads to irreversible destruction of the joints.
- Pain and swelling of the joints, most often the fingers and toes
- Morning stiffness for more than 30 minutes
- A finger that is completely swollen, like a “sausage”
- Pain in the lower back and sacrum at night, relieved by movement
- Heel pain at the insertion of the Achilles tendon
Psoriasis is also associated with an increased risk of cardiovascular disease, obesity and diabetes. Therefore, controlling blood pressure, weight, cholesterol and sugar is part of patient management, and not a separate task.
Treatment
The approach depends on the area affected and the impact of the disease on life. Mild forms are treated externally; moderate and severe forms require systemic therapy.
- Topically: topical glucocorticosteroids, vitamin D analogues, calcineurin inhibitors for the face and folds, keratolytics for removing scales
- Emollients are the basis of care, applied daily and constantly, and not just during an exacerbation
- Phototherapy: narrowband UVB and PUVA - for common forms
- Systemic drugs: methotrexate, acitretin, cyclosporine - as prescribed by a doctor with monitoring of tests
- Biological therapy - for severe forms and psoriatic arthritis; most effective group
- Sanatorium-resort treatment, sea water and dosed sun help some patients
Care and lifestyle
- Daily moisturizing of the skin with emollients, especially after a shower
- Warm rather than hot showers, mild, fragrance-free cleansers
- Quitting smoking and limiting alcohol have been proven to influence the course of
- Weight loss if overweight improves response to treatment
- Working with stress: sleep, physical activity, psychotherapy if necessary
- Be careful with skin trauma: washcloths, scrubs, tight clothing