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VERIFIED CONTENTConsultation: prof. dr hab. n. med. Barbara Zegarska, specialist in dermatology, venereology and allergology, head of the Department of Cosmetology and Aesthetic Dermatology at Collegium Medicum in Bydgoszcz, UMK in Toruń

Skin psoriasis, plaque psoriasis, nail psoriasis, scalp psoriasis, pustular psoriasis, articular psoriasis … anyone who has ever had a contact with any type of psoriasis knows how bothersome and ungrateful this disease can be. What is psoriasis? What are the symptoms of psoriasis, what are the causes and types, and is psoriasis contagious?

What is psoriasis?

Psoriasisis a severe and chronic skin disease. It is a recurring disease - in many patients the skin looks relatively good only in summer, because it is positively affected by the sun.

It is worth knowing that in Polandpsoriasisis one of the most common skin diseases - according to data from 2022, about 1 million people suffer from psoriasis in Poland, and as many as 80 percent of them are aged 20-40.

Psoriatic lesions can appear virtually all over the body - on the trunk and limbs, on the scalp, in the intimate areas, and on the nails (in the form of so-called oil spots or nail vitiligo). About 40 percent. Patients also develop psoriatic arthritis.

Ispsoriasiscontagious? The answer to that question is definitely not.Skin psoriasisis not contagious - it is impossible to get infected by shaking your hand, using the same towels or sleeping in the same bed.

Psoriasis - causes

The causes of psoriasis still haven't been adequately explained . Genetic factors play a role in the pathogenesis of this disease, including the polymorphism of the HLA-Cw6 gene (the participation of genetic factors in the development of the disease is estimated at up to of all cases), as well as improper functioning of the immune system. The body produces antibodies that recognize its own tissues as foreign. Then the dermis becomes inflamed.

The skin of people suffering from psoriasis exfoliates excessively. A characteristic feature of psoriasis is that the skin cell cycle is eight times shorter - in a he althy epidermis cells move from the basal layer to the stratum corneum within 28 days, and in psoriasis it takes 3-4 days.

The epidermis is 4 to 6 times thicker than ua he althy person, the number of keratinocytes and individual cells is greater.

Types of psoriasis

There are currently two types of psoriasis:

  • psoriasis type I -hereditary. It usually starts early, with the onset of psoriasis between the ages of 10 and 40. This type of psoriasis is also known as juvenile psoriasis.
  • psoriasis type II- manifests itself in people aged 50-70 years and does not show signs of a familial occurrence.

Psoriasis - symptoms

Psoriasis has the following symptoms:

  1. the skin shows characteristic clusters of red-brown lumps, clearly demarcated from the rest of the skin and covered with dry, silvery scales, which are located in the areas exposed to microtrauma, e.g. on the elbows, knees or on the hairy scalp (these are typical locations for these lesions). Sometimes psoriatic lesions also appear on the face (in its central part, but also on the cheeks), as well as on the hands or in the intimate areas. Early lesions are small, reach the size of a pinhead, the fully developed ones (referred to as psoriatic plaques) even several centimeters in size. After scratching the scale, there is a slight bleeding, because the skin underneath is thin and shallowly vascularized.
  2. in the case of nail psoriasis, the psoriatic lesions on the nail plate may resemble a thimble.
  3. in the case of exudative psoriasis, oozing lesions appear in the folds and bends of the skin, while in the case of pustular psoriasis, the eruptions appear as pustules and papules.
  4. Psoriasis lesions can be extensive (so-called plaque psoriasis), sometimes they can cover the entire body surface (this is generalized psoriasis, so-called erythroderma). It happens that skin eruptions are accompanied by changes in the area of ​​the joints - pain, swelling and deformation of the joints (articular psoriasis).
  5. characteristic of activeskin psoriasisis the so-called Köbner's symptom - after a local trauma to the epidermis (e.g., scratching), psoriatic lesions appear within 8-14 days. This symptom does not occur when the disease is in remission.

Psoriasis can be accompanied by many systemic diseases. People with psoriasis often suffer from numerous illnesses apparently withskin psoriasisunrelated, such as metabolic disorders, rheumatological diseases, and heart diseases.

The disease is also accompanied by ailments such as pruritus (present in 60-90% of patients), hyperalgesia and skin pain (43% of patients), as well as sexual disorders (35-71% of patients suffer from them) and depression- its severe form occurs in as much as 28 percent. sick.

Psoriasis lesions have a characteristic appearance:

What aggravates the symptoms of psoriasis?

The spread of psoriatic lesions can be provoked by various factors. Psoriasis symptoms worsen:

  • skin injuries
  • cigarettes
  • stress
  • alcohol
  • microbial infections, mainly streptococci and staphylococci
  • use of certain medications - including non-steroidal inflammatory drugs, beta-blockers, progesterone, cimetidine, amiodarone.
  • pregnancy and childbirth
  • menopause
  • hypocalcemia.

Varieties of psoriasis

There are several types of psoriasis. The most common forms of psoriasis are:

  • psoriasis vulgaris(ordinary)
  • guttate psoriasis- eruptions resemble a droplet shape, and this type of psoriasis most often occurs in children
  • plaque psoriasis- eruptions merge into large patches, reaching even a dozen or so cm
  • generalized psoriasis (erythrodermic psoriasis) - covers the skin almost all over the body (there are few places free from lesions)
  • pustular psoriasis - spots appear next to papules and scales on the skin. In its generalized form, it is one of the most common forms of psoriasis. In the local form, the lesions are located around the hands and feet.
  • nail psoriasis (nail psoriasis) - is often confused with onychomycosis. Stains appear under the nail plate (oil stain or vitiligo), the nails become brittle and brittle, and there are small depressions on the surface resembling a thimble
  • articular psoriasis (arthritis psoriasis, psoriatic arthritis)
  • Inverse psoriasis - is the opposite of classic plaque psoriasis, as psoriasis lesions appear between the skin folds - in the groin, armpits, between the buttocks or under the breasts. The epidermis peels off minimally, but the skin lesions are strongly red, they are easily irritated,
  • psoriasis in children.
  • Scalp psoriasis
  • Pustular psoriasis
  • Nail psoriasis

Psoriasis - how does a doctor make a diagnosis?

If you notice symptoms of psoriasis on your skin, see a dermatologist or GP. The primary care physician, based on the symptoms and their severity, will decide whether he will treat you on his own or will refer you to a dermatologist.

Do not try to make a diagnosis on the basis of symptoms compared to those described on the Internet - only a doctor is able to assess whether the changes in the skin may bea symptom of psoriasis, or are they related to another disease - e.g. atopic dermatitis.

The diagnosis of psoriasis is usually not complicated - it is enough for the doctor to identify the presence of skin eruptions characteristic for this disease, located in typical locations, i.e. on the elbows, knees and on the scalp.

In some cases - for example, if the lesions are located on the hands, feet or nails - it is necessary to differentiate from mycosis, allergy, eczema or infection. In this case, a visit to a dermatologist is necessary. Sometimes it is also necessary to perform a biopsy of the lesion for its histopathological assessment.

Psoriasis - treatment. General rules

Treatment of psoriasis should always be consulted with a specialist dermatologist. Psoriasis cannot be cured permanently and completely, e.g. due to the genetic make-up of this disease. Therefore, its relapses are the rule.

There are a number of medications available for the treatment of psoriasis that can be used both topically and orally to remove scales, inhibit excessive epidermal growth and inflammation, and affect the responses of the immune system.

The choice of the doctor depends, among other things, on on the severity of the symptoms. The goal of treatment is both to alleviate the disease and its negative impact on the patient's daily life, and to achieve the longest possible remission period.

People withpsoriasiscovers up to 25 percent skin surfaces are treated topically.

Patients with psoriasis affecting a larger area of ​​the skin require combined treatment, i.e. local treatment and general treatment, as well as phototherapy. An indication for the general treatment of psoriasis is also a situation when the disease significantly burden a mentally ill person or prevents him from performing professional duties, as well as articular psoriasis, pustular psoriasis and psoriatic erythroderma.

See: what will a dermatologist help with?

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Topical treatments for psoriasis

Topical treatment begins with cleaning the diseased skin of accumulated scales. Then it is necessary to use drugs that inhibit the process of excessive exfoliation of the epidermis.

In the topical treatment of psoriasis, the following are used:

  • ointments and creams for psoriasiswith salicylic acid, retinoids, urea, ketatolytic, i.e. relaxing keratin connections in the skin, which allows other drugs to penetrate into the deeper layers of the skin.
  • preparations with glucocorticosteroids- anti-inflammatory, inhibit excessive reproductionskin cells develop.
  • preparations with vitamin D3 derivatives(calcitriol, calcipotriol and tacalcitol). These compounds have an anti-inflammatory effect and inhibit the too rapid growth of the epidermis. However, they can disturb the calcium-phosphate balance, so using an ointment for psoriasis with a derivative of vitamin. D3, strictly follow the dosage prescribed by your doctor.
  • Dziegcie- means derivatives of hard coal. Tar ointments and pastes have an anti-proliferative effect (inhibit the rapid growth of epidermal cells). They can have side effects - irritation, allergies, inflammation of the hair follicles, phototoxic reactions.
  • calcineurin inhibitors- is a topical drug for the treatment of atopic dermatitis: in psoriasis, it is used for the topical treatment of facial psoriasis and skin folds.

General psoriasis treatment

In general therapy, a number of methods and medications are used, which the doctor selects individually, taking into account the patient's condition, the course of the disease and the severity of symptoms, age, sex or accompanying diseases.

Treatments for general psoriasis treatment are:

  • UVB 311 phototherapy - is irradiation with narrow-range UVB rays (spectrum 311nm) emitted by special lamps. Phototherapy incl. reduces proliferating cells in the epidermis, has an antibacterial effect, favorably modifies the bacterial flora of the skin, reduces pathological changes.
  • photochemotherapy - this method consists in combining a drug that sensitizes the skin to light (phototoxic furocoumarin derivatives - psoralens), and after two hours it is exposed to UVA rays. This therapy is very effective in severe forms of psoriasis. Its version is the bath PUVA, which consists in bathing in a psoralen solution and then irradiating it.
  • Oral retinoids. Synthetic vitamin A derivatives reduce inflammation and normalize skin exfoliation. They are used in pustular psoriasis, sometimes also in psoriatic arthritis, psoriasis of the hands and feet, and in psoriatic erythroderma.
  • methotrexate - cytostatic drug, folic acid antagonist. It is used in severe forms of psoriasis, most often in articular psoriasis and erythrodermic psoriasis
  • cyclosporin A - is an immunosuppressive drug that inhibits the activity of T lymphocytes. It is effective in all forms of psoriasis.
  • antibiotics - penicillin derivatives. They are prescribed when the disease is caused by an infection (spreading psoriasis).
  • biological drugs - these are proteins with a therapeutic effect, obtained from living cells or by gene recombination.They are reserved for patients with severe psoriasis who have failed other treatments. They are effective - after 3 months of therapy, a reduction in psoriatic lesions by 75% is observed, and in some patients even complete remission. Currently, three groups of biological drugs are used in the treatment of psoriasis: MCA monoclonal antibodies, FP fusion proteins and recombinant human proteins. These drugs are administered by subcutaneous or intravenous injection, are used in treatment programs and require close cooperation between the patient and a dermatologist.

Psoriasis - skin care

In psoriasis, proper skin care is very important, as it supports the treatment, and in the remission phase, it may delay the recurrence of the disease symptoms. The skin must be regularly cleaned, moisturized and lubricated, and when necessary, also soothe the feeling of itching.

Rules for the care of skin with psoriasis:

  • For everyday hygiene, choose preparations with soothing, antifungal and antibacterial properties - the best solutions are specialized preparations designed for people with psoriasis. A shower is better than a bath (water dries up the skin very much) - but if you prefer bathing, add a moisturizing emollient to the water.
  • After washing, grease the skin quickly - then it will better absorb the ingredients contained in cosmetics.
  • In periods of exacerbation of the disease, if the skin itches, use anti-itching cosmetics (available at pharmacies), e.g. containing clear ichthyol, which reduces itching and regulates the process of epidermal cell division.
  • Psoriasis lesions on the face should be washed with micellar lotions or saline solution every day, and then moisturized and lubricated with a cream recommended by a dermatologist (cosmetics containing vegetable oils or ectoine are often recommended).
  • Do not use home peels - for exfoliating flaky skin, a dermatologist will recommend a specific ointment, e.g. with urea, which additionally improves the absorption of ingredients contained in creams and medications.
  • The skin must be additionally protected with a cream with a UV filter. Do not sunbathe, especially when taking oral medications - unless specifically directed by your doctor.
  • In the period of remission, in the absence of skin changes, you can perform treatments in the field of aesthetic dermatology (botulinum toxin, hyaluronic acid), gentle peels, and in a cosmetology office, moisturizing and relaxing treatments.

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Dermatology