HEALTH GUIDE: Psoriasis

What is psoriasis?

Medically the question "What is psoriasis?" is answered as follows. It is a chronic skin disease that manifests itself as severe scaling and reddened inflammatory sites. It is usually episodic with alternating short and long acute phases. More than three percent of the German population is affected, with the majority of cases aged between 20 and 40. Although seldom, some people are afflicted in their 50s. Children are also susceptible to psoriasis.

In addition to the skin and nails, psoriasis can also affect joints. Sometimes the disease impacts the liver, vessels or heart which in turn may influence metabolic processes. Above all, those afflicted by psoriasis experience itchiness where new inflammation occurs. Cracks in the skin form due to increased scratching and this leads to further bleeding. The extent and severity of psoriasis varies considerably from patient to patient. Effective treatment is vital to alleviate the symptoms, especially as there is no definitive cure for this disease at present.

Causes of psoriasis

Based on current insights, there are numerous causative factors responsible for the onset of psoriasis. These include environmental influences, hereditary predispositions or a faulty regulation of the body's immune system.

Genetic causes of psoriasis

Hereditary predisposition may increase the risk of psoriasis. Approximately a quarter of patients affected have a family history of the disease. Doctors meanwhile believe the probability of a child developing the condition is around 30 percent if both parents show a predisposition. Should this be the case with one parent, the risk is only 10 percent. However a child may suffer from psoriasis even though neither parent shows any symptoms. The converse may also be the case where both parents are affected, yet the child is spared the disease. Studies show evidence that inheriting the condition from the father is higher.

Light-skinned people are more prone to the disease than those with a darker skin typical in southern countries.

Psoriasis triggers

Scientists frequently list a patient's own immune system as a trigger for psoriasis as well as other internal and external stimuli. These for example include:

Metabolic disorders
Infections caused by viruses and bacteria (such as inflammation of the middle ear, tonsillitis, gastrointestinal infections, HIV)
Skin irritation (sunburn, tattoos and injuries)
Emotional strain over a long period of time (stress, mobbing)
Psoriatic diet
Climatic influences
Overweight
Smoking

The incidence of psoriasis in smokers is much more prevalent than in non-smokers. Smoking ten cigarettes a day can triple the risk of the disease.

Diagnosis of psoriasis

So as to correctly diagnose psoriasis, a dermatologist will use an exclusion method. In an initial interview, s/he will first ask questions such as:

Have you already taken any medication?
What are the current symptoms?
How long have they been present?
Does itching also occur at night?
Do any other family members suffer from psoriasis?

A thorough examination of the affected person will follow. In most cases, the dermatological expert will be able to visually diagnose psoriasis based on typical skin changes present.

If other family members suffer from psoriasis, this is an indicator that the symptoms may be a manifestation of the same disease. By contrast, if there is no genetic predisposition and the visual diagnosis inconclusive, a biopsy needs to be performed. During this examination, the doctor determines whether the top layer of skin is inflamed and excessively keratinised. If this is the case, microscope imagery usually show an increased number of defence cells in the form of white blood cells and macrophages. However if psoriatic symptoms are mild, further examinations need to be made. This is necessary to rule out possible confusion with other skin conditions including:

Fungal skin diseases
Ichthyiosis (a cornification disorder of the skin, also called fish scale disease)
Eczema
Early stages of syphilis
Nodular lichen (lichen ruber planus)

With individuals who have joint complaints, blood tests as well as X-rays will be necessary. Psoriasis where joints are affected is often not readily distinguishable from chronic joint disease without typical skin symptoms.

Symptoms of psoriasis

Psoriasis is usually characterized by inflamed, reddened patches of skin with silvery-white scales that are easily distinguishable from healthy skin. The process of skin renewal with this condition is around seven times faster than normal, which, from a chronological standpoint, results in the skin renewing itself in just four to five days while a healthy skin takes 28 days. The consequence of this speeded up process means that skin cells do not completely die and are shed as scales. The cells cling together causing the skin to thicken. Painful cracks in the affected areas are prone to bleeding.

Psoriasis may occur in different areas of the body but it mainly affects:

A hairy scalp
Nails
Behind and around the ears
Eyebrows
Chest and back
Elbows
The belly button area
The sacral region
Armpits, knee pits, anal cleft
Soles of the feet and palms of the hands

With a hairy scalp, inflammation areas often spread from the hairline to the face. For those affected, this leads to an additional psychological burden, as it is hard to conceal the afflicted patches. Unpleasant itching on the scalp can also lead to hair loss.

In approximately 50% of patients, fingernails or toenails become affected. These tend to display hollows and take on a yellow to brownish colour. Psoriatic arthritis is an exceptional form of the disease. It attacks joints resulting in painful swelling of individual toes or fingers. Inflammation of synovial tendon sheaths or even the spine may occur. However the manifestations of the disease are very diverse and can be mixed.

In acute cases, symptoms are not solely limited to specific skin areas but can also manifest in various regions of the body at the same time without any detectable signs. A burning sensation and persistent itching is common with all forms of psoriasis.

The disease may also affect babies and children.

Psoriasis in babies

Occurrences of this ailment in babies are quite rare. In such cases the parental genetic predisposition should initially be considered. However infections, skin irritations or allergies may also be responsible for the characteristic symptoms. Nevertheless caution should be exercised as psoriasis in babies is often not detected as the symptoms are similar to nappy rash or neurodermatitis.

Psoriasis in children

A rare form of the disease is guttate psoriasis that frequently occurs in children and teenagers after tonsillitis. One to two centimetre dot-shaped large red skin lesions are located over the entire body and cause very painful itching. Medications are also known to be possible triggers.

Which treatments and therapies help against psoriasis?

Although a full cure of this chronic disease is not yet available, the suffering endured by those affected can be counteracted by a variety of measures and treatments. It is best for patients to be proactive especially as many people who are affected make the mistake of ending a treatment plan when the disease becomes symptom-free. However the positive impact of better skin appearance only sets in after a prolonged period, so it is crucial not to stop a psoriasis therapy without first consulting a doctor.

The choice of cream or ointment for psoriatic treatment primarily depends on the severity of the symptoms and the active ingredient included. Cooling gels and lotions can also be used. In addition, preparations with the following active ingredients promise to alleviate psoriasis:

Calcineurin inhibitors against neurodermatitis – also used for psoriasis
Dithranol inhibits increased cell division
Glucocorticoids against acute inflammation in the short-term

What else helps against psoriasis?

Suggested treatments:

Skin care (regular oiling, psoriasis cream)
Medication (antihistamines, if using cortisone, consult a doctor first)
Diet (avoid hot spices, alcohol, foods containing histamine such as chocolate, cheese, nuts)
Skin cooling (compresses, breathable clothing, cool air indoors)
Acupuncture (can relieve itching)
Gloves (protection against mechanical irritation, prevent scratching during sleep)
Nail care (shorten nails to avoid injuries from scratching)

Ultraviolet radiation is a recommended complementary treatment. UV light inhibits immune processes and counteracts increased cell growth. This leads to a significant reduction of symptoms during summer. A change of climate can also be very beneficial as part of psoriasis therapy. Staying at the North Sea or in high or low mountainous regions has proven to be effective. The iodine and especially oxygen-rich air as well as the salt content of seawater sometimes show even more pronounced results than medicinal treatments. Those who like travelling long distance will benefit from the Dead Sea!

Preventing psoriasis

It is currently not possible to prevent the onset of psoriasis. However affected people can themselves identify factors that aggravate or even trigger relapses. Avoiding stress is just one way of preventing the disease.

A tip. Psoriasis help!

Take advantage of services offered by health insurers, such as information on psoriasis nutrition and how to help against psoriasis. Training self-confidence and relaxation exercises have a positive effect on the psyche too.

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