Psoriasis (psoriasis)

Psoriasis: Short overview

description: inflammatory, non-contagious skin disease, severe scaling, relapsing course

• Causes: genetic predisposition, autoimmune reaction in the skin, triggers such as stress, infections, hormonal changes, skin irritation and damage
• Treatment: anti-inflammatory ointments and creams, immunomodulators, TNF-alpha inhibitors, interleukin inhibitors, nutritional adjustment, relaxation techniques
• Nutrition: Mediterranean diet, lots of fish, low meat, lots of vegetables, omega-3 edible oils, no alcohol
• symptoms: covered with silvery scales, sharply defined, reddened areas of the skin, severe itching
• Forecast: incurable, number, duration and severity of the relapses are clearly reducible, complete freedom from symptoms rare

Psoriasis: causes and triggers

Psoriasis (psoriasis vulgaris) is an inflammatory, non-contagious skin disease. It runs in batches. Typically, sharply defined, reddened skin areas that shed strongly and often itch extremely.

Genetic predisposition

People with psoriasis have a genetic predisposition to the skin condition. Therefore, children whose parents suffer from psoriasis have a much higher risk of contracting as well. But not everyone who carries the risk genes gets psoriasis. Often, the disease only breaks out when a triggering trigger factor is added. In other cases, however, the symptoms appear without a special trigger

Misdirected immune system

The main player in the onset of the disease is the immune system. The immune cells respond to a psoriasis episode such as a skin injury: they trigger inflammatory reactions in the skin and accelerate skin renewal processes. That is why overly many new skin cells are constantly forming.

Normally, the epidermis renews within four weeks. In patients with psoriasis it is only three to four days.

Psoriasis Triggers

There are a number of factors that can cause psoriasis or provoke a new onset of illness.

infections: In the course of an infection, the immune system turns not only against the pathogens, but also against healthy skin. In principle, any infection can cause a psoriasis boost – for example, a streptococcal infection, measles, a flu infection, HIV infection, or chronic inflammation.

Stress: In some cases, the disease breaks out in times of greater mental stress, after death of relatives, school stress or job loss, for example.

Hormonal changes: Psoriasis often occurs for the first time when the hormonal balance is disturbed. This can be puberty, pregnancy or menopause.

Skin lesions: Cutting and abrasions but also burns and even a sunburn can provoke a thrust.

Mechanical irritation: Scratching, pressure, for example due to a tight belt, also abrasive clothing are other possible triggers.

medications: Some medicines are known to cause relapses as well. These include, among others

• Antihypertensives (ACE inhibitors, beta-blockers)
• Painkillers (ASA, ibuprofen, diclofenac)
• interferon
• antimalarials
• Some antibiotics (eg tetracyclines)

Psoriasis – treatment

Psoriasis can not be cured at this time. The severity and number of relapses can be significantly reduced with modern treatment approaches. If the symptoms improve by at least 75 percent, the treatment is considered successful.

Skin care as a basis

The basis of every psoriasis therapy is the right care. The skin of psoriatics is dry. Oil-containing and moisturizing products are therefore the right choice. There are also creams and ointments with urea or salicylic acid. They help the skin to retain moisture.

Medications slow down the immune system

Creams and ointments, which help to reduce the inflammation in the skin, help with this. These are preparations containing, for example, cortisone or dithranol.

In middle and heavy bleeding, one not only treats the skin directly but also attenuates the excess activity of the immune system with tablets or injections. These include the immunomodulators acitretin, ciclosporin, fumaric acid esters and methotrexate (MTX).

Therapeutics of the youngest generation are genetically engineered antibodies. They are targeted against certain messengers that fuel the activity of the immune system. These include various TNF-alpha inhibitors and interleukin antibodies. They are very expensive and therefore only prescribed when other treatment options are not sufficient.

Light and bath treatments

The skin of people with psoriasis also benefits from sunlight. Therefore, phototherapy with appropriate radiation can help.

Likewise, salt water soothes the discomfort, especially brine. Often, light and spa treatments are also combined into a balneo-photo therapy: the salt water makes the skin more sensitive to the light rays.

Relaxation techniques and psychotherapy

Stress is one of the main causes of psoriasis attacks. Psoriasis patients therefore benefit from learning relaxation techniques such as autogenic training or progressive muscle relaxation. Psoriasis can be very stressful mentally. The patients feel unattractive and are inhibited. In fact, they often experience stigmatization: people encounter them with disgust and rejection. Many people are unaware that psoriasis is not contagious. Psychotherapy can help deal with the psychological burden of the disease.

Would you like more information about the treatment options for psoriasis? Then read the post psoriasis treatment

Psoriasis – nutrition

The symptoms of psoriasis are caused by excessive inflammatory reactions in the body. Food and beverages that fuel such inflammatory processes should be avoided by people with psoriasis. These include above all:

• alcohol
• Food rich in arachnoidal acid, such as meat and sausage

But there are also foods that are anti-inflammatory. This includes:

• Fruits and vegetables that trap aggressive oxygen molecules
• Fish, especially fatty sea fish, which provides plenty of anti-inflammatory omega-3 fatty acids
• Edible oils with omega-3 fatty acids such as linseed oil or grapeseed oil

Many psoriasis patients report that their skin gets better when they omit certain foods, such as citrus or spicy spices. Which are, but varies from patient to patient.

So you should find out for yourself what is good for your skin. A nutrition diary will help you with that.

Remove obesity

Adipose tissue, especially fat deposits in the abdomen, constantly produces inflammatory messengers. Overweight psoriasis boosters can significantly improve their discomfort as they lose weight. In that case, the diet should help to lose weight. With the above-described dietary rules succeeds particularly well.

If you want to know more about the diet of Psoraisis, read the article psoriasis – nutrition

Psoriasis: symptoms

Most psoriasis patients suffer from psoriasis vulgaris. Psoriasis is characterized by sharp, red and slightly raised patches on the skin. They are covered with silver-white scales. They are called plaques.

The affected areas of skin are sometimes small and punctiform, but they can also cover larger areas and itch.

The superficial scales are easy to scrape off. The lower ones, on the other hand, are more firmly seated on a young, thin layer of skin. If one removes this layer of scurf, small, punctiform skin bleeding occurs (Auspitz phenomenon).

The plaques occur preferentially in the following parts of the body:

• elbow
• knee
• Sacrum
• Hairy head
• gluteal fold
• Area behind the ears
• Navel region

In severe cases, the inflamed lesions are not limited to specific regions. They then occur over a large area on large parts of the body skin.

Special forms of psoriasis

There are many different forms of psoriasis that cause different symptoms. The following are the main ones explained:

Psoriasis guttata:A common form of psoriasis is psoriasis guttata. It occurs mainly after previous (tonsil) infections and manifests itself in the form of numerous small spots. Often psoriasis guttata is associated with severe itching.

It can go back to the past after an infection, or it can become chronic psoriasis vulgaris. Then the spots are usually not so numerous, but larger.

Eruptive exanthematic psoriasis: The eruptive-exanthematic psoriasis occurs mainly after infections, but may also be the first form of a new disease (first manifestation) with psoriasis.

Within a few weeks small, often itchy foci of body parts, where the “ordinary psoriasis” (psoriasis vulgaris) does not occur. The eruptive-exanthematic psoriasis can heal by itself or become chronic.

Psoriasis exudative: A highly inflammatory form of psoriasis is psoriasis exudative. It usually begins with symptoms of eruptive-exanthematic psoriasis. The affected areas then redden strongly and then develop an inflamed “hem”. Wound secretions appear on the surface, covering the psoriasis centers in the form of yellowish crusts.

Psoriasis pustulosa:Psoriasis pustulosa is a rather rare form of psoriasis. Typical are pus-filled blisters (pustules) on reddened skin. This form of psoriasis usually occurs on the hands and feet, especially on the palms of the hands and the soles of the feet. In the generalized form, however, the whole body is affected.

Psoriatic erythroderma: Psoriatic erythroderma is a rare form of psoriasis in which the entire skin becomes reddened and thickened. This makes them more rigid and can tear over the joints and form so-called cracks. The scaling is less pronounced in this form.

Through the large-scale skin inflammation, the patients usually develop general symptoms such as fever, fatigue and malaise.

Psoriasis inversa: Inversa psoriasis is found mainly in areas of the body where the skin rubs against one another, for example the armpits, the anal folds and the popliteal fossa.

Psoriasis of the scalp

In more than two-thirds of patients, psoriasis also affects the scalp. Often the plaques reach over the hairline and are clearly visible on the forehead or in the neck. This is particularly stressful for those affected, as it is difficult to hide the skin lesions here.

The treatment is carried out with the same active ingredients as on the rest of the body, except that on the hairy head no creams, but appropriate shampoos are used. For these to have an effect, the scales must first be loosened and, if possible, removed. Also there are special shampoos.

If an external treatment is not enough, psoriasis of the scalp also helps to inhibit the activity of the immune system.

You can read more about this form of psoriasis in the article psoriasis – scalp.

Psoriatic arthritis

About every fifth psoriasis patient develops psoriatic arthritis as the disease progresses. Until then, it usually takes a few years. Then the inflammation jumps over to the joints. However, psoriatic arthritis can also occur before skin symptoms appear. In some cases, the skin is even completely symptom-free.

Psoriatic arthritis can affect the skin of the joints, bones, periosteum and the appendages of joint capsules, tendons or ligaments.

Frequently, the finger or toe joints become inflamed. They then hurt and swell. Often, these symptoms are mistaken for rheumatism or gout.

Some patients, especially the larger joints cause discomfort, symmetrically from the clavicle to the ankle joint.

Rarely, the symptoms occur in the spine or the sacrum-iliac joints of the pelvis. The joints can stiffen. Often this form is mistaken for an ankylosing spondylitis.

Difficult diagnosis

The diagnosis of psoriatic arthritis is often only made when the characteristic skin and nail changes are present and also the so-called rheumatism factor in the blood can not be detected.

Psoriatic arthritis is treated in mild cases with non-steroidal anti-inflammatory drugs, which are designed to reduce inflammation. Also a physiotherapy can help. In more severe cases, the patient receives stronger agents that attenuate the immune system.

More detailed information on this form of psoriasis can be found in the article psoriatic arthritis.

nail psoriasis

Psoriasis often changes the finger and toenails. Typical are then various characteristic stain patterns. Often they lose their strength. They then become porous or even crumbly. Usually not only one nail is affected, but several.

The nail may also fall off completely, for example, when the nail bed is inflamed or when the skin under the nail bruises.

confusion

Diagnosis is difficult when nail psoriasis develops before the psoriasis skin symptoms are visible. Then there is a likelihood of confusion with fungal infections or eczema.

Nail psoriasis should be treated as quickly as possible so that the condition of the nails does not deteriorate further.

For treatment, there are preparations that are applied to the diseased nail. They contain either cortisone or cortisone plus calcipotriol.

Further information on this special aspect of psoriasis can be found in the text Nagelpsoriasis.

Psoriasis: examinations and diagnosis

The doctor recognizes psoriasis on the typical skin changes that occur mostly on characteristic body regions such as elbows, knees, gluteal fold, hairy head.

Pointed bleeding

A clear indication also provides a simple skin test: typical for psoriasis is that punctate skin bleeding occurs when it is removed the last cuticle of an affected area.

Altered nails

The nails also change in psoriasis often: they are patchy, yellowish and brittle. Such nail changes can harden the suspicion of psoriasis.

If the diagnosis is unclear, the doctor may take a skin sample (biopsy) to rule out other conditions with similar symptoms. This includes:

• fungal diseases
• skin lichen
• syphilis
• eczema

Psoriasis: Disease course and prognosis

Psoriasis can occur at any age. Often, however, it breaks out for the first time in adulthood. In Germany, about two percent of the population, around two million people, have more or less severe psoriasis.

The disease is currently not curable. It runs in spurts, that is, relatively symptom-free times alternate with periods of severe psoriasis symptoms. In some patients, the symptoms disappear completely for a long time or even do not even return.

Psoriasis runs individually very different in terms of:

• Severity and type of skin symptoms
• Localization (location) of the skin symptoms
• Duration of the relapses
• Frequency and severity of thrusts
• Duration of (relatively) symptom-free periods

Prevent spurts

By appropriate lifestyle, psoriasis patients themselves can contribute to the relapses are rare and less difficult. This includes, in particular, the ability to deal with stress and avoid unnecessary burdens, an anti-inflammatory diet, the reduction of overweight and abstinence from alcohol and cigarettes.

Additional information

Books:

• Psoriasis (psoriasis) / Atopic dermatitis (endogenous eczema) – answers to everyday questions of A-Z (Günther N Schäfer, self-published, 2006)

guidelines:

• S3 guideline “Therapy of psoriasis vulgaris” of the German Dermatological Society (2017)

Support Groups:

• German psoriasis federation e.V. & # X202f;
• Psoriasis Selbsthilfe Arbeitsgemeinschaft e.V. & # X202f;