Psoriasis is a long-lasting, common disease associated with exacerbations. Typically, the disease is characterized by red, scaly skin patches covered with silvery scales and sharp margins.
Is psoriasis a common disease? What is the incidence of this disease by age?
Psoriasis is common all around the world and genetic and environmental factors affect the incidence rate. A child may be genetically predisposed to develop the disease, but the disease may not occur in the child. The disease occurs in about one or two out of every 100 people. The prevalence is equal for both sexes. Generally, the disease emerges at the age of 15-30 years.
What is the underlying cause of psoriasis? What are the causative factors of attacks?
The underlying cause of psoriasis is not exactly known, but it is considered that the immune system and the genetic and environmental factors play a role. Environmental factors (Streptococcal throat infections, medications [cortisone, lithium, some antihypertensive agents, aspirin etc.], excessive alcohol use, smoking, scratch, rubbing with a coarse bath-glove, sun burn etc.) and mental stress may trigger or exacerbate the disease.
Is Psoriasis Contagious?
Psoriasis is not transmitted by physical contact.
What are the symptoms of psoriasis?
The symptoms of psoriasis vary depending on the clinical characteristics.
Psoriasis vulgaris (plaque-like psoriasis): It is the most common clinical picture of psoriasis (80%). Typical symptoms include raised, ovoid - round red spots covered with silvery scales. It is observed in the knee, elbow, scalp and coccyx. Sometimes, it is located in skin folds such as the armpit, groin, inframammary fold, back of the knee, medial surface of the elbow and neck (inverse psoriasis). It may be observed in palmar and plantar surfaces (palmoplantar psoriasis).
Guttate psoriasis: Pink-red, scaly, small, round, teardrop-shaped spots are observed on the upper trunk as well as arms and legs. The condition is common in children and adolescents. It is generally associated with throat infection and it regresses within a few weeks or a month.
Erythrodermic psoriasis: The disease involves more than 90% of the body. The disease may progress secondary to triggering factors, such as medication, sunlight, trauma and infection. Treatment should be given at hospital.
Pustular psoriasis: Pus-filled blisters exist on a background of red skin. It develops on typical psoriasis plaques or intact skin. The disease may be generalized (diffuse pustular psoriasis) or confined to plantar or palmar surfaces (palmoplantar pustular psoriasis).
Psoriatic arthritis: The condition is observed in 2 out of 10 cases and affects people in their 40s. The finger joints and the sacroiliac joint are mostly involved. The symptoms include morning stiffness, stiffness secondary to prolonged sitting or standing and swelling in fingers or toes (“sausage” finger/toe). Nail involvement is also common when the joints are involved. The disease is, usually, accompanied by dermal symptoms.
Nail changes in psoriasis: Nails are affected in about half of the cases. Pinhead-sized pits on the nail surface, detachment of nails from the nail bed, yellow discoloration underneath the nail (appearance of oil stain), partial loss of the nail and the thickened skin underneath the nail are common changes.
How is the course of psoriasis?
Exacerbation and symptom-free periods generally last long. Symptoms and severity of the disease is subject to interpersonal variations and they may even alter in the same person in time.
Does pregnancy affect course of the disease?
A woman with psoriasis may conceive. Effects of the pregnancy on the disease vary; the disease, usually, disappears during pregnancy and recurs along with attacks after the childbirth. Pustular psoriasis may develop in a limited number of pregnant women. It is necessary to consult with a physician for medications to be used during pregnancy and lactation.
Psoriasis and Other Diseases
Increased intraluminal fat deposition, hypertension and diabetes are common which cause predisposition to cardiovascular diseases especially in those who have severe psoriasis. Also, obesity (overweight) and inflammatory bowel disease are frequently observed as well.
How is psoriasis diagnosed?
The disease can be diagnosed in the light of clinical findings. Rarely, skin biopsy may be necessary.
How is psoriasis treated?
Psoriasis is a lifelong disease. The disease can be managed through certain measures and appropriate treatment plan. It is necessary to avoid medications and actions (scratch, bath puff, rubbing with a coarse bath glove etc.) that may exacerbate the disease. First, common treatment methods are employed for patients with psoriasis with partial involvement (scale-removing agents, cortisone drugs, Calcipotriol [synthetic Vitamin D] and calcineurin inhibitors). These methods can be combined as well. If the disease is resistant and diffuse, methotrexate, cyclosporine-A, Acitretin (synthetic Vitamin A) and phototherapy are used. If there is no response to these treatments, biological agents can be applied (adalimumab, etanercept, infliximab, ustekinumab and Secukinumab etc.). Many factors are taken into consideration when the treatment method is decided and duration of treatment is determined (severity of the disease, location, nail and joint involvement etc.).
In treatment period, the patient and the patient’s relatives should cooperate with physician. In addition to medical treatment, it is important to follow a healthy diet lifelong for chronic conditions. There is no exact diet to adhere for the disease. It is necessary to follow the unnecessary dietary restrictions. Also, patients should quit smoking, decrease alcohol consumption and do exercise regularly.