What is Psoriasis? Symptoms and Treatment Methods

What is Psoriasis?

Psoriasis, also known as psoriasis, is a chronic and incurable disease and is seen at a rate of approximately 1-3% worldwide. Although it often begins in the thirties, it can occur at any age from birth. There is a family history in 30% of cases.

In psoriasis, various antigens are created by the cells in the skin. These antigens play a role in activating the immune system. Active immune cells return to the skin and cause cell proliferation and the resulting formation of psoriasis-specific plaques on the skin. Therefore, psoriasis is a disease that the body develops against its own tissues. Such disorders are classified as autoimmune diseases.

In psoriasis patients, T lymphocyte cells of the immune system are activated and begin to accumulate in the skin. After the accumulation of these cells in the skin, the life cycle of some skin cells accelerates and these cells form the structure of hard plaques. Psoriasis occurs as a result of the proliferation process of these skin cells.

Skin cells are produced in the deep layers of the skin, slowly rise to the surface, and after a certain period of time, they complete their life cycle and are shed. The life cycle of skin cells lasts approximately 1 month. In psoriasis patients, this life cycle may be shortened by up to a few days.

Cells that complete their life cycle do not have time to fall off and begin to accumulate on top of each other. Lesions that occur in this way may appear as plaques, especially in the joint areas, but also on the patients hands, feet, neck, head or facial skin.

What Causes Psoriasis?

The underlying cause of psoriasis has not been definitively revealed. Recent studies emphasize the idea that genetic and immune system-related factors may be jointly effective in the development of the disease.

In psoriasis, which is an autoimmune condition, cells that normally fight against foreign microorganisms synthesize antibodies against the antigens of skin cells and cause characteristic rashes to occur. It is thought that some environmental and genetic factors may trigger the development of skin cells that regenerate faster than normal.

The most common of these triggering factors are:

• Throat or skin infection
• Cold and dry climate conditions
• Accompaniment of different autoimmune diseases
• Skin traumas
• Stress
• Tobacco use or cigarette smoke exposure
• Excessive alcohol consumption
• After rapid discontinuation of steroid-derived drugs
• After use of some drugs used to treat blood pressure or malaria

To the question of whether psoriasis is contagious, the answer can be given that this disease can occur in anyone and that there is no such thing as spreading between people. A history of childhood onset can be detected in one-third of cases.

Having a family history is an important risk factor. Having this disease in close family members may result in an increased chance of a person suffering from psoriasis. Genetically inherited psoriasis is detected in approximately 10% of individuals in the risk group. Of this 10%, 2-3% develop psoriasis.

Various studies have revealed that there may be 25 different heart regions associated with the risk of psoriasis. Changes in these gene regions can trigger T cells to behave differently than normal. Rashes in the form of dilation of blood vessels, acceleration of cell cycle and dandruff occur on the skin invaded by T cells.

What are the Symptoms and Types of Psoriasis?

Psoriasis has a chronic course and most patients experience skin plaques and dandruff. The disease is very common in a quarter of cases. Spontaneous recovery is rare, but in some cases, periods of remission and exacerbation may occur. Stress, alcohol, viral or bacterial infections can cause flare-ups. Tobacco use is also among the factors that can aggravate the disease.

Most patients have itching as well as plaques on the skin. In common disease, there may be difficulty in maintaining body temperature, chills, shivering, and increased protein consumption. In some cases, rheumatism may develop due to psoriasis. In rheumatism related to psoriasis, it may occur in the wrist, fingers, knee, ankle and neck joints. In these cases, there are also skin lesions.

Symptoms of psoriasis can appear anywhere on the body, but most often occur in the knees, elbows, scalp and genital area. When psoriasis occurs on the nails, tiny pits, yellow-brown discoloration and nail thickening may occur.

Psoriasis has different forms depending on the type of skin lesions:

• Plaque Psoriasis

Plaque psoriasis, or psoriasis vulgaris, is the most common subtype of psoriasis and accounts for approximately 85% of patients. It is characterized by gray or white rashes on thick red plaques. Lesions most commonly occur on the knees, elbows, lumbar region and scalp.

These lesions, which vary in size from 1 to 10 centimeters, can reach a size that covers a part of the body in some people. Trauma caused by actions such as scratching on intact skin may trigger the formation of lesions in that area. This situation, called the Koebner phenomenon, may indicate that the disease is active at that moment.

Detection of punctate bleeding in samples taken from lesions in plaque psoriasis patients is called the Auspitz sign and is important for clinical diagnosis.

• Guttate Psoriasis

Guttate psoriasis forms lesions in the form of small red circles on the skin. It is the second most common psoriasis subtype after plaque psoriasis and is present in approximately 8% of patients. Guttate psoriasis tends to begin in childhood and young adulthood.

The resulting lesions are small, spaced apart and drop-shaped. Rashes, which occur more frequently on the trunk and extremities, can also appear on the face and scalp. The thickness of the rash is less than that of plaque psoriasis, but it may thicken over time.

There may be various triggering factors in the development of guttate psoriasis. Bacterial throat infections, stress, skin injury, infection and various medications are among these triggering factors. The most common factor detected in children is upper respiratory tract infections caused by streptococcus bacteria. Guttate psoriasis is the form of psoriasis with the best prognosis among all subtypes.

• Pustular Psoriasis

Pustular psoriasis, one of the severe forms of psoriasis, produces red pustules, as the name suggests. Lesions can occur in many parts of the body, including isolated areas such as the palms of the hands and feet, and can reach sizes that cover a large area. Pustular psoriasis, like other subtypes, can affect the joint areas and cause dandruff on the skin. The resulting pustular lesions are in the form of white, pus-filled blisters.

In some people, the attack period in which pustules occur and the remission period may follow each other cyclically. During the formation of pustules, the person may experience flu-like symptoms. Fever, chills, rapid pulse, muscle weakness and loss of appetite are among the symptoms that may occur during this period.

• Intertriginous Psoriasis

This subtype of psoriasis, also called flexural or inverse psoriasis, generally occurs in the breast, armpit and groin skin where the skin folds. The resulting lesions are red and shiny.

In patients with intertriginous psoriasis, a rash may not occur due to the moisture in the areas where the lesions appear. Caution should be exercised as this condition may be confused with bacterial or fungal diseases in some people.

Individuals with this psoriasis are found to be accompanied by different subtypes in other parts of the body. Caution should be exercised as lesions may become worse with friction.

• Erythrodermic Psoriasis

Erythrodermic psoriasis, also known as exfoliative psoriasis, is a rare subtype of psoriasis that forms burn-like lesions. This disease can be severe enough to require urgent medical attention. Impaired body temperature control is one of the most important reasons for hospitalization in such patients.

In erythrodermic psoriasis, which can cover a large part of the body area at a time, the skin looks like it does after sunburn. The lesions may crust over time and fall off in the form of large molds. The rashes that occur in this very rare subtype of psoriasis are quite itchy and can cause burning pain.

• Psoriatic Arthritis

Psoriatic arthritis is a rheumatological disease that is quite painful and restricts a persons physical activities, and affects approximately 1 in 3 of psoriasis patients. Psoriatic arthritis is divided into 5 different subgroups depending on the symptoms. Currently, there is no medicine or other treatment method that can definitively cure this disease.

Psoriatic arthritis in patients with psoriasis, which is essentially an autoimmune disorder, occurs after the immune system targets the joints as well as the skin. This condition, which can especially severely affect the hand joints, can occur in any joint in the body. The appearance of skin lesions in patients usually occurs before the occurrence of joint complaints.

How is Psoriasis Diagnosed?

The diagnosis of the disease is often made by the appearance of skin lesions. The presence of psoriasis in the family helps diagnosis. In most cases, psoriasis can be diagnosed by physical examination and examination of the lesions alone. Within the scope of physical examination, the presence of symptoms related to psoriasis is questioned. In suspicious cases, a skin biopsy is performed.

During the biopsy process, a small skin sample is taken and the samples are sent to the laboratory to be examined under a microscope. With the biopsy process, the type of psoriasis can be clarified.

Apart from the biopsy process, various biochemical tests can also be performed to support the diagnosis of psoriasis. Complete blood count, rheumatoid factor level, erythrocyte sedimentation rate (ESR), uric acid level, pregnancy test, hepatitis parameters and PPD skin test are among the other diagnostic tools that can be applied.

How is Psoriasis Treated (Psoriasis)?

The patients personal opinions are also taken into account when deciding on psoriasis treatment. Since the treatment will be long-term, the patients compliance with the treatment planning is very important. Many patients also have metabolic problems such as obesity, hypertension and hyperlipidemia. These situations are also taken into consideration when planning treatment. Treatment planning is carried out according to the severity of the disease and whether it impairs the quality of life.

In cases localized to a certain area of ​​the body, appropriate skin creams are used. Creams containing cortisone are often preferred. Creams are recommended to keep the skin moist. Pregnant women are treated with less potent cortisone creams and phototherapy. Before this, the gynecologist can be consulted to obtain information that the treatment will not cause any harm.

Cream, gel, foam or spray-derived medications containing corticosteroids may be useful in cases of mild and moderate psoriasis. These drugs are used daily during exacerbations, and are used for extended periods of time during periods when the disease is not present. Long-term use of strong corticosteroid drugs may cause skin thinning. Another problem that occurs with long-term use is that the drug loses its effectiveness.

When performing light therapy (phototherapy), both natural and ultraviolet rays of various wavelengths are used. These rays can eliminate immune system cells that have invaded healthy cells of the skin. In mild and moderate cases of psoriasis, UVA and UVB rays can have a positive effect on controlling complaints.

In phototherapy, PUVA (Psoralen + UVA) therapy is applied in combination with psoralen. The rays that can be used in the treatment of psoriasis are UVA rays with a wavelength of 311 nanometers and narrow band UVB rays with a wavelength of 313 nanometers. Narrow band ultraviolet B (UVB) rays can be used on children, pregnant women, breastfeeding women or elderly people. The subtype of psoriasis that responds best to phototherapy is guttate psoriasis.

In some cases, physicians may prefer medications containing vitamin D. Coal tar is also among the treatment options. Creams containing vitamin D have an effect on reducing the renewal rate of skin cells. Products containing charcoal can be used in cream, oil or shampoo forms.

In severe cases of psoriasis, systemic medications are used in addition to phototherapy and topically applied creams are also added to the treatment. It is important to keep the skin moist and soft. Systemic drug therapy is preferred especially in cases of joint inflammation and nail involvement.

Cancer drugs such as methotrexate and cyclosporine, vitamin A forms known as retinoids and fumarate-derived drugs are among the systemic drugs used in the treatment of psoriasis. In patients where systemic treatment is initiated, routine blood tests should be performed and liver and kidney functions should be closely monitored.

Retinoid medications suppress the production of skin cells. It should not be forgotten that psoriasis lesions may reoccur after discontinuation of the use of these drugs. Retinoid-derived drugs also have various side effects, such as inflammation of the lips and hair loss. Pregnant women or women who want to become pregnant within 3 years should not use medications containing retinoids due to possible congenital defects.

The purpose of using chemotherapy drugs such as cyclosporine and methotrexate is to suppress the immune system response. Cyclosporine is very effective in controlling psoriasis symptoms, but its immune-weakening effect may predispose the person to various infectious diseases. These drugs also have other side effects, such as kidney problems and high blood pressure.

It has been observed that fewer side effects occur when using methotrexate in low doses, but it should not be forgotten that serious side effects may also occur with long-term use. These serious side effects include liver damage and disruption of blood cell production.

In psoriasis, there are situations that trigger the disease and cause it to flare up. These include tonsillitis, urinary tract infection, tooth decay, damage to the skin through scratching, abrasions and scratches, emotional problems, painful events and stress. All of these conditions must be treated appropriately. Patients receiving psychological support from psychiatrists or psychologists are also among the approaches that may be beneficial.

Psoriasis is a disease that is very suggestible. The patients positive feelings about getting better can closely affect the course of the disease. It is accepted that these alternative methods applied to patients psychologically relieve them and have a suggestion effect. For this reason, it is important for people with psoriasis to be under the supervision of a physician and to benefit from traditional methods.

The relationship between eating habits and lifestyle and psoriasis has not yet been fully elucidated. Getting rid of excess weight, avoiding the consumption of products containing trans or natural fats, and reducing alcohol consumption are nutritional plan changes that answer the question of what is good for psoriasis. At the same time, patients should be careful about which foods they consume cause the disease to flare up.

Stress is a major triggering factor for psoriasis. Coping with the stress of life can be beneficial in both reducing exacerbations and controlling symptoms. Breathing exercises, meditation and yoga practices are among the methods that can be used for stress control.