Psoriasis - an autoimmune disease that goes deep under the skin

24. February 2023 | Skin problems

Psoriasis is a multifaceted, chronic (i.e. lifelong) systemic disease that affects more than just the skin, as inflammation can occur elsewhere - for example, up to 30% of people with psoriasis are also affected by psoriatic arthritis.

Psoriasis is a chronic autoimmune disease that affects millions of people worldwide. This skin disease manifests itself with intermittent worsening symptoms such as red and scaly patches on the skin, itching, and pain.

Although psoriasis has no cure, there are many ways to relieve the symptoms and improve the quality of life of people suffering from this disease.

What is psoriasis?

Psoriasis, or psoriasis, is a chronic autoimmune disease. It is named after the Greek word psora, which means itch.

It is one of the most common skin diseases. It is estimated that 2-3% of the world's population suffers from psoriasis, and in Slovenia between 30 and 40 thousand people suffer from it. Psoriasis can occur on the scalp, nails, hands, face, and other parts of the body.

The sexes are roughly equally represented in this skin disease, with whites more often affected than blacks.

Psoriasis is often accompanied by other comorbid conditions that result from chronic inflammation. Cardiovascular disease, chronic inflammatory bowel disease, diabetes, depression, metabolic syndrome, and high blood pressure are more common.

Causes of psoriasis - Why does psoriasis occur?

The causes of psoriasis are still partly unexplored. Scientists assume that it is an autoimmune disease in which the immune system attacks healthy skin cells thereby triggering an inflammatory response.

T cells are key in this process, stimulating skin cell overgrowth and inflammation. As a result, the body cannot remove the dead cells as quickly, so they accumulate on the surface of the skin.

It takes a healthy skin cell 357 hours to divide, compared to only 37 hours for psoriasis. In healthy skin, it takes between 28 and 35 days for an epidermal cell to move from the lower to the upper epidermal layer, whereas in psoriasis this time is reduced to 4-7 days.

In this situation, the skin cells do not mature properly and the epidermis is unable to perform its barrier function - i.e. to protect the organism from harmful external influences.

In addition to the autoimmune response, psoriasis can also be caused by other factors, such as:

Genetics: Genetics plays an important role in the development of psoriasis. Psoriasis is often inherited and is more likely to occur in families with a history of psoriasis. The likelihood of a child of a parent with psoriasis getting the disease is 10-20% and increases significantly if both parents have psoriasis when it is 60-70%.
Stress: Stress can worsen the symptoms of psoriasis and increase the risk of developing the disease.
Infections: Infections with bacteria or viruses (strep throat or candidiasis) can trigger the onset of psoriasis or worsen its symptoms.
Skin injuries: skin injuries such as scratches, sunburn, cuts, or insect bites can trigger psoriasis or worsen symptoms.
Certain medicines: Certain medicines, such as beta-blockers, lithium, and antimalarial medicines, can cause psoriasis symptoms to appear or worsen.

Other triggers such as smoking, heavy alcohol consumption, cold weather, diet, and allergies can also worsen psoriasis symptoms or cause the disease to flare up again.

Types of psoriasis

There are several types of psoriasis, the most common of which is chronic psoriasis or plaque psoriasis (psoriasis vulgaris). It is a disease in which red, scaly, and itchy plaques appear on the skin, which may cluster together to form large areas. These plaques can be localized on any part of the body, but are most common on the elbows, knees, scalp, and back.

In addition to chronic psoriasis, there are other types of psoriasis, such as:

1. Droplet psoriasis (psoriasis guttata)

The droplet form is the second most common form of the disease. It is most common in children and is most often manifested as tiny cells on the torso. It often occurs as a result of streptococcal infection. The scaling is less pronounced than in the chronic form and may eventually disappear.

2. Psoriasis inversa (psoriasis inversa)

Psoriasis inversa is a rarer form of psoriasis affecting large skin folds, with inflammatory lesions in the folds of the joints, genital area, buttocks, under the abdomen, under the armpits, and the breasts in women.

The rubbing of one skin surface against another and the moisture content of the skin folds are important factors in the formation. The skin does not peel, shiny plaques form and patients feel itching or burning.

3. Psoriasis pustulosa

In this form of psoriasis, pustules appear on the skin and are filled with a whitish fluid. Pustular psoriasis mostly affects the palms of the hands and soles of the feet.

4. Psoriasis of the nails (psoriasis unguium)

Psoriasis of the nails is often associated with other forms of psoriasis. It can be recognized by the presence of dot-like indentations in the nails. In some cases, the nail may also be detached from the base or thickened.

5. Erythrodermic psoriasis

This is the most severe form of psoriasis, in which the skin appears distinctly red and covered with scales. Symptoms can be extremely painful and include itching, burning, and dryness of the skin. The patient loses heat, water, and electrolytes in this form of psoriasis, so this type of psoriasis requires hospital treatment.

6. Psoriasis of the scalp

Psoriasis on the scalp appears as red patches that may be covered with scales. These patches can spread over the entire scalp and can also appear on the forehead, neck, and ears. Scratching can cause bleeding and infection.

7. Psoriatic arthritis (psoriasis arthropatica)

This form is a rheumatic inflammation of the joints, which occurs mainly in patients with a more severe course of the disease. It most commonly affects the joints of the hands and feet.

8. Psoriasis on the hands

Psoriasis on the hands appears as dry, cracked, and red skin that may itch or burn. Hand psoriasis can occur on the palms, fingers, nails, or the back of the hands.

Common signs and symptoms of psoriasis

The symptoms and signs of psoriasis vary from person to person. They depend on the form and severity of the disease. The most common signs include:

individual small, reddish spots
red, raised, and inflamed areas on the skin
red, scaly plaques on the skin
itching, burning of the skin accompanied by pain
dry and cracked skin which may bleed
swelling and pain in the joints
changes in the nails such as thickening, yellowing, or cracking

Psoriasis can occur at any time in life but is most common between the ages of 15 and 35. The disease is not contagious and is not transmitted by touch or air.

Treatment of psoriasis

Psoriasis is considered an incurable disease, but outbreaks of rashes can be treated. Treatment is individual for each patient. Treatment options include:

1. Local treatment

When a small part of the skin is affected and the patient has a milder form of the disease, e.g. psoriasis on the hands, psoriasis can be treated locally, i.e. with ointments, fluids, or creams, while the patient is advised to avoid aggravating factors as much as possible.

Ointments applied to the skin protect the skin and dissolve the scales while soothing the inflammation and nourishing the damaged skin.

2. Topical topical treatment

In addition to topical treatment, dermatologists often use a glucocorticosteroid. This works by reducing the immune and inflammatory response and multiplying the cells of the epidermis. Although the use of glucocorticosteroids can improve symptoms quickly, caution is needed.

Prolonged use and overapplication can thin and irritate the skin. In addition to glucocorticosteroids, vitamin D derivatives, and keratolytic are often used for treatment.

Medicines containing vitamin D derivatives are used to treat mild to moderate psoriasis as they inhibit the thickening of the epidermis. As the effect is not immediate, they are often combined with topical corticosteroids. Keratolytics are preparations with salicylic acid, which remove scales on the surface. This allows the other active ingredients to penetrate the skin.

3. UV phototherapy

Phototherapy, or light therapy, involves exposing the skin to ultraviolet rays, which reduce inflammation and skin cell overgrowth.

4. Systemic medicines

Systemic medications are given to patients with severe psoriasis who do not respond to other medications or have severe symptoms. These medicines affect the immune system and prevent excessive skin cell growth.

This type of treatment consists of tablets or injections and includes methotrexate, cyclosporine A, acetitrom, and retinoids, which are anti-inflammatory.
Some systemic medicines are biologics that reduce inflammation and skin cell overgrowth. Biologics are quite effective in treating psoriasis, but they also have side effects and should only be prescribed by specialists.

How to make life with psoriasis easier

Moisturizing the skin

Patients must take proper care of their skin, both during the flare-up period and during periods of improvement. Continuous use of nourishing ointments several times a day and short showers with non-aggressive soaps are recommended.

This helps to protect the skin, makes it more elastic, and maintains its natural microbial flora. Oil baths are also highly recommended.

Avoiding triggers

Avoiding triggers such as stress, smoking, alcohol, certain foods, and environmental factors can help prevent psoriasis symptoms from worsening.

Stress is one of the more common triggers of psoriasis. Although the pace of life today is fast and stress is almost impossible to avoid, you can at least try to alleviate it.

In this day and age, this is easier said than done, but ''time to yourself'' is very important. Many people help themselves with techniques such as yoga, meditation, and breathing.

Sunbathing

On the one hand, sunlight can help reduce psoriasis symptoms such as redness and scaling, as UV rays help reduce inflammation of the skin. In addition, the sun can stimulate the production of vitamin D in the body, which is beneficial for the health of the skin and the body in general.

On the other hand, the sun and UV rays can also worsen the symptoms of psoriasis. Too much sun exposure can cause sunburn, which can lead to additional skin problems. In addition, UV rays can also cause further irritation and inflammation of the skin, which can worsen the symptoms of psoriasis.

Dressing

It is important to choose clothes that have a soothing effect on the skin and do not irritate it. Therefore, avoid wool as it can irritate the skin.

At the same time, it is important to let your skin breathe. Covering the affected areas can worsen the condition, as sweating has an irritating effect on them.

Wear loose clothing that does not chafe the skin and choose fabrics that are breathable, soft, and wick moisture away from the body.

Healthy diet

A balanced diet is good for overall health and is even more important for psoriasis sufferers. Being overweight is one of the factors that increase the risk of developing a more severe form of psoriasis.

It is recommended to consume enough fruit and vegetables and protein (lean meat, fish, eggs). It is also advisable to include healthy fats in the diet (nuts, avocados, etc.). Try to avoid processed foods and excessive alcohol consumption.