Psoriasis is a common condition characterized by prolonged periods of inflammation. It typically presents with well-defined areas of redness covered with silvery scales, which give the disease its name.
IS PSORIASIS A COMMON DISEASE? AT WHAT AGE IS IT USUALLY SEEN?
Psoriasis is widespread worldwide, with its frequency influenced by genetic and environmental factors. While susceptibility to the disease can be inherited from parents, it may not necessarily manifest in offspring. It affects about one or two individuals out of every 100. It occurs equally in males and females and typically begins between the ages of 15 and 30.
WHAT ARE THE CAUSES OF PSORIASIS AND WHAT FACTORS LEAD TO FLARE-UPS?
The exact cause is not fully understood, but it is believed to involve the immune system, genetic predisposition, and environmental factors. Environmental factors such as streptococcal throat infections, medications (such as corticosteroids, lithium, certain blood pressure medications, aspirin, etc.), excessive alcohol consumption, smoking, scratching, trauma, sunburn, and psychological stress can trigger or exacerbate the disease.
IS PSORIASIS CONTAGIOUS?
Psoriasis cannot be transmitted through contact with others.
WHAT ARE THE SYMPTOMS OF PSORIASIS?
The symptoms of the disease vary depending on its clinical features.
PLAQUE PSORIASIS (PSORIASIS VULGARIS)
This is the most common clinical presentation of psoriasis (80%). Typical symptoms include well-defined, red, raised patches covered with silvery scales. These patches are commonly found on the knees, elbows, scalp, and sacrum. They may also occur in areas such as the armpits, groin, under the breasts, between buttocks, behind the knees, inner elbows, and neck (inverse psoriasis). Palmoplantar psoriasis can also occur on the palms and soles.
GUTTATE PSORIASIS
Small, round, pink-red, scaly bumps resembling raindrops are seen on the upper body, arms, and legs. This type is common in children and adolescents and often follows a throat infection, resolving within a few weeks or months.
ERYTHRODERMIC PSORIASIS
This type involves more than 90% of the body surface. It can be triggered by factors such as medications, sunlight, trauma, or infection. Treatment should be administered in a hospital setting.
PUSTULAR PSORIASIS
Pus-filled pimples appear on a red base. These pustules can occur on typical psoriatic plaques or on seemingly healthy skin. It can be widespread (generalized pustular psoriasis) or localized to the palms and soles (palmoplantar pustular psoriasis).
PSORIATIC ARTHRITIS
This affects about 2 out of 10 patients and usually appears in their 40s. It commonly affects the finger and spine joints, causing symptoms such as morning stiffness, stiffness after prolonged sitting or standing, and swelling (resembling “sausage fingers”). Nail involvement is also common. Skin symptoms typically accompany joint involvement.
NAIL CHANGES IN PSORIASIS
Approximately half of patients experience nail involvement, which can manifest as pitting, separation of the nail from the nail bed, yellowish discoloration under the nail (oil drop sign), loss of a portion of the nail, and thickening of the skin under the free edge of the nail.
WHAT IS THE COURSE OF PSORIASIS?
The disease usually persists for a long time with periods of flare-ups and remission. Symptoms and severity can vary from person to person and may change over time in the same individual.
DOES PREGNANCY AFFECT THE COURSE OF THE DISEASE?
A person with psoriasis can become pregnant. The effects of pregnancy vary; the disease often improves during pregnancy but may worsen again after childbirth. A small number of patients may develop pustular psoriasis during pregnancy. Medications that can be used during pregnancy and breastfeeding should be consulted with a physician.
PSORIASIS AND OTHER DISEASES
Individuals with severe psoriasis are often prone to cardiovascular diseases, increased blood lipids, high blood pressure, and diabetes. Obesity and inflammatory bowel disease are also common.
HOW IS PSORIASIS DIAGNOSED?
Diagnosis is primarily based on clinical findings. Occasionally, a skin biopsy may be necessary.
HOW IS PSORIASIS TREATED?
There is no definitive cure for the disease, but it can be managed with appropriate treatment, leading to long-term relief. Treatment should involve collaboration between the physician, patient, and their close contacts. Medications and behaviors that can exacerbate the disease (scratching, vigorous exfoliation during bathing, exfoliating scrubs, etc.) should be avoided.
For localized psoriasis, topical treatments are usually preferred (medications that remove scales from the skin’s surface, corticosteroids, anthralin, calcipotriol [synthetic vitamin D], calcineurin inhibitors). These methods can also be used in combination. For resistant, widespread disease, methotrexate, cyclosporine A, acitretin (synthetic vitamin A), and phototherapy are used. If these treatments are ineffective, biologic agents (adalimumab, etanercept, infliximab, ustekinumab, etc.) may be chosen.
Many factors influence treatment selection and duration (extent of the disease, location, nail and joint involvement, etc.). The success of treatment depends not only on the dermatologists’ knowledge and experience but also on the patients’ adherence to the recommended treatment.
