Psoriasis is a chronic auto-inflammatory disease that mainly affects the skin. It is not contagious. Clinically it is characterized by erythematous macules, papules, and plaques, which are covered by silvery scales. The classic location of the lesions is on the elbows and knees. It affects men and women of all ages equally and approximately 1-3% of the world's population.
Factors associated with psoriasis's onset and progression are genetic and environmental. There is a heredity relation to the predisposition to the disease. Stress, climate – and especially low temperatures combined with high humidity – some medications and certain microbial infections are blamed for triggering psoriasis, while drinking alcohol and smoking worsen the symptoms.
There are several types of psoriasis
- Plaque Psoriasis: It is the most common type and manifests as well-defined, red, scaly plaques, and its characteristic symptoms are itching, scaling, and spotting.
- Guttate Psoriasis: Characterized by the appearance of small, red, individual tear-shaped papules or plaques on the skin. These lesions appear in extensive areas of the body, such as the trunk, limbs, and perhaps the scalp and face. Psoriasis symptoms of this type usually appear very suddenly in younger patients, especially after a streptococcal infection.
- Inverse Psoriasis: Usually occurs in overweight people in the armpit, groin, lower abdomen, and chest areas. Symptoms of psoriasis of this type do not include peeling but redness in the area of the folds with clear boundaries.
- Pustular Psoriasis: It is characterized by the formation of pustules, which dry up after a few days. Localized pustular psoriasis of the palms and soles and generalized pustular psoriasis characterized by a generalized rash occur.
- Erythrodermic Psoriasis: Appears either suddenly without a previous history of psoriasis or as a result of worsening of pre-existing chronic psoriasis. This is a severe form of the disease, characterized by universal inflammation and redness of the skin (>90%), and requires immediate medical treatment.
- Nail Psoriasis: Occurs on fingernails and toenails and is characterized by pitting, yellow discoloration that looks like an oil drop under the surface of the nail, onycholysis, and thickening of the skin under the nail that can lead to nail loss.
Psoriatic arthritis is a painful, inflammatory disease of the joints. Its incidence among patients with psoriasis reaches 15 to 25%. It causes inflammation in the joints and, more often, in the wrists, knees, ankles, and neck. It usually affects the tips of the fingers and toes and may also affect the spine. Its course is often progressive and requires timely and effective systemic treatment to prevent joint erosion.
Existing treatment approaches for psoriasis include topical treatments, phototherapy, classical systemic therapies, and biological agents. Treatment is individualized for each patient and takes into account the severity, extent, and form of the disease, as well as the patient's response to previous treatments. At the same time, the dermatologist will evaluate the possibility of administration regarding the chosen treatment's tolerance and safety. When administering a particular treatment, age, psychological status, and even seasonality are also considered (e.g., for some patients, exposure to the sun during the summer months is beneficial in itself).
