As the Dermatologist – Venereologist Dr. Konstantina Mamali explains, “Psoriasis usually appears as erythematous plaques covered by silvery white scales, which are detached from the skin. It appears mainly on the knees and elbows, nails and scalp, but can also occur anywhere on the body and in various types. The affected area may be red and scaly, or it may show pustules, depending on the type of psoriasis.”
What exactly is it?
The word “psoriasis” comes from the ancient Greek word “mange” (psora) which means scales. It occurs with intense skin manifestations, which are often found in conspicuous places and lead to an unsightly appearance. This is why they are often treated with fear by patients.
Psoriasis can occur at any age. The duration of the disease varies depending on the case, but in most patients, periods of flare-ups and remission alternate for many years during their lifetime in different clinical stages of psoriasis. With proper treatment, patients can learn to live with their condition and be in remission for a long period of time.
It is, after all, a multifactorial disease that can be caused by genetic, immunological, environmental and psychological factors. The disease causes itching in 60-70% of cases, is not contagious, is not caused by an allergy and is due to a genetic or hereditary predisposition. Approximately 1/3 of sufferers have a patient in their family. Other risk factors for psoriasis are smoking, sun exposure, seasonal changes, certain medications, especially antihypertensive drugs, as well as stress and alcoholism.
Types of Psoriasis according to symptoms
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Plaque Psoriasis
It is the most common type of psoriasis that manifests itself with red and white scaly plaques on the surface of the skin and its characteristic symptoms are itching, scaling and spotting.
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Psoriasis from Staphylococcus aureus
It is characterized by the appearance of small, scaly pink or red drop-shaped lesions. These lesions appear on 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 and in younger patients, especially after a streptococcal infection.
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Inverse Psoriasis
Usually occurs in overweight people, in the underarm, groin, lower abdomen and chest areas. Psoriasis symptoms of this type do not include scaling, but redness in the area of the folds with clear borders. It is aggravated by rubbing the area and sweating, is susceptible to fungal infections and can cause severe pain and itching.
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Pustular Psoriasis
Appears as clearly excoriated small pus-filled bumps, mainly on the palms and soles. The skin around them is sensitive, red and dry. There are 2 main types of pustular psoriasis, localized, which is limited to the hands and feet, and extensive, where psoriasis symptoms appear anywhere on the body.
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Erythrodermic Psoriasis
It is a particularly important inflammatory form of psoriasis that appears as extensive inflammation and peeling of the skin almost all over the body. The skin becomes red and is accompanied by itching, swelling and pain. It can be fatal because it increases the heart rate, raises the body temperature and causes thermoregulatory and hemodynamic disturbances in the body.
Types according to location
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Nail psoriasis
Occurs on the nails of the hands and feet. It causes discoloration, yellowish color of the nails, lines along the nails, hardening of the skin under the nails, crumbling and detachment of the nails surrounding them with inflammation. Symptoms of psoriasis of this type include subungual spotting.
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Psoriatic Arthritis
The person suffers from both psoriasis and arthritis or perhaps arthritis alone, and the symptoms are inflammation in the joints and connective tissue. It occurs most often in the fingers and toes and causes swelling. It also affects the hips, knees and spine. About 10-30% of psoriasis sufferers also have psoriatic arthritis.
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Psoriasis of the scalp
It manifests as hyperkeratotic plaques on the scalp with intense itching, pain, flaking (dandruff-like) and discomfort to the patient.
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Psoriasis of the genitals
Genital psoriasis is a form of inverse psoriasis. In this type, genital psoriasis does not show hyperkeratosis due to the specific environment of the area. Genital psoriasis is characterized by red itchy plaques with clear borders very similar to a fungal infection. Genital psoriasis requires specific treatment as the area is sensitive to corticosteroids.
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Psoriasis on the face
Psoriasis on the face is rarer than psoriasis of other areas of the body. Usually, the occurrence of psoriasis on the face is also associated with a more severe prognosis of the disease in general. It may have the appearance of red plaques with fine scaling or resemble smooth facial warts. The treatment of facial psoriasis requires a specialized Dermatologist – Venereologist as this area is quite sensitive to corticosteroids.
Treatment
Psoriasis
For each type of psoriasis, a different treatment is effective. The treatment of psoriasis is not easy and one should consult specialized Dermatologists – Venereologists. The methods available for treating Psoriasis are as follows:
Is psoriasis curable?
The skin disease is considered incurable and chronic, and no definitive cure has yet been found. It is not unlikely to suddenly subside and stay in remission, but many times the symptoms return. However, most treatments contribute significantly to symptom suppression, with long periods of disease clearance, and greatly improve patients’ quality of life. Now with modern treatments with biologic agents we achieve impressive clearance and stabilization for a long period of time.How long does the treatment of psoriasis last?
Your dermatologist will advise you on the indicated duration of treatment, as it depends on the type of treatment and the type of psoriasis. However, there should always be a maintenance treatment as there is no definitive treatment that promises no recurrence in the future.
Topical Corticosteroids
They are often the initial treatment of small, mild to moderate areas, reducing the rate of skin cell growth and reducing inflammation and itching. They are divided into mild and strong, with the latter to be used in moderation and avoiding sensitive areas such as the eyelids, face and genitals. Strong ones are mainly used on less sensitive areas, such as elbows and knees, while mild ones are used on the face, underarms or groin.
Often, these topical medications are also combined with topical keratolytics to reduce the thickness of the plaque.
Phototherapy
It is based on the effectiveness of the exposure of the skin to ultraviolet radiation from artificial sources, with or without concurrent medication that increases the skin’s sensitivity to light. Light reduces inflammation, causes local immunosuppression and helps to eliminate or reduce psoriasis. Treatment may include systemic exposure to sunlight or artificial ultraviolet light therapy and may be used in the treatment of moderate to severe psoriasis. There are 2 types of phototherapy, Ultraviolet B (UVB) phototherapy and PUVA phototherapy. UVB phototherapy exists in both natural and artificial light and helps to slow down the hyperproliferation of skin cells in the affected areas. PUVA phototherapy is based on ultraviolet A radiation.
Treatment with Laser Excimer
This form of psoriasis treatment uses localized laser light beams to control mild and moderate forms of psoriasis without damaging the healthy surrounding area. The Excimer laser produces ultraviolet B (UVB) radiation of a specific wavelength (308 nm) directly to the affected area. It does not come into contact with healthy skin, and therefore the risk of exposure to UV radiation is reduced. It has similar effectiveness to traditional phototherapy, but fewer sessions are needed as the light is stronger and penetrates deeper into the skin.
Use of biologic agents
Preferred in severe forms of the disease, when classical treatments have failed or there is a contraindication to their administration or there is a risk of increased toxicity from their use and if the psoriasis significantly affects the person’s quality of life. The use of biologic agents has a more specific effect and is therefore considered a targeted therapy. Before any biologic agent is administered, clinical and laboratory testing must be carried out, as well as the necessary vaccination schedule for influenza or any other vaccine that needs to be administered. The use of biologic agents has been effective mainly in combating extensive forms of the disease and psoriatic arthritis.
FAQ
Psoriasis
What are the causes of psoriasis?
Psoriasis is a multifactorial disease whose causes can be genetic, immunological, environmental and psychological factors. These are due to changes in the function of skin cells, mainly keratinocytes and fibroblasts.
Other factors that can increase the risk of developing psoriasis are also smoking, sun exposure, seasonal changes, possible trauma or burns, stress, certain drugs and alcoholism. All of the aforementioned can affect the onset and duration of psoriasis flare-ups.
Which medical specialties deal with psoriasis?
Dermatologists specialize in the diagnosis and treatment of psoriasis, while rheumatologists specialize in the treatment of joint damages and psoriatic arthritis.
Is psoriasis contagious?
Psoriasis is not contagious and is not transmissible, as it is not an infectious disease. Many people mistakenly believe that psoriasis is contagious because they confuse it with scabies, which is caused by a skin parasite and has nothing to do with psoriasis.
Is it true that sun exposure improves psoriasis?
Natural light has a positive effect on psoriasis, which is why the condition of most sufferers improves in the summer. This is why ultraviolet radiation treatments have been developed. The ideal exposure is at regular but short intervals. The use of sunscreen is essential and overexposure should be avoided as burns aggravate psoriasis.
If I have psoriasis, am I at risk of contracting other diseases?
Sufferers of psoriasis, especially if it is severe, may be at risk of other serious diseases such as cardiovascular problems, hypertension, obesity, diabetes, heart attack, depression and premature death. You can minimize your risk by consulting your dermatologist and following appropriate treatment as soon as the first symptoms appear.
Why should I choose Cosmetic Derma Medicine for the treatment of psoriasis?
Cosmetic Derma Medicine Medical Group is the largest and most specialized medical group in the field of Dermatology and Plastic Surgery, with 16 clinics in Greece & Cyprus. At Cosmetic Derma Medicine we apply a variety of methods for the treatment of psoriasis, such as Laser Excimer treatment, Phototherapy, as well as the administration of topical corticosteroids and the use of biologic agents.
The Medical Director of Cosmetic Derma Medicine is the Dermatologist – Venereologist Dr. Amalia Tsiatoura, while the staff consists of a medical team of highly experienced and specialized doctors of many different specialties, as well as a fully trained team of nurses. Our team is at your side every day, 24/7 for whatever you need.