Psoriasis is a chronic and inflammatory disease characterized by specific lesions on the skin. These changes occur as a result of abnormal and excessive keratinization of the epidermis. Genetic conditions are a common factor in the occurrence of the disease.
So what is psoriasis?
Psoriasis is a skin disease. But it happens that its symptoms are observed in the case of nails, and nail changes may accompany skin changes or appear on their own. In some cases, it can also affect the joints, but these are the only internal organs that can be affected.
It is a chronic and recurrent disease that is not contagious. Patients’ skin lesions are often visible, and the disease usually affects specific areas. Psoriasis attacks:
- Scalp psoriasis;
- A larger area of the patient’s skin.
What causes Psoriasis?
Although people have had psoriasis for many years, the disease’s causes have not been clearly explained. However, it is indicated that the genetic background in which polymorphism within the HLA-Cw6 gene was observed is of great importance. The second of the indicated reasons is the immunological background.
In this case, Langerhans cells, which are located in the epidermis, as well as thymus-dependent lymphocytes, T lymphocytes, and in particular their Th1 and Th17 subpopulations, play a significant role. Environmental factors are also important – past infections, injuries, stress, and pharmacotherapy.
Symptoms of psoriasis that are observed within the skin in the active phase of the disease are characteristic. It is the so-called primary eruption which resembles a reddish-brown papule. This lump is visible against the background of healthy skin, and its surface is fine, peeling.
Individual lumpy lesions and lesions of about 1 to 2 cm in diameter are observed in the early lesions. Exfoliation of the epidermis within the primary efflorescence, scratching off the characteristic scales, changes the appearance of the patient’s skin, which becomes shiny and smooth. This condition is called the stearin candle symptom.
Another characteristic symptom is the so-called symptom of Auspitz. The skin is sensitive, and rubbing it causes damage to blood vessels and bleeding droplets at the point where the scales have been scraped off.
In the course of the disease process, the so-called symptom of the last scales consists of gradual exfoliation and removal of subsequent scales, under which the skin is smooth and pink. It is a transitional stage preceding the appearance of the stearin candle symptom.
Kobner’s symptom is a condition that is characteristic of the active form of psoriasis. The phenomenon was first described in 1872 by Heinrich Kobner. It consists in the fact that with the active form of the disease, after an injury to the skin caused by e.g., scratching, surgical cutting, piercing of an ear lobe, etc., after 6 to 12 days, lesions characteristic of psoriasis develop (along with the damage).
In the symptoms of psoriasis, apart from the characteristic stages of lesions, the course of the disease itself is also very important, especially in terms of skin lesions’ evolution and the location of these lesions. Characteristic skin changes occur one after another, in strictly defined stages.
What does psoriasis look like?
The initial changes are usually not extensive, there are small lumps, not rarely as small as a pinhead, which form skin eruptions about 1-2 cm in diameter when peeling off. Then the changes cover larger parts of the skin, transforming into large changes, usually a few centimeters in diameter. The silvery scales that cover these lesions change over time to form a thickened lesion with an uneven, rough surface.
Symptoms of common and scalp psoriasis are also observed in some cases on the scalp. Then the so-called psoriatic crown, which is characterized by changes in the form of papules and silvery scales of extensive character. Often these changes are also seen below the hairline on the skin of the forehead. Then a characteristic band is created, called a crown.
The hair is unchanged, and it is often observed that in sick people, the hair is healthy and lush. It is because the hair follicles are very well-nourished. After all, the papillae of the skin are dilated.
There are two main types of symptoms in psoriasis that affects the nail plates. The first of them is the thimble symptom with characteristic depressions on the surface of the nail plate. The second is called an oil stain symptom. These are yellow discolorations observed on the surface of the nail plate. They are lesions of the psoriatic papule that appear under the nail.
Other symptoms of psoriasis:
- Furrows on the nail surface;
- Brittleness of tiles;
- Matting the nail plate.
Main Psoriasis diagnosis
Psoriasis is diagnosed based on the patient’s examination. The clinical picture shows a chronic, relapsing course. The examination shows characteristic skin changes, including the appearance of the stearin candle symptom, Auspitz’s symptom, Kobner’s symptom, and the last husk symptom. In the history of some patients, there is a family history of the disease.
The skin lesions most often occur in very characteristic places, such as the area of the knees and elbows in the case of psoriasis Vulgaris, as well as in the case of the scalp.
Genetic conditions are cited as one of the causes of psoriasis. An analysis of the incidence within the family showed that psoriasis is frequent within the family. The highest percentage of the incidence was observed in 70% of the examined monozygotic twins with the same psoriasis lesions.
Similarly, high rates were obtained in the case of children and parents, where the probability of a child who has psoriasis (or scalp psoriasis) when both parents are ill was as much as 70%. The value of the studied index decreased when only one of the parents had psoriasis. Then the probability value drops from 70 to 30%. The inheritance of psoriasis is, therefore, quite high.
Is psoriasis contagious?
Although psoriasis is a chronic and inflammatory disease, it should be noted that it is not contagious. Infection with psoriasis does not occur through droplets, it is not caused by bacteria and airborne viruses, but it is based on genetic predisposition. There are two types of psoriasis.
Type I, in which the issues of autosomal inheritance are at the root of the disease, and the HLA Cw-6 gene is found in over 85% of cases. This type occurs in young people, and the onset of the disease is observed until the age of 40. Type II concerns patients diagnosed between the ages of 50 and 70.
Psoriasis cannot be infected through contact with a sick person.
Types of psoriasis
The main types are:
- Common psoriasis, in which skin lesions are located on the knees, elbows and hairy scalp, are typical, characteristic areas of lesions,
- Long-term psoriasis, the symptoms of which are similar to ordinary psoriasis, but the lesions are enlarged and thickened, and remain on the skin surface for a long time,
- A papillary psoriasis is a rare form of the disease that arises due to the neglect of ordinary psoriasis. It is characterized by papillary epidermal hyperplasia, most often in the lower leg area,
- Exudative psoriasis, usually accompanied by articular psoriasis, affects characteristic areas on the body, especially skin folds or joint bends,
- Sulcus psoriasis is a form of long-term exudative psoriasis. Changes on the skin are observed in the same location as in the case of exudative psoriasis, but the changes look different – they are hypertrophic, layered and wet,
- Articular psoriasis, in which the joints are affected by the disease, inflammations occurring within the joints cause morning stiffness, and in many cases also cause deformities, which can lead to permanent disability,
- Pustular psoriasis,
- Hands and feet, characterized by pustular erythematous and exfoliative eruptions.
The method of treating psoriasis depends primarily on the type of disease and the surface area of the patient’s body covered by the disease process. In light lesions where the surface of the damaged epidermis covers no more than 25% of the total body surface, local treatment is used.
In cases where the degree of epidermal damage is greater, combined treatment methods are used, in which both systemic and local treatments are used.
In the first stage of local treatment, the activities have undertaken focus primarily on the removal of characteristic psoriasis scales, and only in the second stage, the treatment focuses on inhibiting too much proliferation (cell division) of the epidermis. Four groups of preparations are most often used in local treatment. Those are:
Keratolytic preparations, representatives of this group are mainly salicylic acid and urea; the purpose of using these preparations is to reduce the number of scales, soften lesions, and thus strengthen the effect of other preparations,
Tars derived from the dry distillation of wood; in the treatment of common & scalp psoriasis they are mainly used as pastes and crinoline ointments
Topical glucocorticosteroids are a group of drugs characterized by strong anti-inflammatory, and immunomodulating properties. Drugs from this group may cause side effects. Therefore it is recommended that they should be used only under the supervision of a physician,
In particular, vitamin D3 analogs, such as calcipotriol and tacalcitol, are an alternative solution to glucocorticosteroids.