Psoriasis: causes, symptoms, diagnosis and treatment

By Cristiano Antonino On Aug 24, 2023

Psoriasis is a chronic and permanent dermatological disorder that predominantly affects immunocompromised individuals and can progress or regress spontaneously, to the point of leaving almost no trace of it

Its history is very ancient.

There are many books and medical manuscripts from Greek, Roman and Egyptian times that refer to the appearance of a disorder that afflicts the skin with red spots and pustules, covered with whitish scales.

Even some passages in the Bible mention it as something to stay away from.

A divine punishment very similar to leprosy and scabies, systematically leading to social isolation.

The same situation that many patients still go through today because, although psoriasis does not give great problems on a physical level (it only affects the surface of the epidermis, not the body and its systems and apparatuses), those that it does give on a personal and social level are by no means to be underestimated.

In addition to the treatments of the past, consisting of baths, mud baths and the use of creams and ointments, new and more effective ones are now being added because, although psoriasis cannot be definitively eradicated, it can be alleviated and kept under control.

Let’s take a look together at what it is, how to recognise it through the main symptoms, what the triggering factors can be and the treatments.

What psoriasis is and how to recognise it

Psoriatic disorder is not easy to spot and only a professional dermatologist can accurately diagnose it.

It is a dysfunction of the epidermis that, in most cases and in its early stages, resembles dermatitis (with which it can easily be confused).

When the epidermis is affected by psoriasis, its superficial cells, called keratinocytes, do not regenerate as they should and undergo an excess of their differentiation with relative accumulation, giving rise to accumulation, inflammation, spots and other problems such as papules or pustules.

In some cases, the most annoying and severe ones, the appearance of reddish plaques is accompanied by a constant itching sensation.

Usually, however, the disease is completely asymptomatic so that it is difficult to prevent it and catch it in time.

Psoriasis, once contracted, is chronic and relapses

It affects – fortunately – only the most superficial layers of the epidermis, generating no other problems at the level of organic systems and apparatuses.

Although it is a fairly common inflammation, it presents itself differently each time, depending on who contracts it.

In general, doctors have found certain factors that act as triggers for the disease – such as genetics, immunodepression, and the environment in which one lives – but there is still no absolute certainty as to their actual correlation to the disorder.

Psoriasis: the causes

As already mentioned, precise and systematic causes leading to the appearance of the disorder have not yet been identified.

The most established hypothesis remains the genetic one (children of a parent with psoriasis are more likely to contract it), but other factors have been identified that may contribute to the appearance or worsening of the disorder.

Psoriasis can appear due to:

trauma or injury to the skin or following all those situations that have brought great physical stress, such as violent sunburn, bone fractures and surgery;
psychological stress. In this case the body, seeing no way out for the stress to drain away at a physical level, carries out a process of somatisation at skin level, causing the signs of the pathology to appear;
infections and viruses, especially those of the streptococcus family and herpes. This type of psoriasis can almost completely disappear after antibiotic treatment;
in rarer cases it can be triggered by hormonal factors and changes, as well as by bad eating habits, excessive alcohol and smoking;
following the intake of certain particular types of drugs, which are rather destabilising for the body (systemic corticosteroids, beta-blocker drugs, antimalarials, lithium, gold salts).

In itself, psoriasis is not a serious disease, but it can remain dormant for a long time and only arise after traumatic events (and the consequent altered activity of the immune system and its T lymphocytes).

It is not contagious and is not fatal. Being near someone who has it does not lead to its transmission and, once the disease is contracted, it does not affect deeper systems and apparatuses, only the skin.

Psoriasis: the symptoms

Often only recognised by the doctor during an objective test (it is difficult for patients to recognise it and they tend to mistake it for dermatitis), psoriasis presents with red patches, papules or pustules, very similar to those given by a severe sunburn, topped by dry, whitish flaking skin.

To these more common ‘visual’ signs, one can add other symptoms such as itching, sometimes swelling or infections of the tonsils, mainly caused by streptococcal psoriasis.

The areas of the body that are usually most affected are the scalp, elbows, knees, lumbosacral and umbilical area.

However, there are several patients who also contract it in more humid and fold-prone areas such as the groin area, or on the nails, which are often the first anatomical part on which it appears.

There are also special cases in which psoriasis is quite acute and affects joints to the point of inflammation.

In these situations one speaks of psoriatic arthritis, whose symptoms and manifestations are reminiscent of a more common rheumatoid arthritis.

Ocular psoriasis, on the other hand, erupts in the area next to the eyes.

Depending on the type contracted, the symptoms and type of skin manifestations change.

Types of psoriasis

Psoriasis can present itself with patches of different shapes and colours, because there are very different types, depending on the anatomical area affected.

In rarer cases, more than one type may occur at the same time.

Plaque psoriasis. Also known as patchy or vulgar psoriasis, plaque psoriasis consists of the formation of reddish plaques on the epidermis, which in turn are covered by a thin layer of silvery scales (keratinocytes). The plaques can be of different sizes (from a few millimetres up to a centimetre in size). If they are very close together, they may join to cover entire areas of the body. It is often accompanied by itching for which it is best to avoid scratching, as bleeding of the underlying capillaries may occur.
Guttate or eruptive psoriasis. It mainly occurs in adolescents and young people who have contracted streptococcal infections, e.g. after tonsillitis. Guttate psoriasis is so called because of the almost rapid outbreak of papules, i.e. small, teardrop-shaped skin lesions, especially on the trunk, belly and back. Often before its eruption, many patients experience discomfort and disease in the pharynx, larynx and tonsils. If treated with appropriate antibiotics, however, it regresses on its own within a few days.
Pustular psoriasis. This is a form of psoriasis commonly called palmoplantar psoriasis, as it mainly affects the palms of the hands and feet. It is recognisable by the formation of pustules that, at first glance, are very reminiscent of warts, but which, once they reach the surface, flake off on their own, leaving the erythema in the open air. Sometimes the pustules may also be yellowish and contain pus. If it remains on the palmar level, it does not cause any particular problems; on the contrary, its generalised form is more ‘severe’ but equally rare.
Erythrodermic psoriasis. This is the most severe form of psoriasis in which the disease affects all (or almost all) of the skin, creating erythema and scaling. It is quite problematic because it can also have indirect effects on the metabolic system, as well as causing itching, swelling and often pain. It is quite rare and in cases where it does erupt it usually does so following immunodepressant or cortisone-based therapies.
Seborrhoeic psoriasis. This is a very mild form of psoriasis, also called sebopsoriasis or seboriasis. It is easy to confuse it with a simpler dermatitis, but a dermatologist normally notices it because, associated with the symptoms, the spots occur in areas not prone to dermatitis, such as the nails.
Psoriasis amiantacea. This is a special form of psoriasis that only affects the scalp. It manifests itself through the growth of a layer of whitish scales covering the head, especially in children, which at first glance can be mistaken for simple dandruff or dermatitis. Sometimes it may extend to the forehead, nape of the neck and ears. It causes itching, but not hair loss.
Psoriasis of the folds or fissures. In this particular case, spots erupt only in particular anatomical areas that are usually the wettest, such as the groin folds. It mainly occurs in people suffering from obesity or in the elderly, as they are more likely to have areas of the body that are not adequately oxygenated or ventilated and therefore moist.

In general, the level of severity of psoriasis is determined by the intensity of the erythema (the redder it is, the stronger it is) and by how much the skin itself flakes.

How psoriasis is diagnosed

Psoriasis is usually diagnosed following a clinical dermatological examination.

In some cases, however, it can also be detected by the general practitioner, who will usually prescribe a specialist examination.

The diagnosis occurs because the practitioner in charge identifies one or more of the symptoms listed above, also based on the patient’s medical history.

Sometimes, especially for more advanced cases, the dermatologist may proceed to perform a histological test or skin biopsy, taking some tissue samples for analysis.

Psoriasis usually appears in adulthood, around the age of 50 or 60.

However, it is not uncommon for it to be diagnosed early, between the ages of 20 and 30 or even in adolescence, especially if one or both parents are already affected.

It generally affects men and women regardless of gender and age.

Psoriasis: the most effective treatments

Psoriasis is a chronic, relapsing disease that never disappears completely, but can regress spontaneously, especially at certain times of the year.

Doctors have noted that proper exposure to UV radiation and solar vitamin D positively influences the course of the disorder, making it less aggressive in the summertime.

The possible treatments discovered and used vary depending on the case and the intensity with which the disease manifests itself.

There are no 100% effective cures because everything varies depending on the person who contracts it.

As a rule, these drugs and therapies are able to prevent psoriasis from worsening, keeping the inflammation under control.

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Here are the main effective treatments to date:

Use of topical products to be applied directly on the affected epidermal area: these can be creams, lotions, natural oils and emollients, or antibiotic-based (Antralin, Corticosteroids, Calcipotriol, Tazarotene).
Systemic oral therapy or injections. This is preferred for more severe cases of the disease, where a solution cannot be achieved using creams alone.
These drugs (Retinoids, Methotrexate, Cyclosporine, Mycophenolate Mofetil, Tacrolimus) act from the inside by attenuating inflammation and rehabilitating the correct functioning of lymphocytes. They should be taken with caution and only with a doctor’s prescription.
Biological or smart drugs whose active ingredient is antibodies that target only ‘sick’ keratinocytes. Using the same principle as cancer therapies, they are more specific drugs that act directly on the disease and components of the immune system. They have immunosuppressive side effects because they switch off part of the immune system, making the body more open to infection. They cannot be used during pregnancy, by those with tumours and hepatitis or heart disease.
UV and vitamin D phototherapy. Often combined with the intake of photosensitising principles, the sun has been observed to have a positive effect on the course of the disease. However, sunburn should be avoided as it worsens the situation of an already inflamed skin. They have little effect on psoriasis on the scalp, as it is prerogative for the affected area to be exposed to the sun for a fairly prolonged period of time.

In general, stress relief helps a lot against the development of the disease.

Experts always recommend maintaining a healthy lifestyle in which exercise, good nutrition and relaxation are active components.

Psoriasis: how to prevent it and effects on daily life

Although the medical industry has not yet fully identified what triggers psoriasis, it is thought to stem from hereditary reasons, autoimmune and environmental responses.

Its manifestation varies from person to person, not only depending on the level of antibodies and lymphocytes, but also on age, gender and geographical location.

Not fully understanding what triggers this epidermal reaction makes it difficult to establish certain rules of prevention.

It is advisable for individuals who are already familiarly predisposed to it to avoid excessive stress, both physical and mental, as one of the main causes is a total lack of relaxation resulting in constant anxiety.

Psoriasis, as with all diseases and disorders, has repercussions on daily life that do not so much affect the general physical state of health (as it only affects the skin and has zero mortality), but more a condition of mental well-being.

Often those who contract it feel different and uncomfortable among people, they feel judged and in the public eye because of that very obvious ‘defect’.

A person with psoriasis may gradually avoid social situations and turn to isolation, resulting in related disorders such as anxiety, social phobia and depression.

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