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Psoriasis Causes, Symptoms and Treatment

The Psoriasis is an inflammatory skin disease. It is usually characterized by the appearance of thick patches of skin that peel off (which come off as white “scales”). The plaques appear in different parts of the body, most often on the elbows, knees and scalp. They leave areas of red skin.

This chronic disease evolves in cycles, with periods of remission. It is not contagious and can be well controlled by treatments.

Psoriasis can be very uncomfortable or even painful when it is manifested on the palmssoles or folds of the skin. The extent of the disease varies considerably from person to person. Depending on where the plaques are located and their extent, psoriasis can be embarrassing and harming social life. Indeed, the eyes of others on skin diseases are often offensive.

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Who is affected?

About 2 to 4% of the Western population would be affected. Psoriasis mostly affects Caucasians.

The disease usually appears in adulthood, late twenties or early thirties. It can, however, affect children, sometimes even before 2 years. Psoriasis affects both men and women.

Causes of Psoriasis

The precise cause of psoriasis is not known. Several factors would be involved in the onset of the disease, especially genetic and environmental factors. Thus, there is a family history of psoriasis in about 40% of cases. Physical stress (infections, injuries, surgery, drugs, etc.) or psychological (nervous fatigue, anxiety, etc.) can contribute to the onset of the disease.

Psoriasis could also be caused by autoimmune reactions occurring in the skin. These reactions would stimulate the multiplication of the cells of the epidermis . In people with psoriasis, these cells are renewed at a rate much too fast: every 3 to 6 days rather than every 28 or 30 days. Since the lifespan of skin cells remains the same, they accumulate and form thick crusts.

Types of psoriasis

There are several types of psoriasis. The most common form is plaque psoriasis, also called psoriasis vulgaris (because it accounts for more than 80% of cases). Other forms are

– The psoriasis in drops,

Observed mainly in children and young adults, it corresponds to an efflorescence of small lesions of psoriasis less than 1 cm in diameter predominant on the trunk and the root of the arms and thighs, sparing most often the face and occurring the most often within 15 days of an infectious ENT (but also anogenital) episode with β-haemolytic streptococcus group A (2/3 of cases), C, Gou viral. Most of the time, the rash of psoriasis in drops develops during 1 month approximately, then persists 1 month then are in half of the spontaneously resolving cases the 3rd or the 4th month. However, it happens that the gout psoriasis becomes chronic, in the form of some residual patches, or even outbreaks of disease for several years. In addition, gout psoriasis can be a mode of

The treatment of gout psoriasis is most often based on Ultra Violets delivered in the cabin under medical supervision

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– Erythrodermic psoriasis (generalized form)

– And pustular psoriasis. See the Symptoms section for a detailed description.

The locations of the plaques vary from one person to another, and we can distinguish among others:

  • The scalp psoriasis , very common;
  • The psoriasis palms and soles , which affects the palms and soles of the feet;
  • The inverse psoriasis , which is characterized by plates in skin folds (groin, armpits …);
  • The nail psoriasis (or nail).
In almost 7% of people, psoriasis is associated with joint pain with swelling and stiffness, known as psoriatic arthritis or psoriatic arthritis. This form of arthritis requires specific management by a rheumatologist and may require heavy treatments.

Evolution and possible complications

The disease evolves by quite unpredictable outbreaks and very variable depending on the individual. The symptoms usually last 3 to 4 months, then they can disappear for several months or even years (it is the period of remission) and then reappear in most cases. People with moderate to severe psoriasis can be very affected by their appearance and suffer from stress, anxiety, loneliness, loss of self-esteem and even depression.

It seems that people with psoriasis suffer more from cardiovascular disorders, metabolic syndrome and obesity, for reasons that still ignores.

The symptoms of psoriasis

  • Plaque (or vulgar) psoriasis. Well defined red plates, round or oval, covered with thick crusts of white skin that desquamate. Usually located on the elbows, knees, scalp and buttocks. These plaques can cause discomfort, pain and sometimes itching.
  • Psoriasis of the nails. Various anomalies of the nails of the hands and the feet: small “depressions” which resemble holes of thimble, detachment, crumbling, discoloration, thickening, streaks.
  • Psoriasis of the scalp. Red plates with silver scales on the scalp and the edge of the forehead.
  • Palmo-plantar psoriasis. Dry plates on the palms and soles of the feet, often painful and cracked.
  • Inverted (or inverted) psoriasis. Red plaques that appear in the folds (armpits, groin, near the genitals, in the folds of the buttocks), without scales, and sometimes painful since exposed to friction.
  • Pustular psoriasis. Plates covered with small white pustules, especially on the hands and the sole of the foot (palmoplantar pustulosis). This shape can also touch the fingertips.
  • Erythrodermic psoriasis. Almost all the skin is red and inflamed, with no specific plaques. There is often fever and chills. This is a serious form, which requires urgent treatment.
  • Psoriasis in drops. Rare form that affects mostly children and adolescents and occurs after a streptococcal infection (angina or pharyngitis, most often). The plates are small (less than 1 cm), tear-shaped, and are often present on the trunk, arms and legs.

Note. One cannot transmit the plates to other people or spread them elsewhere on one’s own body. They are not contagious.

People at risk for Psoriasis

  • People who have a family history of psoriasis. Nearly 40% of patients have one or more members of their family who are also affected. If one of the parents is affected, the risk for the child to suffer from this condition varies from 5 to 10%.
  • Obese people. Obesity is associated with an increased risk of psoriasis, like type 2 diabetes and metabolic syndrome.
  • People infected with HIV.

Risk factors

Several factors can trigger plaque formation in people who already have psoriasis.

  • drug reaction  , including lithium prescribed to treat bipolar disorder, beta-blockers for hypertension, and anti- malarial medications   ;
  • A high level of stress;
  • Scratching, cutting or insect sting
  • A sunburn ;
  • Cold and dry climates;
  • Exposure to chemicals
  • Alcohol consumption ;
  • Smoking. It worsens the symptoms and is a risk factor for this disease;
  • An infection of the throat or respiratory tract (in the case of psoriasis drops).

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Prevention of psoriasis

Preventive measures to reduce the frequency and intensity of eruptions
There is no known way to prevent psoriasis. However, it is possible to reduce the frequency and intensity of relapses. In addition to careful monitoring of the prescribed treatment, it is possible to observe what triggers the onset of symptoms. This step requires time and patience.

Here are some general tips:

  • During long exposure to the sun, it is advisable to wear an effective sunscreen (SPF 15 minimum).
  • Alcohol consumption must be greatly diminished or totally eliminated
  • Do not smoke. Several studies have clearly shown that the severity of psoriasis was related to the number of cigarettes smoked.
  • Some sufferers have their disease diminish considerably after losing a little weight. Consider changing lifestyle habits accordingly if necessary.
  • Find solutions to better manage stress. Stress is known to play a role in the onset or exacerbation of psoriasis flares. Anecdotally, it has been observed that the severity of the symptoms of a patient followed for 20 weeks was clearly related to disturbing events in his life and to his psychological distress. On this subject, consult our file Stress and anxiety.
  • Sufferers may eventually undertake psychotherapy to become aware of the events or mental states that cause certain psoriasis flare-ups.

 

Medical treatments for psoriasis

The psoriasis is a chronic disease that has no cure, it can therefore never be certain that outbreaks will not return. Nevertheless, it is possible to relieve symptoms effectively using drug products applied to the lesions. The goal is to reduce the extent of plaque and the frequency of relapses, but it is difficult to achieve complete disappearance. It may be necessary to try several treatments before finding one that is effective. It is also important to be regular in the application of treatments and to follow the doctor’s instructions, even if it is binding, if one wants to obtain good results.

The treatment is based mainly on the application of creams and ointments on the plates. In some cases, more potent treatments may be employed to slow down the proliferation of skin cells, including phototherapy or oral medications. However, the skin may become resistant to treatment over time.

Attention. Some medicines make the skin more sensitive to sunlight. Ask your doctor or pharmacist.

Creams and ointments

In any case, moisturizing or emollient creams may be helpful in reducing itchiness and moisturizing dry skin and frequent use of medicated creams. Choose a moisturizer for sensitive skin.

If the symptoms are mild or moderate, the dermatologist usually prescribes topical ointments to calm the inflammation .

These are usually corticosteroid or retinoid creams (tazarotene, Tazorac in Canada, Zorac in France), to be applied alone or in combination. A calcipotriol cream (Dovonex in Canada, Daivonex in France, most often associated with a dermocorticoid, in Daivobet in France), a derivative of vitamin D, is also used to decrease the proliferation of the cells of the epidermis. Corticosteroid creams should not be used over a prolonged period because of the risk of side effects (loss of pigmentation, thinning of the skin …) and the loss of progressive efficacy of the treatment. There are lotions and even corticosteroid shampoos for scalp lesions.

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Remarks

– Treatment of facial psoriasis, skin folds and genitals
In these areas, the skin is thinner and topical corticosteroids may cause more localized side effects. They are therefore used with caution intermittently. Calcipotriol is too irritating and is not approved for the face. Creams based on pimecrolimus or tacrolimus , which belong to the family of topical calcineurin inhibitors, are sometimes used in Canada but do not have the Marketing Authorization (MA) in France for this indication.

– Treatment of nail psoriasis Nail
psoriasis is difficult to treat because topical treatments are not very effective. Injections of corticosteroids through the nail can be made but they are very painful.

Phototherapy and PUVA therapy

Phototherapy involves exposing the skin to ultraviolet light (UVB or UVA). They are used if psoriasis covers a large part of the body or if flares are frequent. Ultraviolet rays slow cell proliferation and relieve inflammation.

These rays can come from various sources:

  • Short and daily exhibitions in the sun. Avoid prolonged exposures, which can worsen the symptoms. Ask your doctor
  • A broad spectrum or narrow spectrum UVB irradiation apparatus;
  • An excimer laser device. The UVB rays are then more powerful, but this therapy is still experimental.

Phototherapy is generally used in combination with an oral or topical medicine that sensitizes the skin to the action of ultraviolet rays: this is called photochemotherapy. For example, PUVA therapy combines exposure to UVA with psoralen, a substance that makes the skin more sensitive to light. Psoralen is administered orally or by immersion in a “bath” prior to UVA exposure. The short-term risks of PUVA therapy are negligible. In the long run, it will slightly increase the risk of skin cancer. To treat moderate-to-severe psoriasis, several sessions per week are required for approximately 6 consecutive weeks.

Oral medication

For larger and more severe forms of psoriasis, oral or injection medications are prescribed:

  • The retinoids (acitretin or Soriatane), often in combination with calipotriol or topical corticosteroids. The main side effects are dryness of the skin and mucous membranes. These drugs are also dangerous for the fetus in pregnancy and should be taken only with effective contraception.
  • The methotrexate or cyclosporine which decrease the activity of the immune system ( immunosuppressant ) and are very effective but are reserved for short phases of treatment due to significant side effects (liver damage and kidney damage, increased risk of infection).

If other treatments fail, so-called “biological” medications (adalimumab, etanercept, infliximab) may be used.

Tips for psoriasis plaque care

  • Short, regular exposures to the sun can ease a psoriasis crisis. Apply adequate sunscreen (minimum SPF 15) beforehand;
  • Take a bath each day so that the plates are flaking naturally. Add bath oil, colloidal oatmeal or Epsom salts to water. Soak for at least 15 minutes. Avoid too hot water. Use a mild soap;
  • Avoid using irritating toiletries, for example those containing alcohol;
  • After bathing or showering, apply moisturizing cream to wet skin (this is especially important in winter);
  • Avoid scratching and rubbing the affected areas. If necessary, during the night, wrap the skin with plastic wrap after applying an emollient cream or ointment .

 

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