Psoriasis

In psoriasis, a non-infectious scaly skin condition is at the forefront. The skin is characterized by a sharply demarcated white raised scaly plaques on a red bottom of various sizes. Sometimes pustules are also present and from the culture there are no signs of infection. Psoriasis is often located symmetrically on the elbows, knees, around the navel, buttocks, hairy head. Itching can also occur and sometimes pain. Nails can also join, characterized by pitting, nail thickening, brown discoloration of the nail (oil slick phenomenon) and even nail peeling.

1 in 3 people also suffer from their joints. This is called psoriatic arthritis (AP). The complaints are stiffness, joints feel warm, painful and swelling in and around the joints such as hands, feet, elbows, knees, ribs and pelvis. Also enthesitis (pain of attachment of tendons to bone). for example Achilles tendon occurs. In psoriatic arthritis, the joint complaints are asymmetrical and the joint between the middle and end phalanges of the finger is affected, also called the DIP joint (Distal Interphalengale joint). The combination of the clinical picture, X-ray or ultrasound of the affected joints and blood tests can make the diagnosis AP plausible. Unfortunately, there is no reliable blood marker that can detect AP.

Other conditions linked to psoriasis include: metabolic syndrome (such as obesity, diabetes), high blood pressure, gastrointestinal (50% have non-alcoholic fatty liver disease, 0.5% have Crohn’s disease, 0.2-4.3% Celiac disease), kidney diseases, slightly increased risk (1.18-1.22x) of malignancies and mood disorders are common in psoriasis patients.

Psoriasis vulgaris is the most common form. It is characterized by symmetrical white plaques on the elbows, knees and lower back.

Psoriasis guttata is the tear drop psoriasis variety. They are small papules 1-10 mm in size, scattered over the body. It can be provoked by a throat infection, but also medicines such as beta-blockers, NSAID, antimalarial pills. There are no nail abnormalities or joint complaints.

Psoriasis inversa is located in the folds of the body, such as groin, armpits, buttocks and genital region.

Psoriasis capitis occurs on the hairy head, along the ears and hairline of the forehead. Unlike eczema, psoriasis capitis is sharply defined red scaly.

Psoriasis unguium hereby the nails are affected. There are pits, yellow-brown discoloration, thickening of the nail, onycholysis where the end of the nail comes loose, cuticle inflammation. This is often associated with psoriasis vulgaris, estimated to affect 50-80% of people, but also isolated – with no skin abnormalities. This is the case for 5-10%. Often psoriasis unguium is confused with nail fungus. In fungal nails, it is darker in color and breaks off more easily. More differences between fungal nails vs psoriasis unguim.

Psoriasis pustulosa palmoplantaris there are spots on the palms of the hands and soles of the feet. Pustules are in the foreground and flakes. It often occurs in women who smoke. Psoriasis palmoplantaris are typical psoriasis spots without pustules.

Psoriasis arthropathica joint pain due to psoriasis. 2-25% Of people with psoriasis have joint symptoms. The age is between 30-55 years old, but can also occur in children. 70% of the cases can affect 1-4 joints and only in 15% is it symmetrical (for example, both left and right wrist or left and right index finger are affected in the same period). The joints are painful, warm, swollen or stiff. More about Rheumatic complaints in psoriasis

Psoriasis occurs in both men and women and in all races. The first visible skin abnormalities start in puberty, with a peak age between 15-25 years. It can occur at any age and you can divide psoriasis into two groups based on age.

Type 1: is the most common early form and develops before the age of 40.

Type 2: the late onset psoriasis occurs after the age of 40. It can occur well into one’s 80s.

It also occurs in children, even at an age of 1 month old it can occur. Often a genetic predisposition is the cause. 1 in 3 have family members who also have psoriasis. If 1 parent has psoriasis, the child has a 10% chance of developing psoriasis. If both parents have psoriasis then the chance is 50%.

The cause has not yet been fully elucidated, the innate and acquired immune system and genetic predisposition play an important role. Often a genetic predisposition is the cause. Normally normal skin renewal takes 30 days, in psoriasis this is shortened to 3-4 days. Due to this rapid growth, the skin cells accumulate and lead to the characteristic thick white plaques.

Triggering factors differ from person to person. The triggers of psoriasis are: skin damage due to trauma, insect stings, smoking, alcohol, NSDAID painkillers, beta-blockers, tetracycline (antibiotics), ACE inhibitors, lithium carbonate, chloroquine, throat infections, especially streptococci, psychosocial stress and air pollution, especially by Cadmium.

While dermatological treatment can reduce or clear psoriasis, preventing skin triggers is also important.

There is a dermatological stimulus called Koebner phenomenon. When psoriasis is active, a mild trauma such as a scratch can cause a new area to form or even spread. About 25-30% of people with psoriasis show this phenomenon.

The basis is prevention:

• Try to avoid skin injuries such as cuts, lacerations and insect bites.
• Make sure your skin does not get sunburned. Even a mild sunburn can make existing psoriasis worse and cause new psoriasis.
• Easier said than done, but try not to scratch. Scratching tends to worsen psoriasis.

To relieve itching:

• Cold compress on the affected area.
• Apply medication as directed by your dermatologist to your skin until the psoriasis clears.
• Hydrate your skin every day. In addition, apply a cream or ointment before bedtime. This can be a soothing, conditioning cream or petroleum jelly.

Flaky hairy head:

• You can loosen flakes on the hairy head the fastest by applying a greasy ointment, Vaseline or oil in the evening. Place a towel on your pillow before bed and wash your hair the next morning. Then apply your doctor’s medicated lotion to towel-dried hair.