Psoriasis

Dr. Wu's analysis

What is psoriasis?

Psoriasis is a chronic, non-contagious skin condition in which the immune system triggers an abnormally accelerated cell division in the skin. This results in thickened, scaly patches, often accompanied by redness, itching, and irritation. Psoriasis affects about 2 to 3% of the population. The condition progresses in waves, with quieter periods and flare-ups. It is not an allergy or an infection, but an autoimmune reaction. Good care and avoiding triggers can visibly improve the skin condition.

What causes psoriasis?

Psoriasis is caused by a disruption of the immune system, often in combination with genetic predisposition. Various external influences (such as stress, infections or skin damage) and factors in the body (such as hormonal fluctuations or certain medications) are the main causes and triggering factors.

Genetic predisposition

Psoriasis often occurs within families, indicating that heredity plays a role. Certain genetic characteristics, such as the HLA-Cw6 gene, are more commonly found in people with psoriasis. This gene increases the susceptibility to develop the condition, especially in people who start having psoriasis at a young age. If one of the parents has psoriasis, the chance is greater that a child will also get it — and that chance increases if the parent had symptoms at a young age.

Disruption of the immune system

In psoriasis, the immune system becomes disrupted, causing a certain type of immune cell, T-cells, to wrongly trigger an inflammatory response in the skin. This stimulates skin cells (keratinocytes) to divide much too quickly, leading to the formation of thick, scaly plaques. This autoimmune reaction forms the core of the condition.

Emotional and physical stress

Long-term stress, emotional pressure, or physical exhaustion can worsen or retrigger psoriasis. This is because stress affects the immune system through the connection between nerves and hormones (neuro-endocrine pathways). As a result, substances are released that stimulate inflammation in the body, which can enhance the skin reaction in psoriasis.

Medication and lifestyle

Some medications, such as lithium, beta blockers (for high blood pressure among other things) and antimalarial drugs, can worsen or trigger psoriasis. Lifestyle factors also play a role: eating salty food, smoking, alcohol use, and obesity are associated with more symptoms and a more severe course of the disease. Adjusting these habits can contribute to fewer flare-ups and a better skin image.

Infections as a trigger

Especially throat infections caused by streptococcal bacteria can trigger a specific form of psoriasis, namely guttate psoriasis. This can be recognized by small, droplet-shaped spots on the skin and is especially common in children and young adults. Other infections, such as respiratory infections or HIV, can disrupt the immune system, causing psoriasis to flare up or worsen.

Who is susceptible to psoriasis?

Not everyone gets psoriasis, but some people are more likely to develop it. This is often related to genetic predisposition, hormonal fluctuations, and certain lifestyle factors. Below is an overview of groups that are more susceptible to the development of this skin condition.

People with hereditary burden

Psoriasis is more common in people who have it in their family. Especially if both parents have psoriasis, the chance of developing the condition is greater. This is related to hereditary factors that affect the immune system. A known genetic trait is HLA-Cw6, which is often seen in people who start having psoriasis at a young age. Other hereditary variations, such as IL12B, IL23R and TNFAIP3, can also contribute to activating inflammatory processes in the skin. Due to this genetic predisposition, the body reacts faster to stimuli, which can cause psoriasis to occur earlier or more severely.

Young adults and elderly

Psoriasis can start at any age, but there are two moments when it often occurs. The first peak is between the ages of 15 and 35 - we call this type I psoriasis. This form often starts earlier in life and usually occurs in people with a genetic predisposition. The second peak, type II, is more often seen after the age of 60. This usually arises without a clear family history. Both forms can have a different course and are sometimes triggered by different factors, such as stress, infections or certain medications.

People with overweight

Overweight and obesity can exacerbate psoriasis because adipose tissue releases inflammatory-promoting substances, such as cytokines (for example, TNF-α and IL-6). These substances stimulate the immune system, which can lead to increased activity of the inflammatory processes that are already disrupted in psoriasis. As a result, flare-ups can become more frequent or severe.

People with other autoimmune diseases

Psoriasis often occurs in people who also have other inflammatory diseases, such as rheumatoid arthritis, celiac disease, or chronic intestinal inflammations (such as Crohn's disease or ulcerative colitis). This seems to be related to a shared disruption of the immune system, where not only the skin, but also other parts of the body are affected. It emphasizes how psoriasis is not just a skin condition, but can be part of a broader immune response.

Smokers and alcohol users

Both smoking and excessive alcohol consumption can exacerbate psoriasis. They cause inflammatory processes in the body to become more active, which can intensify symptoms and make treatments less effective. For many people with psoriasis, it turns out that quitting smoking and moderating alcohol consumption can really make a difference in how well the skin responds and how stable the condition remains.

How do you recognize and distinguish pigmentation spots?

How can you recognize psoriasis?

Psoriasis is often recognizable by noticeable skin changes, but how it looks can vary from person to person. However, there are a number of complaints that many people with psoriasis experience. These are the most common:

Redness and flaking

Typical for psoriasis are well-defined, red spots with a white or silvery scaling. These so-called plaques often appear on the elbows, knees, lower back and the hairy scalp. The skin there is thickened and feels rough. The spots are often symmetrically distributed over the body. Less known, but common locations are also the navel and buttock crease—spots that are easily overlooked during inspection.

Itching and a tight feeling

Many people with psoriasis suffer from itching, which can sometimes be very intense. The skin can also feel taut or tense, especially when it dries out or during rapid temperature changes, such as going from outside to inside in the winter. Scratching often provides temporary relief, but can actually further damage the skin. This can lead to new psoriasis spots forming in areas where the skin is irritated or injured, a phenomenon known as the Köbner phenomenon.

Changes to the nails

Nail psoriasis is common in people with psoriasis and manifests itself in pits, discoloration or detachment of the nail. Approximately 40% of people with skin psoriasis have nail abnormalities; with psoriatic arthritis, this is even 80%. Because these nail changes sometimes occur years before joint complaints, they can be an early sign of arthritis. Early recognition is therefore important for both skin and joint care.

Flakes on the scalp

You can recognize psoriasis on the scalp by coarse, white-silver flakes that are firmly attached to a red and sometimes painful skin. Unlike regular dandruff, the skin is often inflamed and sensitive. Combing or touching can be painful, and the flakes can also extend beyond the hairline, such as on the forehead or behind the ears.

Symmetrical distribution (bilateral)

A typical characteristic of psoriasis is that it often occurs symmetrically: on both sides of the body in the same place. Think of both elbows, knees or ear folds. This bilateral distribution helps doctors in making the correct diagnosis, as other skin conditions often occur more on one side.

Which skin problems look like psoriasis?

Psoriasis can strongly resemble other skin conditions in appearance. Therefore, a correct diagnosis is important to avoid confusion and initiate the right treatment. Below is an overview of skin conditions that are often confused with psoriasis.

Seborrheic eczema

Seborrheic eczema is characterized by redness and fine to moderately coarse, yellowish-oily scaling. The skin feels oily and is mainly affected in sebaceous gland-rich areas such as the nasal folds, eyebrows, and the hairy scalp. Unlike psoriasis, the edges are not sharply defined.

Constitutional eczema

Eczema causes dry, red, and itchy spots, often in the elbow or knee folds. The flakes are thinner than with psoriasis and the distribution is often asymmetrical. The symptoms can come and go in waves, depending on factors such as allergies or stress.

Lichen planus

Lichen planus is recognized by purplish, shiny bumps that often itch. They usually appear on the wrists or ankles and are flat in shape. Nail changes can also occur, but flaking - as with psoriasis - is usually absent.

Pityriasis rosea

This rash often starts with one larger spot (the "herald patch"), followed by smaller flaking spots in a herringbone pattern on the torso. It usually occurs in young people and disappears on its own within 6 to 8 weeks.

What types of psoriasis are there?

Psoriasis has various clinical forms, each with its own characteristic, location, and course. Below is an overview of the most common types.

Psoriasis vulgaris (plaque type)

The most common form of psoriasis, recognizable by thickened, flaking plaques on the skin. These spots are sharply defined, red, and covered with silvery scales. They often appear on the elbows, knees, lower back, and scalp. This type has a chronic, varying course.

Guttate psoriasis

Guttate psoriasis is recognized by small, drop-shaped red spots that appear scattered across the torso, arms, and legs. This form of psoriasis often comes on suddenly, usually after a throat infection. It is more commonly seen in children and young adults. Sometimes the rash disappears on its own, but it can also transition into the more chronic plaque form of psoriasis.

Inverse psoriasis

In case of inverse or flexural psoriasis, smooth, red spots without clear scaling occur, especially in the armpits, groin, buttock crease or under the breasts. Due to the moist skin folds, the skin can become irritated quickly. This form is often confused with fungal infections or intertrigo.

Nail psoriasis

Nail psoriasis can occur independently, but can also be associated with skin or joint complaints. Characteristic symptoms are small pits in the nail, yellow-brown discoloration, thickening of the nail and sometimes partial detachment of the nail plate. These changes can make it difficult to use the hands and in some cases are an early indication of psoriatic arthritis, an inflammatory form of rheumatism that affects the joints.

Pustular psoriasis

This rare form is characterized by sterile pus blisters on a red, inflamed skin. This can be limited to the palms of the hands and soles of the feet (palmoplantar) or spread over the entire body (generalized). Often accompanied by fever and general malaise; medical treatment is necessary.

How do you effectively treat pigmentation spots?

What can I do about it myself?

Self-care plays a major role in controlling psoriasis. With the right skin care and a few lifestyle adjustments, you can reduce flare-ups and make your skin feel more comfortable.

Daily moisturizing keeps the skin supple.

A dry skin often makes psoriasis worse. Therefore, apply a mild, fragrance-free cream to your skin daily. Opt for ingredients such as niacinamide or aloe vera - these soothe the skin, reduce flaking, and help restore the natural skin barrier.

Do not damage the skin.

Scratching, shaving without proper protection, or tight clothing can irritate the skin. This can lead to new spots due to the so-called Köbner phenomenon. Wear soft clothing, keep your nails short, and be careful with wounds.

Stress Management

Psoriasis and stress are closely linked. Relaxation techniques such as breathing exercises, yoga, or walking in nature can contribute to a more stable skin. A good sleep routine and sufficient breaks throughout the day also help to calm the nervous system.

Pay attention to what you eat.

There is no special diet that cures psoriasis, but healthy eating can provide support. Think of food with omega-3 fatty acids, antioxidants, and sufficient vitamin D. Try to limit processed food, alcohol, and sugar-rich products as much as possible.

Gentle cleansing

Use a pH-skin neutral cleanser that does not contain alcohol, perfume or sulfates. Too aggressive cleaning damages the acid mantle, causing the skin to become irritated more quickly and flaking to increase. Cleanse with lukewarm water and gently pat the skin dry.

What treatments are there?

For moderate to severe psoriasis, additional treatments are often necessary, under the supervision of a doctor. These treatments aim to reduce inflammation in the skin and restore the accelerated cell division to balance. They are usually used when local creams do not have enough effect or when the symptoms spread over a large part of the body.

Medicinal creams and gels

Metronidazole, azelaic acid, or ivermectin (Soolantra) can reduce inflammation and redness. They are usually applied one to two times per day on the affected skin.

Oral antibiotics

For persistent inflammations, low doses of doxycycline or minocycline are often prescribed. These work anti-inflammatory, not just antibacterial.

Dishwasher

Effective for visible veins (telangiectasia) or persistent redness. Works by cauterizing small blood vessels and reducing redness. The most suitable period to have it done is in the autumn and winter months.

Brimonidine gel (vasoconstrictor)

Is used for persistent redness as an alternative to vascular laser. It temporarily narrows the superficial blood vessels. The effect starts quickly, but is temporary (a few hours).

Treatment of ocular rosacea

Eye complaints are treated with artificial tears, warm compresses, and sometimes oral antibiotics. If complaints persist, a visit to an ophthalmologist may be necessary.

What other treatments are there?

For moderate to severe psoriasis, additional treatments are often needed, under the supervision of a doctor. These treatments aim to reduce inflammation in the skin and rebalance accelerated cell division. They are usually used when local creams do not have enough effect or when the symptoms spread over a large part of the body.

Local therapies

Ointments with corticosteroids, vitamin D analogues or combinations thereof are frequently prescribed. They inhibit inflammation and slow down cell division. When used correctly, they effectively reduce redness, flaking and thickening, with relatively few systemic side effects.

Light therapy

UVB light therapy can be effective for widespread psoriasis. It slows down cell division in the epidermis and reduces inflammation. The treatment takes place under medical supervision and requires multiple sessions per week.

Systemic medication

In severe or therapy-resistant forms, agents such as methotrexate, cyclosporine or acitretin are used. There are also biological medicines available that specifically inhibit inflammation pathways. These treatments are prescribed and monitored by a dermatologist.

What are the triggers?

Certain habits and products can worsen psoriasis or provoke flare-ups. By avoiding these triggers, you support a more stable skin condition.

Tobacco and alcohol

Smoking increases the risk of developing psoriasis and makes the skin more susceptible to inflammation. Alcohol often worsens the course and can reduce the effectiveness of medication. Quitting or reducing yields health benefits and skin improvement.

Chronic stress

Prolonged tension and emotional stress activate inflammatory pathways in the body. Stress hormones affect the immune system, which leads to a worsening of psoriasis. Create moments of rest in your day and be alert to signs of overload.

Aggressive skincare

Some ingredients in cosmetics can unnecessarily burden your skin, especially if you have psoriasis. Think of substances such as SLS (foaming agent), alcohol, perfume, and other irritating additives. They can disrupt the natural protective layer of your skin, which can lead to more itching, redness, and flaking. Preferably choose mild, fragrance-free products with a skin-friendly pH, which are specially developed for sensitive or affected skin.

Skin damage and sunburn

Small injuries such as abrasions, cuts, or even sunburn can trigger new psoriasis spots in those areas - this is called the Köbner phenomenon. Try to protect your skin as much as possible, for example during sports or gardening. Always use a sunscreen with mineral filters such as zinc oxide or titanium dioxide, especially if you are sensitive to sunlight.

Iconic Elements products

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🛈 These products are cosmetic and intended for the care of healthy, sensitive, or unbalanced skin. They are not intended as a medical treatment or to replace professional medical advice. For personalized skin advice, we recommend consulting a skin therapist or doctor.

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Product

Description

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Tips when you have psoriasis

Tip 1: Take care with niacinamide

Niacinamide (a form of vitamin B3) is a mild ingredient that helps to strengthen the skin barrier. It can reduce redness and is suitable for daily use, even on sensitive skin. For the best results, choose products with 4-5% niacinamide.

Tip 2: Aloe vera for relaxation and recovery

Aloe vera is known for its soothing and hydrating effects. It helps calm the skin after a flare-up and reduces the feeling of dryness or tightness. Together with ectoine and oat extract, it forms a nice, skin-friendly base.

Tip 3: Prevent dehydration

Psoriasis spots lose moisture faster. Therefore, use a protective cream several times a day that both hydrates the skin and seals against moisture loss. Ingredients such as shea butter, squalane, and glycerin help retain moisture and make the skin more supple.

Tip 4: Be careful with exfoliating.

Scrubs or peelings can actually irritate a vulnerable skin and provoke new spots. It's better to avoid coarser products. Do you still want to exfoliate? Then choose a mild variant and possibly consult with a skin therapist or doctor about what suits your skin condition.

Tip 5: Also consider lifestyle

Your skin reacts to more than just skincare products. Peaceful sleep, less stress, and healthy nutrition can make a big difference. Think of omega-3 fatty acids from fatty fish, vitamin D, and antioxidants from colorful vegetables and fruit - all building blocks that support your skin from the inside out.

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