- Dermatology Unit, Conditions
Psoriasis
What is
What is Psoriasis?
Psoriasis is an inflammatory skin condition of unknown cause, which usually affects the scalp, elbows and knees, although it can also appear in other locations. It is common for patients with psoriasis to have a family member with the condition.
Information
What causes
Its cause is unknown, it is a disease produced by the confluence of multiple factors; it is necessary, on the one hand, the genetic predisposition of the person, and this, together with some other triggering factors that are unknown, induce the onset of the disease through the alteration of certain immunological pathways.
How it manifests itself
It is a disease with multiple forms of clinical expression depending on the type of psoriasis present: vulgar, guttate, erythrodermic, inverted, palmoplantar and nail psoriasis.
Psoriasis vulgaris
It presents in the form of red, scaly plaques, most frequently located on the scalp, elbows and knees, but can appear in almost any location.
2. Guttate psoriasis
It is more frequent in young people and children, and frequently appears after pharyngeal infections. It appears in people predisposed to suffer it, in the form of small droplets of lesions distributed all over the body that usually respect the face. These lesions usually resolve spontaneously and sometimes without any treatment. They may recur or even develop into psoriasis vulgaris some time later.
3. Erythrodermic psoriasis
Consists of involvement of virtually the entire body surface by an outbreak of psoriasis. Usually the face is spared. These patients often have a personal or family history.
Inverted type is that which affects folds, in the form of bright red patches with virtually no desquamation, affecting the axillary, inframammary, inguinal or intergluteal folds. These patients are usually misdiagnosed as fungal infections, although they respond poorly to these treatments.
4. Palmoplantar psoriasis
It affects only or preferentially the palms and soles, usually with the appearance of small pustules, which give rise to scaly and erythematous lesions.
5. Nail psoriasis
It can appear with any type of psoriasis, but also in isolation or prior to the appearance of lesions in other locations. It can manifest itself as small dimples in the nail plate or striations along the nail plate, which indicate that the nail matrix is affected by psoriasis, or also in the form of the so-called “oil stain” in the free area of the nail.
How it is diagnosed
The diagnosis is fundamentally clinical and must be made by a dermatologist who is accustomed to observing this type of lesions.
In those patients in whom there are doubts, a skin biopsy may provide new data to help establish the diagnosis.
Treatment
Depending on the patient’s condition, different levels of severity of the disease can be established. Treatments will be selected according to this clinical severity.
In cases of mild psoriasistreatment will be initiated with cream medications (topical treatments). Usually, topical corticosteroids are applied alone or in combination with keratolytic agents (which reduce psoriasis scale) or vitamin E derivatives. Depending on the response to the treatments or the patient’s perception, the treatments included in the following group may be chosen.
In cases of moderate psoriasiswith extensive skin involvement, treatment with phototherapy, i.e. UVA and/or UVB radiation controlled by trained health personnel, may be considered. Drug treatments can also be used. Among them, Acitretin (vitamin A derivative), Methotrexate and Cyclosporin A (immunosuppressants) have been shown to be effective and safe. These drugs must be prescribed under medical supervision and blood tests must be performed to check that the patients do not have any organ involvement, although this is rare.
In cases of severe psoriasisIn cases of severe psoriasis, so-called biologic drugs have recently appeared, which regulate the immune system by blocking certain molecules that have been specifically implicated in the development of psoriasis. These drugs have been shown to be safe and effective, although on the other hand, they have a very high treatment cost.
FAQs
Can psoriasis be cured?
To date, no curative treatment is available.
In any case, with current treatments, psoriasis patients can be maintained with very good results in the medium to long term.