Psoriasis: what are the symptoms

Psoriasis is still poorly understood, but very often disabling due to physical symptoms and its psychological consequences.

Although in some cases it resembles a simple dermatitis, psoriasis is a chronic systemic inflammatory disease. It is not a rare disease, in fact it affects about 3% of the population and it is estimated that it affects over 125 million people worldwide. A figure probably underestimated, since there is, according to clinicians, a considerable share of unrecognized or undiagnosed cases.

Psoriasis affects men and women equally and can occur at any age, even in childhood, but its appearance occurs most frequently between 15 and 35 years.

Contrary to what many people believe, psoriasis is neither an infectious nor contagious disease. The belief that it is, the result of a lack of knowledge, is instead rather rooted and leads to the marginalization of the people who are affected.

Causes and triggers

The precise causes of psoriasis have not yet been identified; It is a problem that depends on many factors, as well as a genetic predisposition.

It is certainly known that the disease is associated with an alteration of the immune system, which involves in particular T lymphocytes, which cause inflammation of the skin and induce the growth of skin cells at a higher rate than normal.

Recent research has found that interleukin 17A (IL-17A) plays a key role in the onset of psoriasis and that in the skin that is affected it is present in higher concentrations than in healthy skin. This discovery is leading to the production of drugs directed against this target.

The disease has a discontinuous and relapsing course, with phases of regression of symptoms that can last a long time, alternating with others of recovery and progression.

Some factors can cause the disease to worsen: among them stress, considered a trigger, infections, skin traumas such as stings and sunburn, smoking, obesity, hormonal or climatic changes. Trauma such as a car accident, a bone fracture or particularly debilitating surgery can promote the onset of psoriasis. Dry skin is also considered a predisposing factor, and the use of drugs such as lithium, beta blockers, ACE inhibitors is associated with the occurrence of psoriasis.

The different types of psoriasis

There are several forms of psoriasis, the most common of which is plaque psoriasis, which affects more than 80% of patients. This presents with thick and diffuse skin lesions that cause itching, peeling, burning and pain, sometimes with blood loss.

Guttate psoriasis, from the Latin term gutta which means drop, concerns 10% of cases and presents with small roundish red spots, with a diameter of two centimeters, located mainly on the upper part of the body and arms, rarely on the face. The rash resembles that of an exanthematous disease. It also affects children and adolescents, often as a result of streptococcal infections.

Much less common are the other forms, each affecting about 3% of patients. Erythrodermic psoriasis causes larger erythematous and very annoying spots associated with intense itching and burning sensation. Often this form develops in patients who suddenly stop oral treatment for plaque psoriasis. It is a severe form that exposes the person to a difficulty of thermoregulation, since the skin loses its barrier function.

The pustular form most often affects the palms of the hands and feet, with the appearance of pustules containing pus, sometimes painful and disabling.

Finally, inverse psoriasis affects the areas of contact, such as the axillary cables, the groin or the area between the buttocks. Here desquamation is absent, while the skin appears inflamed and reddened, but smooth and dry.

Symptoms of psoriasis

Skin manifestations of psoriasis most often affect the elbows, knees, scalp, lower back. However, they can appear in any area of the body, as well as on the nails and mucous membranes of the mouth or genital area. In some cases scalp psoriasis can cause hair loss.Plaque psoriasis causes raised red patches, covered with a silvery/white layer of dead skin cells.

Psoriasis is not simply an aesthetic problem, but a disease that causes numerous disorders and that can compromise many aspects of people’s daily lives: relational, affective, social, work. Those suffering from psoriasis are also more prone to anxiety and depression, can be led to isolate themselves socially due to the difficulty of being accepted and see their working capacity reduced.

The disease can cause stress, anger, frustration, feeling of embarrassment and physical discomfort; Even when it occurs in a mild form, it produces negative effects on daily life. Psoriatic syndrome can also affect overall health, increasing the risk of developing other diseases such as diabetes and heart disease.

In addition, approximately 30% of patients develop psoriatic arthritis and/or ankylosing spondylitis over time. These are two severely progressive rheumatic forms that, if not treated promptly, damage the joints and spine, causing deformities and disability.

Diagnosis

The diagnosis of psoriasis requires consultation with a dermatologist and is done with a careful examination of the skin.

The diagnosis is not always immediate because psoriasis resembles other dermatological diseases; In doubtful cases, the doctor may resort to a biopsy, which is also useful to accurately determine the type of psoriasis, taking a skin sample from a lesion. It is not possible to diagnose psoriasis through blood tests.

The severity with which the disease manifests itself varies greatly from person to person. Psoriasis is classified according to the degree of body surface involvement and impact on quality of life.

The severity classification has three stages: mild, moderate and severe. Moderate-to-severe psoriasis is when the disease affects more than 10% of the body surface or when exposed areas such as the face, hands and feet are involved. Fortunately, only about 10% of patients have a severe stage, which can be difficult to treat, while 65% have a mild form. It must be said that severe forms are generally such from the onset, while a worsening from mild to very common forms is less frequent.

Therapies

Psoriasis cannot be cured, but treated with different therapies depending on the form and level of severity.

Topical treatments involve the application of emollient and moisturizing creams and lotions based on cortisone, not to be used for prolonged periods and on large areas of the body, or retinoids.

Another therapeutic possibility is represented by phototherapy: UVB or UVA rays, sometimes in combination with drugs, are administered through specific devices in a hospital or outpatient setting.

More severe cases are treated with immunosuppressive drugs such as methotrexate or cyclosporine. In recent years, patients with moderate-to-severe psoriasis have used monoclonal antibodies, drugs that have been shown to be able to completely “cleanse” the skin of lesions.

Whatever it is, the prescribed treatment should be followed scrupulously without suspending it on one’s own initiative or changing the doses, as is the case very frequently.

Even mild forms should be addressed immediately, while it is not recommended to wait and let the disease “vent”. The person with psoriasis should never lose contact with their doctor: even in the stages of improvement it is important to monitor the disease.

As much as the sun is beneficial for psoriasis, finally, it is necessary to expose oneself with caution; Sunburn can worsen injuries.

Psoriasis and nutrition

There are no systems for preventing psoriasis, but lifestyle still has a bearing on the evolution of the disease. Although a causal role of nutrition has not been demonstrated, it is certain that some foods can cause significant worsening of the clinical picture. Regular consumption of alcohol and spirits, for example, is linked to an increase in the extent of the disease and scales and symptoms such as itching and burning.

All foods with pro-inflammatory activity should therefore be limited, if not avoided: cold cuts and red meats, eggs, milk and dairy products, fried foods, aged cheeses, salt, sugar, coffee and chocolate.

Psoriasis and clothing

In cases of lesions extended to large areas of the body, contact with certain tissues can aggravate the symptoms of psoriasis, first of all itching.

The most suitable clothing should be made from natural fibers (breathable, which prevent overheating of the skin), should preferably be light in color and should not adhere to the skin.

Instead, avoid direct contact with wool, which due to the structure of the fiber (seen at the miscroscope appears composed of very dense “blades”) causes rubbing and irritates the lesions. All synthetic fabrics (polyester, elastane, polypropylene, polyamide) should be avoided because they reduce perspiration; The humidity that forms increases itching.

There are also “smart” fabrics. These are materials composed of a fluorine-synthetic fiber: they are waterproof, always fresh, slippery, do not absorb creams and ointments and let the skin breathe.