Psoriasis is a chronic inflammatory skin condition, non-contagious, that can appear at any age and shows no gender preference. It is classified as an autoimmune disease. More specifically, it involves the excessive proliferation and incomplete maturation of keratinocytes in the epidermis, resulting in the appearance of the characteristic lesions of psoriasis. It is a common condition, with an estimated prevalence of 1.5% to 3% of the global population.
Psoriasis is a disease with a not fully clarified pathogenic mechanism (autoimmune disorder), and its onset is influenced by multiple factors, both genetic and hereditary.
Heredity appears to play a significant role in the development of the condition (studies show that approximately 40% of patients with plaque psoriasis have a first-degree relative who also has the disease). Additionally, various environmental factors seem to favor its manifestation, such as infections (e.g., streptococcal), medications (e.g., beta-blockers, antimalarials), trauma (Koebner phenomenon), stress, and others.
The primary clinical manifestation, in most cases, is the presence of plaques covered with silvery scales. In addition to these silvery plaques, pustules may appear, as well as small drop-like plaques or large red plaques without scaling in areas prone to friction and sweating. The most common sites for lesions are the elbows, knees, and scalp.
However, the distribution can vary depending on the form of the disease, with involvement of skin folds (armpits, genital area), nails, and the palms and soles. Diagnosis is usually clinical, and in rare cases, a biopsy may be required to confirm the diagnosis or rule out other conditions.
Psoriasis is clinically categorized into the following main types:
Plaque psoriasis (Psoriasis Vulgaris): This is the most common form, characterized by erythematous, scaly plaques covered with silvery, thick, and slightly adherent scales.
Guttate psoriasis: More commonly seen in childhood and adolescence, it usually appears after an acute streptococcal upper respiratory infection. It manifests as multiple, scattered, pink, drop-like papules and plaques up to 1.5 cm in size, mainly located on the trunk and proximal limbs, often sparing the palms and soles.
Inverse psoriasis: Occurs in body folds, such as the inguinal regions, armpits, and intergluteal area.
Erythrodermic psoriasis: The most severe form of psoriasis, though rare. It presents with generalized skin inflammation, redness, and extensive scaling. It may be accompanied by symptoms such as fever, chills, malaise, and intense itching. Temporary hair loss and nail growth abnormalities may also occur. It can appear suddenly or as a progression of pre-existing plaque psoriasis.
Pustular psoriasis: Occurs in less than 5% of cases and is characterized by the presence of pustules due to the accumulation of neutrophils in the skin.
- Palmoplantar psoriasis:
Presents in one or more of the following forms: clearly demarcated plaques covered with silvery or yellowish scales, erythematous plaques, or pustules. - Nail psoriasis:
Observed in 25%–50% of patients, more commonly over the age of 40. It is often associated with psoriatic arthritis or other forms of psoriasis, and more rarely appears as an isolated condition.
It is of great importance to investigate and examine patients for possible arthritis, as 15%–30% of individuals with psoriasis will develop psoriatic arthritis. Its onset usually follows the appearance of skin symptoms. Studies have shown an increased risk of developing Crohn's disease, cardiovascular conditions, as well as metabolic syndrome in patients with psoriasis.
The available treatment options for managing psoriasis include the following:
1. Topical therapy, using topical corticosteroids, vitamin D analogues, combinations of corticosteroids and vitamin D, tar lotions, retinoids, or anthralin
2. Systemic therapy, with the administration of methotrexate, cyclosporine, retinoids, or biologic agents
3. Phototherapy (PUVA or UVB)
The choice of the appropriate treatment in each case depends on the clinical type, the extent of the disease, the patient’s age, general health condition, and the psychological burden caused by the chronic nature of the disease.
No, psoriasis is not a contagious disease. It is a condition that is “written in the DNA” of the individual and is triggered by various factors such as the use of certain medications like beta-blockers, stress, an infection, or even a common cold. It is often mistakenly confused with scabies, which is a contagious condition but entirely different from psoriasis.
At present, there is no medication that offers a definitive cure for psoriasis. Therefore, it is a condition that requires regular monitoring and ongoing treatment aimed at managing flare-ups. Treatment is individualized for each patient, and important factors include the severity and type of psoriasis, as well as the patient’s age. The attending dermatologist will recommend the most appropriate treatment for each case. However, mild forms of psoriasis can be treated with topical corticosteroid preparations or combinations of corticosteroids with vitamin D, or with newer calcineurin inhibitors. In more severe cases, oral medications may be prescribed, such as immunosuppressants (cyclosporine, methotrexate), retinoids (vitamin A derivatives), and others.
Winter is a challenging period for patients with psoriasis. In order for patients to avoid flare-ups of the condition during this time, the experts of the Hellenic Dermatological and Venereological Society (HSDV) recommend:
- Keep the skin properly moisturized, using the thickest and most emollient cream possible, in order to soothe redness and itching and reduce plaque formation.
- Choose lukewarm water, avoid long bubble baths as they strip moisture from the skin, and moisturize immediately while the skin is still damp.
- Regulate temperature and humidity at home. Ideally, indoor temperature should be maintained at 23–24°C and humidity between 30% and 50%. If humidity drops significantly, placing bowls of water near heat sources or using a humidifier can help.
- Dress appropriately. Cold and wind can irritate the skin and trigger flare-ups of psoriasis and psoriatic arthritis. Experts advise wearing soft fabrics (cotton, silk) and avoiding wool, denim, and other rough materials that may irritate the skin. Patients should also avoid sweating, as perspiration may worsen psoriasis, and they should not forget to wear a scarf, hat, and gloves when going outside.
- Drink plenty of water. Just like in summer, individuals with psoriasis should drink ample water during winter, as dehydration may aggravate the condition.
- Try to manage stress. Stress is a known trigger for psoriasis, so it is recommended to dedicate daily time for relaxation.