What is Psoriasis?

It is a chronic and recurrent inflammatory skin disease that occurs in the form of rashes covered with pearlescent white scales in various sizes and shapes.

Where Does Psoriasis Occur in the Body?

Although it can occur anywhere on the body, including the face and nails, it tends to involve the scalp, protruding areas such as the knees and elbows, and the genital area. Sometimes it can be asymptomatic and sometimes it can be accompanied by itching and burning. Up to 30 percent of patients may develop an inflammation of the joints called arthritis, which is characterized by pain and swelling in the joints. Hand knuckles, knees, elbows, and back and waist joints can be affected. If arthritis is not treated, permanent joint damage and deformities may develop. Along with the joints, an inflammatory condition called tendinitis may develop in the surrounding tendons and joint ligaments.

Are There Different Types of Psoriasis?

Psoriasis can be of different levels, including mild, moderate, and very severe. In addition, there are clinical types with different appearances called plaque, guttate, pustular, and erythrodermic. Plaque form is the most common form. It appears as a red-pink-colored raised rash on the skin covered with pearlescent dandruff, more frequently on the knees, elbows, trunk, and scalp. The guttate form, which is seen in the form of small blisters and droplets, is a more common type of the disease, which is generally widespread throughout the body and occurs especially in children following upper respiratory tract infections. Pustular psoriasis, on the other hand, is seen in the form of yellow inflamed vesicles, either only on the hands and feet, or spread throughout the body. When it is widely observed in the whole body, it can cause fever, weakness, and general condition disorders. Hospitalization may be required for the treatment. One of the rarest and most severe forms of erythrodermic psoriasis, which is characterized by widespread redness and dandruff throughout the body, usually requires treatment with hospitalization. Psoriasis can also be named according to the area of involvement (hand-foot, nail, etc.). Sometimes there may be only hand-foot involvement. This type can be confused with eczema and fungal diseases. It can also be seen on the nails as tiny pits or oil drop-shaped yellow-brown stains and thickening under the nail. It can be confused with nail fungus diseases when it is seen only on the nails.

What is the Prevalence of Psoriasis, and in Which Age and Gender Does It Occur?

It usually occurs at young ages (15-35 years). 75% of cases occur before the age of 45. However, it can also occur in infancy, childhood, and later life. Psoriasis in babies is usually observed in the diaper area and can be confused with diaper rash. Psoriasis occurs equally in both sexes. Its incidence in the world varies between 1% and 3%. It is very rarely observed in tropical countries, Latin America, China, and Eskimos. 

Is Psoriasis Hereditary, Is It Transmitted to the Child?

30 to 40% of patients have a family history. It is not a 0 percent inherited disease. If one parent is sick, the child is also at risk, while if both parents are sick, this rate rises to 41%. There is likely a multifactorial inheritance.

What are the Causes of Psoriasis?

The exact cause of psoriasis is not known. It is not a contagious disease. It occurs with the interaction of genetic and triggering environmental factors. It occurs when the normal working order of immune system cells is disrupted. These abnormally functioning immune cells cause the rapid proliferation of skin cells called keratinocytes and the activation of other immune cells with substances called cytokines and initiate inflammation. While a cell in the skin matures in approximately 28-30 days and is excreted from the skin surface, this period is reduced to 3-4 days in psoriasis patients. Therefore, since the cells are not excreted, they accumulate in the skin and the skin takes on a thick, scaly appearance.

What are the Triggering Factors of Psoriasis?

Physical trauma: Skin irritation, scratching, drying cleaners, harsh scrubbing, rubbing.

Stress: It has an important role in both the emergence of the disease and the increase in its severity.

Infections: Especially streptococcal upper respiratory tract infections may have a triggering role.

Smoking and excessive alcohol consumption: It is one of the most important risk factors that both facilitate the emergence of the disease and increase its severity.

Medications: Some medications are known to have a triggering role in the disease (such as beta-blockers, lithium, antimalarial medications, Ace inhibitors, terbinafine, calcium channel blockers, some painkillers, etc.).

What Are the Points To Be Considered During Pregnancy and Breastfeeding Periods in Psoriasis?

Psoriasis may first appear during pregnancy. On the other hand, 40% of patients with psoriasis who have had psoriasis before and become pregnant usually show improvement, while up to 50% may worsen. In the postpartum period, exacerbation can be seen in 50% of patients. A dermatologist should be consulted about which medications are safe or not during pregnancy and breastfeeding.

Are There Other Diseases Associated with Psoriasis?

Psoriasis, which was previously thought to be a disease that only affects the skin and joints, has been proven to be much more common in the general population, especially in severe disease, compared to the risk of cardiovascular diseases such as obesity, diabetes, high blood pressure, high cholesterol, myocardial infarction. The risk of developing metabolic syndrome, which is an important problem of our age, has increased significantly, especially in severe and widespread psoriasis. On the other hand, since it affects the quality of life very negatively, the management of the mental problems and mood disorders experienced by the patients is at least as important as the treatment.

Is There a Relationship Between Season and Severity of Psoriasis?

Dry and moisture-free air and little sunlight can lead to exacerbation of the disease. Natural ultraviolet (sun) rays, which are more exposed in the spring and summer seasons, may have a positive effect, but sunburns, on the contrary, can exacerbate the disease. For this reason, a dermatologist should be consulted about at which hours, how long, and how to go out in the sun.

How to Treat Psoriasis?

There is no definite cure for psoriasis. However, it is possible to control the disease and improve the quality of life with the right and personalized treatments. It should not be forgotten that each patient has a specific treatment method. In other words, there is no one-size-fits-all treatment. Mutual trust and harmony between the patient and the physician is very important to the success of the treatment. In the selection of treatment, factors such as the extent of the disease, the patient's age, weight, other concomitant diseases (diabetes, heart, high blood pressure, etc.), and the patient's occupation, habits and lifestyle are all taken into account. Since psoriasis tends to recur frequently, patients will seek different treatments other than medicine. However, it should not be forgotten that the disease is systemic and chronic, and all recommendations and options for treatment should be evaluated in the presence of a dermatologist. In addition, since stress control is very important in the management of the disease, professional help should not be avoided.

What are the Medications Used in the Treatment of Psoriasis?

Topical treatment: They are medications applied directly to the skin. This treatment is done with creams, ointments, and lotions. Topical medications are the first choice in patients with mild psoriasis symptoms or involvement of less body surface area. These include corticosteroids, retinoids, tar, vitamin D, vitamin A acids, and topical medications such as tacrolimus. Moisturizers should be used frequently at all stages of treatment as they reduce dandruff and dryness.

Phototherapy: It is applied by transmitting the therapeutic wavelengths of sunlight to the skin through fluorescent lamps in a cabinet. It is preferred in widespread diseases or in cases where there is no improvement with topical treatment. It can be applied in the form of PUVA or UVB treatment. It must be applied under the supervision of a doctor.

Systemic treatment: They are treatments in the form of oral pills or subcutaneous injections applied in moderate and severe cases with a disease that cannot be controlled with medications to be applied to the skin, and in patients who cannot be treated with phototherapy or who do not respond to topical treatments.

Conventional systemic treatments: Medications such as methotrexate, cyclosporine, and acitretin containing vitamin A acid are used. Before starting these medications, necessary tests should be done, and doctor's controls should be followed without interruption in terms of monitoring effectiveness and side effects.

Biological treatments: They are medications used in the form of injections into the skin in patients who do not respond to topical, phototherapy, and conventional systemic treatments, or in cases that prevent the use of these treatments due to high blood pressure, high cholesterol, kidney failure, and high liver function tests. They are expensive treatments. The choice of a patient-specific medication is made after the severity of the disease and the entire medical history of the patient is evaluated. It also requires regular doctor control in terms of monitoring side effects.

Preventive and supportive treatments: Quitting smoking, reducing alcohol consumption, dietary changes (fresh vegetables and fruits, low protein and low-calorie diet, fish oil rich in polyunsaturated fatty acids), maintaining a normal weight, regular sleep, regular exercise, relaxation techniques and providing good stress management are at least as important as medication treatment, both in preventing the disease and in controlling the severity of the disease.