Psoriasis

Psoriasis is a skin disease that lasts the entire life; nobody is absolutely immune to it. It can develop in the first days of life as well as over the course of time as a result of metabolic disorders, long-lasting stressful conditions (work, family, and other factors), as well after using specific medication.

Causes of psoriasis

Psoriasis is a genetically determined immune system disorder. Currently, over 50 gene defects have been identified. The genetic changes induce metabolic disorders which cause various health complications.

E.g. skin or cardiovascular damage is mainly caused by defective lipid synthesis. Lipids are adipose matter that acts as a component of the skin’s (epidermis) intercellular “glue”. Defective lipid synthesis results in weakened skin’s protective barrier, which promotes a favourable environment for the development of various viruses. The cells “building” the blood vessels also contain lipids in their cell membrane, and defective blood vessel regeneration processes cause clotting. Blood clots cause functional and pathological defects on all levels – heart blood clots can cause heart attack, whereas blood clots in brain can cause stroke.

If the organism loses its ability to control sugar levels, it can result in diabetes, whereas immune system disorders can cause arthritis.

Signs and symptoms of psoriasis

The main signs of the disease are pink patches covered with silver (grey, white, yellowish)-coloured scales in certain areas of the body – elbows, knees, scalp. These symptoms are caused by wrong immune system signals that facilitate increased cell proliferation – new skin cells are formed within days instead of weeks. Other visual symptoms include:

• Rash,
• Delamination of the nail plate and brittle nails,
• Nail pitting,
• Dry, chapped skin on fingertips,
• Gum inflammation.

The presence of psoriasis can be indicated by other internal symptoms:

• Changes in cholesterol levels,
• Changes in sugar levels,
• Metabolic disorders,
• Joint problems.

Areas of body affected by psoriasis

If psoriasis mainly affects one limb or area of the body, it is referred to as disseminated psoriasis.

• Scalp – psoriatic focus covered with silvery scales (the skin of the scalp is frequently damaged).
• Face – can be red in colour (rosacea). Papules (small, hard and knot-like skin bumps) can form.
• Nails – delamination of the nail plate or layered nails or onycholysis. Also, the so-called thimble phenomenon – pitted impressions in the surface of the nail, reminiscent to needle points. Sometimes white or pink spots underneath the nail have been observed. 80-90% of psoriasis patients suffer from a nail disorder at some point during their lifetime; fingernails are affected more often than toenails (50% vs. 35% of patients).
• Arms – papules on elbows or the insides of elbows.
• Armpits – redness of the skin, with lesser scaling. Visually similar to fungus or erythrasma (an infection).
• Hands – dry, chapped fingertips, dry and chapping psoriatic foci in the folds of palms and insides of finger joint folds.
• Feet – toenail disorder, “moccasins” or papulose-psoriatic foci along the outer side of the foot.
• Knees – papulose foci covered with silvery scales, possibly in the hollow of the knee.
• Penis – from dot-like papules to overall skin redness, even chapped skin. Affects the head of the penis, the foreskin and the skin alike. Symptoms can be similar to fungal infections – if anti-fungal therapy is administered due to the wrong diagnosis, it can give short-term results, although in most cases it gives no results; it is advised to make an appointment with an experienced dermatologist. The disorder can be observed on female genitals as well.

Types of psoriasis and their symptoms

Multiple types of psoriasis are known; these types are classified depending on the area affected or the visual characteristics of the skin lesions.

Plaque-like psoriasis is the most common type of psoriasis. The focus (plaques) or the knot-like bump (papule or their cluster) is a slightly raised, thickened area of the skin with an even surface. It is easy to tell where the healthy skin ends and the focus begins. Foci are usually rose-orange in colour, and, in most cases, covered with silvery-white-coloured plaques. The number of foci and their placement can vary – some people can have one psoriatic focus in a certain area, others – patches over the entire body. 60–70% patients experience itching.

Inverse psoriasis or psoriasis in skin folds usually affects the skin around the armpits, groin, under breasts and other skin folds, including near the genitals and buttocks. The skin in these areas is prone to increased sweating, and the folds cause additional friction. The patches are bright red in colour and smooth (not scaly and without plaques), and are located near the skin folds. The skin can be chapped along the border of the skin lesion. Psoriatic lesions can be caused by yeast fungus (candida mycosis).

Erythrodermic psoriasis is a specific form of the disease that affects most of the body surface. It can develop together with pustular psoriasis. Since this form of psoriasis can be life threatening, medical attention must be sought immediately if the disease develops. Its symptoms include:

• Bright red skin colour;
• Peeling skin over large areas. Unlike the small scaling typical to other forms of psoriasis, this condition is often characterised by large plaques;
• Resembles a burn;
• Severe itching and pain;
• Radically changing body temperature, especially on hot/cold days.

Palmar psoriasis forms when palms are traumatised and come in contact with various substances that can cause non-specific inflammation. The trauma advances the emergence of psoriatic rash.

Guttate psoriasis is characterised by tiny, red, flaky dots instead of thick foci, resembling misted water drops. Commonly develops in children and young adults under the age of 30. Frequently develops suddenly, sometimes as a result of a respiratory infection (e.g. rhinopharyngitis, pharyngitis or tonsillitis). Guttate psoriasis can spontaneously disappear within few weeks or gradually recede. The condition can reappear in the same form or as common psoriasis. 

Psoriatic arthritis commonly develops years after the first psoriatic rash (on average, 12 years later). This chronic condition is characterised by skin inflammation (psoriasis) and joint inflammation (arthritis); it usually develops around the age of 30 to 50. The main cause for this particular health disorder is still uncertain, but it is genetics-related. Children, whose parents suffer from psoriatic arthritis, are three times more likely to develop the disease as well. The condition progresses in up to 42% of patients, men and women alike. Severe psoriatic arthritis can cause pronounced joint deformation or even disability.

Pustular psoriasis affects less than 10% of psoriasis patients. It can be a complication of plaque-like psoriasis, develop as a side effect to medication, or develop if the medication course is suddenly stopped. Skin lesions are characterised by pus pimples or pustules and usually appear on palms, bottom of feet, fingers and nails. Pustular psoriasis in its general form can be life-threatening. 

Certain types of psoriasis are not classified as a different clinical type of the skin disease, but they are recognised as a clinical form of the condition. One of those forms is the exudative psoriasis – it describes the psoriasis-weakened defensive barrier of the skin combined with allergic contact dermatitis or atopic dermatitis.

Seborrheic dermatitis similarities with psoriasis

Although seborrheic dermatitis shares visual similarities with psoriasis, the skin diseases are different:

• Visually – psoriasis is characterised by a defined, flat and pink papule that is covered with flaky, silvery-white scales, whereas seborrheic dermatitis is characterised by pinkish-yellow patches and papules with greyish or yellow-coloured scales.
• The affected area of the body – psoriatic rash can develop on the scalp, elbows, knees, genitals, nails, etc., whereas seborrheic dermatitis usually develops on the scalp, eyelids, nasolabial (nose-to-cheek) fold, fold under the chin, etc.

The diagnosis can be determined after laboratory examination. Some patients may suffer from both skin diseases.

What are the complications of psoriasis?

If psoriasis is not treated or controlled, it can cause serious health problems:

• Psoriatic arthritis (PsA) develops in cases when psoriasis has been untreated over a long period of time. This type of the disorder affects the joints, bones, axial skeleton, skin, and can cause disability and decrease life expectancy;
• Metabolic syndrome – a complex, multifactorial condition (excess body fat around the waist, increased blood pressure, high triglyceride levels, hyperglycaemia, etc.);
• Cardiovascular illnesses (Crohn’s disease, ulcerative colitis, multiple sclerosis);
• Eye disorders;
• Erectile dysfunction (vascular and blood pressure disorders affect the erection);
• Depression.

Does psoriasis affect pregnancy?

Psoriasis does not affect the woman’s ability to conceive, but multiple factors should be taken into consideration when planning a pregnancy, mostly in relation to the medication that is being used. I.e. the steroids in the medication can get partially absorbed by the blood, but the retinoids used in general therapy, such as methotrexate and cyclosporine, can have a growth-retarding effect on the foetus.

Since the child inherits half of its genes from its mother, some of those genes may also have defects associated with psoriasis development, increasing the risk of a congenital disorder. It is important to bear in mind that every situation is highly individual – the pregnancy can be without complications, and the child can develop normally, regardless of the disease.

The research data on the effects of the disease on the pregnancy period is inconclusive and contradictive, although it has been observed that the pregnancy can have impact on the severity of the disease – during the pregnancy, the mother’s organism is lacking “resources” to renew the skin, exacerbating the rash, since these resources are being used by the unborn child.

Psoriasis in children

Psoriasis in children can develop as early as the first days of life; it is commonly mistaken as atopic dermatitis or seborrheic dermatitis. The rash in children is not as thick and is less covered in scales. Early diagnosis of the disease is important in order to take all the necessary actions for improving metabolic processes. Tests may be difficult to make as it is more challenging to take blood or tissue samples, with or without anaesthesia. The treatment process does not differ much, but the child’s skin’s sensitivity to steroids and other potential side effects from steroids should be taken into consideration.

What causes psoriasis to get worse?

• Traumatising the skin in a way that induces the rash – soap that removes skin’s protective barrier, household chemicals, and other factors that dry out the skin (e.g. central heating in winter months or ventilation),
• Stressful situations (at work, at home, etc.),
• Metabolic disorders that in combination with other health problems can worsen the condition or the disease,
• Select medication – mostly medication containing lithium, beta-blockers for decreasing pressure, anti-malaria medication, etc.

Is it OK to tan or use a tanning bed with psoriasis?

People in North are more likely to suffer from psoriasis than in warmer climates. The general state of health can be significantly improved by taking a vacation to South during winter months. The UVB rays of sunlight have healing, anti-inflammatory effects; most psoriasis patients experience receding or diminished rash and the salts and minerals in the water improve the overall condition of the skin.  

It should be pointed out that a number of studies have concluded that regular tanning increases the risk of developing malignant tumours. In psoriasis treatment, specifically the UVB rays are desired; the doctor may recommend special physiotherapy procedures with UVB lamps.

Tanning beds are not recommended since the UVA spectrum of the tanning beds is not effective – it dehydrates and dries out the skin, promotes ageing processes and causes the formation of various skin growths.

Is it OK to get a tattoo with psoriasis?

Getting a tattoo is not advised since new psoriatic rash can develop around damaged or traumatised areas of the skin.

What are the psychological effects of psoriasis?

People that suffer from psoriasis suffer also psychologically. The degree of psycho-emotional discomfort largely depends on the severity and type of the skin disease. One research has found that 23% of patients experience depression, whereas 14% - anxiety; in 40% of cases, patients have been prescribed antidepressants.

Psoriasis is directly linked to depression and its forms, including vegetative dystonia. Patients with skin disorders are more likely to be depressed since the quality of life is continuously affected by the chronic nature of the disease, rash in visible areas of the body, as well as the necessity for therapy throughout the entire life. Patients often feel inferior, ashamed to go to the beach, sensitive to opinion and attitude of others, and, in severe cases, have suicidal thoughts. Psoriasis can affect the patient’s sex life (problems with erection, rash around genitals).

A new discipline has been developing over the recent years – psychodermatology, which studies the impact of the mental and emotional state on the condition of the skin. It is thought that skin disorders are directly linked to the patient’s psycho-emotional state; if the patient is suffering from depression, the skin becomes dry, itches, loses its elasticity, becomes scaly. Scientists have discovered that 40-60% of psoriasis cases are caused by emotional stress. From the psychosomatic perspective, psoriasis is the result of the person’s dissatisfaction with the self, the body; the more pronounced the negative attitude, the more severe the disease.

Meditation, hypnosis-induced relaxation, music therapy and antidepressants are all important additions to conventional therapy.

Is there a Psoriasis Day in Latvia?

Yes, the World Psoriasis Day takes place on October 29. The purpose of this day is to increase the public awareness of psoriasis (its causes and effects) since the disease affects both the quality of life of the patient and the patient’s family members. Another purpose of this day is to inform the public that psoriasis research and therapy is still incomplete, and it is an important topic for the general public as well. Further research on the disease requires investment. Although the modern therapy with biologic treatments is currently available to patients in Latvia, it is not state-paid or supported.

Is there a Psoriasis Patient Association in Latvia?

Yes. Psoriasis patient association of Latvia was founded in 1993 and is currently the only one of its kind in the Baltics. Its goal is to create a club, help with psychological problems, facilitate collaboration with medical centres.

Is there a Psoriasis Centre in Riga, Latvia?

No, such a centre does not exist, but our clinic has taken part in 6 clinical studies on psoriasis (the full list of clinical studies here). Our specialists have good knowledge of the peculiarity of psoriasis in children and the micro-symptoms of the disease (i.e. symptoms that are hard to detect and have no apparent connection with the disease), as well as are able to diagnose the disease in its early stages. The disease is evaluated not only in its topical form but also in connection with the organism and its functions, incl. metabolic disorders.

Under the supervision of Prof. J. Kisis, the first guidelines of psoriasis in Latvia were developed. These guidelines describe which treatment method should be applied to each type of psoriasis, what actions are significant during the treatment course, as well as what actions should be avoided. The guidelines were accepted by the Latvian government in 2013, and are used for compiling the list of medication that is fully or partially paid by the state during the treatment. The full content of guidelines can be seen here.

In 2016, Prof. Kisis participated in the development of follow-up guidelines on psoriasis treatment methods with biologic medication.

Diagnosing psoriasis 

Thorough examination, accurate diagnosis and identifying the potential causes of the disease are all important factors for determining the clinical diagnosis of psoriasis. During the examination, the heredity, micro-symptoms and potential variation in psoriasis laboratory result markers are all analysed and taken into account. Additional lab tests can be performed – taking of skin tissue, scale or nail sample for microscopic examination.

Important!

Psoriasis requires treatment throughout the entire life, making changes in lifestyle and diet, as well as correcting the metabolic processes. Coping with psoriasis is just as important as the timely and accurate diagnosis of it. Read more here.