Psoriasis

Psoriasis is a chronic, immune-mediated inflammatory disease that most often appears on the skin as red, thickened and scaly plaques. It is not an infection and is not contagious, but it can be long-lasting, flare up repeatedly and significantly affect a person’s wellbeing, sleep, daily comfort and quality of life.

Although psoriasis is often perceived as only a skin disease, it can also be associated with nail changes, scalp involvement, joint inflammation known as psoriatic arthritis, and other inflammatory and metabolic conditions. Therefore, in psoriasis it is important not only to reduce the visible skin symptoms, but also to assess disease severity, flare-up triggers, the risk of comorbidities and the most appropriate treatment.

Psoriasis can begin at any age. In some people it appears only as small plaques on the elbows, knees or scalp, while in others the disease can be widespread and painful, with severe itching, fissures, nail involvement or joint symptoms. Today, in most cases, psoriasis can be well controlled if treatment is selected according to the disease form, severity, location and the patient’s needs.

What is psoriasis?

Psoriasis is a chronic inflammatory disease caused by increased immune system activity and accelerated renewal of skin cells. Normally, skin cells mature and shed gradually, but in psoriasis this process happens too quickly. As a result, thickened, inflamed, pink or red areas with white or silvery scales develop on the skin.

The Latvian term “zvīņēde” is used in everyday language as a synonym for psoriasis. It describes one of the most visible signs of the disease — scaling of the skin. However, psoriasis is not merely a cosmetic problem. It is a systemic inflammatory disease that may be associated with joint inflammation, nail involvement, cardiovascular risk factors, excess weight, diabetes and mental health problems such as anxiety and depression.

The course of psoriasis can vary greatly. In some people, the disease remains mild for a long time and affects only a small area of skin. In others, it causes frequent flare-ups, widespread skin involvement or lesions in areas that particularly affect quality of life, such as the face, scalp, palms, soles, genital area or nails.

How common is psoriasis?

Psoriasis is one of the most common chronic inflammatory skin diseases. It can affect both women and men, and the disease may begin at any age. In Latvia, psoriasis is recognised as an important chronic skin disease affecting approximately 2% of the population, or around 40,000 people.

In some patients, the first signs of psoriasis appear in childhood, adolescence or young adulthood, while in other cases the disease begins later in adult life. The prevalence and course of psoriasis can vary greatly. In one person it may appear only as a small plaque on the scalp or elbow, while in another it may cause extensive skin involvement, nail changes, itching, pain or joint inflammation.

For this reason, psoriasis severity cannot be assessed only by the visible area of skin affected. Location, symptoms, quality of life, response to treatment and possible comorbidities must also be taken into account.

Type 1 and type 2 psoriasis

Psoriasis is sometimes divided into two types according to the age of onset and family history. This classification can help to better understand the course of the disease, but in everyday treatment the doctor always assesses the individual patient’s situation, the form of psoriasis, severity, location and comorbidities.

Type 1 usually starts earlier — often in adolescence or young adulthood. In this case, a family history is more common, meaning that psoriasis has also occurred in other relatives.

Type 2 usually starts later in life, more often after the age of 40. A family history may be less pronounced.

Regardless of type, psoriasis is not contagious. The course of the disease is influenced by genetic predisposition, immune system activity and external factors — stress, infections, skin trauma, smoking, alcohol, excess weight, medications and other triggering circumstances.

Is psoriasis contagious?

Psoriasis is not contagious. You cannot catch psoriasis by touching, hugging, sharing household items, being in the same room, swimming pool, sauna or gym. It is not a fungal, bacterial or viral infection.

This is very important because people with visible skin plaques often face unfounded caution or prejudice from others. Psoriasis plaques can look pronounced — the skin may be red, dry, thickened and scaly — but this does not mean that the disease can be passed on to other people.

Psoriasis develops due to genetic predisposition, immune system activity and external triggering factors, not as a result of infection.

Symptoms of psoriasis

The symptoms of psoriasis may vary depending on the type, location and severity of the disease. Most often, psoriasis appears as clearly defined skin plaques that are pink or red, thickened and covered with dry, white or silvery scales.

The most common symptoms of psoriasis include:

• red or pink inflamed areas of skin;
• white or silvery scales on the skin surface;
• dryness, thickening and flaking of the skin;
• itching, burning or irritation;
• painful fissures, especially on the palms, soles or in skin folds;
• bleeding after scales are removed or the skin is traumatised;
• scaling of the scalp, which may resemble severe dandruff;
• nail changes — pitting, thickening, yellowish discolouration, separation of the nail from the nail bed;
• joint pain, swelling or morning stiffness if psoriatic arthritis develops.

Psoriasis can itch, but itching is not equally pronounced in all patients. For some people, the main problem is skin scaling and visual discomfort, while for others it is severe itching, burning, pain or fissures that interfere with movement, work and sleep.

Itching in psoriasis: why should plaques not be scratched?

Itching is one of the most common and troublesome symptoms of psoriasis. It may be mild, but in some patients itching is intense and interferes with sleep, work and concentration in daily life. Itching may be worsened by dry skin, stress, overheating, sweating, mechanical irritation and unsuitable skin care products.

Although scratching may seem to provide temporary relief, it usually worsens the condition of the skin. Scratching can damage the skin, increase inflammation, cause bleeding, fissures and the formation of new plaques. In psoriasis, this is especially important because of the Koebner phenomenon — skin trauma itself can trigger a new psoriasis plaque.

Itching can be reduced by regular skin moisturising, using lukewarm water when washing, choosing gentle cleansing products, avoiding rubbing and using anti-inflammatory treatment prescribed by a dermatologist. If itching is severe, disrupts sleep or causes scratch marks, the treatment plan needs to be reviewed.

Where does psoriasis most often appear?

Psoriasis can appear almost anywhere on the body, but it has typical common locations. Classically, psoriasis plaques develop on the elbows, knees, lower back and scalp. They may be symmetrical — with similar lesions on both sides of the body.

The most common locations of psoriasis are:

• elbows;
• knees;
• scalp;
• lower back;
• palms and soles;
• nails;
• face and the hairline/forehead border;
• area around the ears;
• skin folds — armpits, groin, under the breasts;
• genital and perineal area.

Special attention should be paid to psoriasis in areas that significantly affect quality of life or require gentler treatment: the face, scalp, genital area, palms, soles and nails. In these locations, even a relatively small area of skin involvement can cause considerable discomfort.

Types of psoriasis

There are several clinical types of psoriasis. Some people have only one form of psoriasis during their lifetime, while in others the manifestations of the disease may change. Identifying the type is important because treatment and disease risks may differ.

Plaque psoriasis (psoriasis vulgaris)

Plaque psoriasis is the most common form of psoriasis. It is characterised by red, clearly defined inflammatory plaques covered with white or silvery scales. They are most commonly located on the elbows, knees, scalp and lower back.

Read more about this form of psoriasis in the Medart article “Plaque psoriasis (psoriasis vulgaris)”.

Guttate psoriasis

Guttate psoriasis is characterised by small, drop-like rashes that often appear suddenly. It is more common in children and young people and may develop after an infection, such as tonsillitis or another upper respiratory tract infection.

Read more about this form in the Medart article “Guttate psoriasis”.

Pustular psoriasis

In pustular psoriasis, sterile, pus-like blisters develop on reddened skin. They are not infectious, but this form can be severe, especially if the involvement is widespread and associated with general symptoms.

Read more about this form in the Medart article “Pustular psoriasis”.

Inverse or flexural psoriasis

Inverse psoriasis affects skin folds — the armpits, groin, skin under the breasts, the buttock crease or the genital area. In these areas, scaling may be less pronounced because the skin is more moist and constantly exposed to friction.

Scalp psoriasis

Scalp psoriasis causes scaling, itching, redness and thickened plaques on the hairy part of the scalp or along the hairline. It may resemble dandruff or seborrhoeic dermatitis.

Nail psoriasis

Nail psoriasis can cause nail pitting, thickening, yellowish discolouration, nail separation or deformity. It can resemble fungal nail infection, so the diagnosis should be confirmed by a doctor.

Erythrodermic psoriasis

Erythrodermic psoriasis is a rare but potentially dangerous form. It is characterised by very widespread skin redness, peeling, pain, weakness and problems with temperature regulation. In this situation, urgent medical care is required.

Causes and triggers of psoriasis

There is no single simple cause of psoriasis. It develops through the interaction of genetic predisposition, immune system activity and external or internal triggering factors. A person may have a predisposition to psoriasis, but the disease may appear only after a particular triggering event or life period.

The most important factors involved in the development and flare-ups of psoriasis include:

• genetic predisposition and a family history of psoriasis;
• immune system dysregulation;
• infections, especially upper respiratory tract and streptococcal infections;
• emotional or physical stress;
• skin trauma, scratches, burns, surgical scars or tattoos;
• cold and dry weather;
• smoking;
• alcohol consumption;
• excess weight and obesity;
• some medications;
• hormonal changes;
• sudden discontinuation of certain medicines without medical advice.

A psoriasis flare-up means a period when symptoms become more pronounced: new plaques appear, existing rashes enlarge, and itching, scaling or fissuring of the skin increases. During remission, symptoms may be minimal or almost unnoticeable, but this does not mean that the predisposition to the disease has completely disappeared.

Why can psoriasis appear at the site of skin trauma?

In some patients, psoriasis plaques may develop in areas where the skin has previously been injured — after scratches, abrasions, cuts, burns, surgical scars, tattoos or strong skin irritation. This phenomenon is called the Koebner phenomenon.

This means that in a person with a predisposition to psoriasis, a new plaque can appear not only “randomly”, but also at the site of skin injury. Therefore, in psoriasis it is important to protect the skin, avoid scratching plaques, avoid aggressive rubbing, not forcibly remove scales and carefully care for the skin after trauma or irritation.

Psoriasis and seasonality

In many patients, psoriasis flare-ups occur more often during the cold and dark part of the year, when the skin becomes drier, there is less sunlight and respiratory infections are more common. In winter, the skin may also be irritated by heating, dry air, temperature changes and heavy clothing.

However, psoriasis seasonality is not the same for everyone. In some people, symptoms improve in summer, while in others heat, sweating, sunburn or skin irritation can worsen the disease. Therefore, it is not correct to assume that sunlight always helps or that treatment is no longer needed in summer.

If a patient notices that psoriasis regularly worsens during a certain season, this should be discussed with a dermatologist. The doctor can adjust skin care, treatment intensity and preventive measures before the typical flare-up period.

How is psoriasis diagnosed?

Psoriasis is most often diagnosed by a dermatologist, who assesses the skin changes, their location, appearance, disease course and the patient’s symptoms. In many cases, the diagnosis can be made during a clinical examination because psoriasis has characteristic features.

The dermatologist may ask about:

• when the rash first appeared;
• whether it recurs or persists continuously;
• whether there is itching, burning, pain or fissuring;
• whether similar skin conditions occur in the family;
• whether there have recently been infections, stress, skin trauma or medication changes;
• whether there are nail changes;
• whether there is joint pain, swelling or morning stiffness.

Sometimes additional tests may be needed to distinguish psoriasis from eczema, atopic dermatitis, seborrhoeic dermatitis, fungal infection, allergic dermatitis or other skin diseases. In rare cases, a skin biopsy may be performed to clarify the diagnosis.

The doctor may also assess the severity of psoriasis — how much skin is affected, how pronounced the redness, thickening and scaling are, how the disease affects quality of life and whether the nails, scalp, palms, soles, face, genital area or joints are involved. Severity assessment may include measures such as BSA, PASI, PGA, DLQI and nail involvement scoring systems.

Treatment of psoriasis

The goal of psoriasis treatment is to reduce inflammation, scaling, itching and pain, decrease the frequency of flare-ups, improve the condition of the skin and quality of life, and recognise joint or other systemic involvement early. Psoriasis is a chronic disease that cannot currently be completely cured, but with modern and appropriately selected treatment it can in most cases be successfully controlled, achieving long-term symptom reduction or complete skin clearance.

The choice of treatment depends on the type of psoriasis, severity, location, the patient’s age, comorbidities, results of previous treatment, pregnancy plans, lifestyle and patient preferences. In mild cases, topical therapy may be sufficient, while moderate to severe psoriasis may require phototherapy, systemic medication or biological therapy.

Topical treatment

Topical treatment means applying medicinal products directly to the skin. It is the most common choice for mild or localised psoriasis, and is also used as additional therapy in more severe forms.

Topical therapy may include:

• moisturisers and skin barrier-restoring products, known as emollients;
• corticosteroid creams, ointments, solutions or foams;
• vitamin D analogues;
• combination products containing a corticosteroid and a vitamin D analogue;
• keratolytic agents that help reduce scaling;
• special products for the scalp — solutions, foams, shampoos or gels;
• gentler products for the face, skin folds and genital area.

Corticosteroid products can be very effective in reducing inflammation, but they must be used according to the doctor’s instructions. Incorrect or overly prolonged use of strong steroids, especially on the face, in skin folds or in the genital area, can cause thinning of the skin and other side effects. Therefore, randomly chosen ointments should not be used for psoriasis treatment for long periods without dermatological supervision.

Phototherapy

Phototherapy is medically controlled treatment using a specific spectrum of ultraviolet radiation. In psoriasis, narrowband UVB phototherapy is often used, as it can help reduce skin inflammation and slow down excessive skin cell division.

Phototherapy may be suitable for patients in whom topical therapy is not sufficiently effective, the disease is more widespread, or plaques are located in areas that are difficult to treat with creams and ointments alone. The number of procedures, frequency and dose are determined by the doctor.

A sunbed is not the same as medical phototherapy. In a sunbed, the type and dose of radiation are not adjusted for psoriasis treatment under the same medical supervision, and it may increase the risk of skin damage and skin cancer. Therefore, sunbeds must not be used as a self-treatment method for psoriasis.

Systemic therapy

Systemic therapy means medicines that act on the whole body — in the form of tablets, capsules, injections or infusions. It is considered in moderate to severe psoriasis, especially when the disease is widespread, significantly affects quality of life, involves special locations or cannot be adequately controlled with topical therapy and phototherapy.

Traditional systemic therapy may include, for example, methotrexate, ciclosporin, acitretin or other medicines prescribed by a dermatologist. These medicines can be effective, but they require careful assessment, checking of contraindications and regular monitoring, including blood tests or other investigations.

Systemic medicines must not be started, stopped or changed independently. The doctor must take into account liver, kidney and blood pressure status, infections, pregnancy, drug interactions and other safety factors.

Biological medicines

Biological medicines are targeted systemic therapies that act on specific inflammatory pathways of the immune system. They are usually considered in moderate to severe psoriasis if other treatment has not been sufficiently effective, has not been tolerated or is not suitable.

Biological therapy can be very effective in controlling both skin symptoms and, in some cases, psoriatic arthritis, but careful assessment is required before starting it. The doctor evaluates infection risk, vaccination status, comorbidities and other safety aspects. Regular monitoring is needed during treatment.

Biological medicines do not always mean that psoriasis is at the “most severe possible stage”. They are part of modern, evidence-based treatment used for specific patients with defined indications.

Skin care and flare-up control

Skin care is important at every stage of psoriasis. It does not replace treatment, but it can help reduce dryness, itching, fissuring and skin irritation.

In everyday life, it is recommended to:

• use moisturisers regularly;
• choose gentle cleansing products without strong fragrances;
• avoid rubbing or scratching plaques;
• avoid skin trauma;
• not forcibly remove scales;
• apply moisturiser after washing;
• follow the treatment plan prescribed by the doctor even when symptoms improve.

Consistency is important in psoriasis treatment. If treatment is used irregularly or stopped too early, the disease may flare up again. If the prescribed treatment does not help, causes side effects or is difficult to use in daily life, this should be discussed with a dermatologist rather than stopping treatment completely.

What to do during a psoriasis flare-up?

During a psoriasis flare-up, it is important to act promptly and avoid increasing skin irritation. A flare-up may present with new plaques, increased redness, itching, scaling, fissures or pain.

During a flare-up, it is recommended to:

• continue or restart the treatment prescribed by the dermatologist according to instructions;
• moisturise the skin regularly with emollients;
• wash with lukewarm rather than hot water;
• avoid rubbing or scratching plaques;
• not forcibly remove scales;
• avoid new cosmetic or skin care products that may irritate the skin;
• review possible triggers — stress, infection, alcohol, medication changes, skin trauma;
• consult a dermatologist if the flare-up is widespread, painful, rapidly worsening or does not respond to usual treatment.

During a flare-up, strong hormonal ointments, antibiotics, antifungal agents or dietary supplements should not be started independently as “treatment” if the diagnosis and treatment plan are unclear. Incorrect treatment can mask the disease, cause side effects or delay the start of effective therapy.

Scalp psoriasis

Scalp psoriasis is one of the most common locations of psoriasis. It may cause scaling, itching, redness, thickened plaques and scales visible in the hair or on clothing. Sometimes the lesions extend beyond the hairline onto the forehead, behind the ears or the back of the neck.

Scalp psoriasis can be confused with dandruff or seborrhoeic dermatitis. In psoriasis, the scales are often thicker, the plaques more clearly defined, and there may also be signs of psoriasis elsewhere on the body, such as the elbows, knees or nails.

Treatment of scalp psoriasis may include medicated shampoos, solutions, foams, gels or other products suitable for the hairy scalp. Treatment should be chosen so that it is effective and practical for everyday use. Strong or prolonged topical medication use on the scalp should follow a doctor’s instructions.

Nail psoriasis

Nail psoriasis can affect the fingernails and toenails. It may cause small pits on the nail surface, nail thickening, yellowish or brownish discolouration, separation of the nail from the nail bed, brittleness or deformity.

Nail psoriasis can sometimes be difficult to distinguish from fungal nail infection, because both conditions can cause thickened, discoloured and brittle nails. Therefore, an accurate diagnosis is important before treatment. If needed, the doctor may order tests to exclude a fungal infection.

Nail involvement in psoriasis is also important because it may be associated with a higher risk of psoriatic arthritis. If nail changes occur together with joint pain, finger or toe swelling, morning stiffness or heel/tendon pain, a doctor’s consultation is needed.

Palm and sole psoriasis

Psoriasis on the palms and soles can be particularly troublesome because these parts of the body are constantly used in everyday life. Even a small lesion on the sole can make walking difficult, while fissures on the palms can interfere with work, daily activities and hand washing.

Palm and sole psoriasis may appear as thickened, dry, scaly skin, painful fissures, redness, burning or blisters. Sometimes it is difficult to distinguish from eczema, contact dermatitis or fungal infection, so an accurate diagnosis is especially important.

This location can be relatively difficult to treat because the skin on the palms and soles is thicker, is often traumatised and is exposed to moisture, friction or chemical irritation. Treatment may require topical products, keratolytic agents, phototherapy or systemic therapy if the disease significantly affects quality of life.

Flexural and genital psoriasis

Flexural or inverse psoriasis affects skin folds — the armpits, groin, skin under the breasts, abdominal folds, buttock crease or genital area. Unlike classic plaque psoriasis, scaling in these areas may be less pronounced because the skin is more moist and constantly exposed to friction.

Flexural psoriasis often appears as pink or bright red, smoother, sensitive areas of skin. There may be burning, pain, fissures and discomfort during movement, sweating or sexual intercourse. This form of psoriasis is often confused with fungal infection, irritant dermatitis or an allergic reaction.

In the genital area and skin folds, the skin is thinner and more sensitive, so treatment must be selected with particular care. Strong corticosteroid products should not be used in these areas for long periods without medical supervision. A dermatologist can prescribe gentler topical products or adjust treatment to the specific location.

Psoriasis in children

Psoriasis can also develop in children. In children, the manifestations of the disease sometimes differ from adults — plaques may be smaller, more mildly scaly, and the scalp, face, skin folds or nappy area in younger children may be involved more often. Children, especially adolescents, also have relatively more frequent guttate psoriasis after infections.

Treatment of psoriasis in children should be particularly gentle and adapted to the child’s age, the extent and location of skin involvement. Not all medicines used in adults are suitable for children, so treatment should preferably be planned together with a dermatologist.

Read more about the signs, diagnosis and treatment of psoriasis in children in the Medart article “Psoriasis in children”.

Psoriasis and psoriatic arthritis

Some people with psoriasis may develop psoriatic arthritis — an inflammatory joint disease that can cause joint pain, swelling, stiffness and restricted movement. Psoriatic arthritis may appear after skin symptoms, at the same time as them or, more rarely, before clear skin changes.

Possible signs of psoriatic arthritis include:

• joint pain or swelling;
• morning stiffness that lasts longer than ordinary “loosening up”;
• swollen fingers or toes;
• heel pain or pain at tendon attachment sites;
• back pain with stiffness;
• nail psoriasis together with joint symptoms;
• fatigue and prolonged inflammatory discomfort.

Joint symptoms should not be ignored because untreated psoriatic arthritis can damage the joints. If a patient with psoriasis develops joint pain, swelling or morning stiffness, further assessment should be discussed with a dermatologist, family doctor or rheumatologist.

Read more about this topic in the Medart article “Psoriatic arthritis”.

Can psoriasis affect the eyes?

Although psoriasis most often appears on the skin, it is a systemic inflammatory disease, and in some patients inflammatory processes may also be associated with eye symptoms. In psoriasis, and especially in psoriatic arthritis, there may be a higher risk of certain eye inflammations.

Eye involvement may be suggested by redness, pain, increased sensitivity to light, blurred vision, watering or the feeling of a foreign body in the eye. In such cases, self-treatment or using only eye drops without a diagnosis should not be relied upon — medical assessment is needed.

If a patient with psoriasis develops significant eye pain, worsening vision or intolerance to light, urgent medical care should be sought.

Psoriasis and comorbidities

Psoriasis is not just a visible skin problem. It is a chronic, systemic inflammatory disease which, especially in moderate and severe cases, may be associated with other health problems. Therefore, in patients with psoriasis it is important to assess not only the skin but also overall health.

Psoriasis may be associated with a higher risk of the following conditions:

• psoriatic arthritis;
• excess weight and obesity;
• metabolic syndrome;
• high blood pressure;
• diabetes;
• cardiovascular risk factors;
• lipid metabolism disorders;
• depression, anxiety and reduced quality of life;
• certain inflammatory bowel diseases.

This does not mean that every patient with psoriasis will develop these conditions, but it does mean that regular health monitoring is important. A doctor may recommend checking blood pressure, body weight, glucose and cholesterol levels, as well as assessing joint and emotional health symptoms.

Lifestyle, diet and psoriasis control

Lifestyle cannot replace psoriasis treatment prescribed by a dermatologist, but it can help reduce the risk of flare-ups, improve overall health and, in some cases, improve treatment effectiveness. This is particularly important for people with excess weight, smoking, regular alcohol consumption, chronic stress or other comorbidities.

In psoriasis, the following may help:

• regular skin moisturising;
• stopping smoking;
• reducing or avoiding alcohol consumption;
• maintaining a healthy body weight;
• a balanced diet with enough vegetables, whole grains, protein and unsaturated fatty acids;
• regular physical activity appropriate to the person’s health status;
• improving sleep quality;
• stress reduction strategies;
• timely treatment of infections;
• reducing skin trauma and irritation.

There is no single universal “psoriasis diet” that cures the disease in all patients. Dietary changes can be useful as part of an overall health strategy, especially if there is excess weight, metabolic syndrome or other risk factors, but they do not replace medical therapy. If significant dietary restrictions are planned, it is advisable to consult a doctor or dietitian.

What can psoriasis be confused with?

Psoriasis can sometimes be difficult to distinguish from other skin diseases, especially at the beginning of the disease or in atypical locations. Therefore, self-diagnosis can be misleading.

Psoriasis can be confused with:

• atopic dermatitis;
• eczema;
• seborrhoeic dermatitis;
• contact dermatitis;
• fungal infection;
• fungal nail infection;
• dandruff;
• allergic rashes;
• other inflammatory skin diseases.

On the scalp, psoriasis may resemble seborrhoeic dermatitis or dandruff. On the palms and soles, it may resemble eczema or fungal infection. Nail psoriasis may look similar to fungal nail infection. In skin folds, psoriasis may occur without pronounced scaling and resemble irritation or candidiasis.

An accurate diagnosis is important because each of these conditions may require different treatment. Incorrect self-treatment can delay the start of appropriate therapy or worsen the skin condition.

Myths about psoriasis

Myth: psoriasis is contagious

Fact: psoriasis is not contagious. It cannot be caught from another person.

Myth: psoriasis is only a cosmetic problem

Fact: psoriasis is a chronic inflammatory disease that can affect the skin, nails and joints, and can influence overall health.

Myth: if psoriasis is not very widespread, it is not serious

Fact: even a small lesion on the face, palms, soles, genital area, nails or scalp can significantly affect quality of life.

Myth: psoriasis can be cured with one universal diet

Fact: there is no single diet that cures psoriasis in all patients. Diet may be part of an overall health strategy, but it does not replace treatment.

Myth: a sunbed is the same as phototherapy

Fact: a sunbed is not medical phototherapy. Phototherapy is performed under medical supervision using a defined radiation spectrum and dose.

Myth: psoriasis can always be treated only with ointments

Fact: in mild cases topical therapy may be sufficient, but in moderate and severe psoriasis, phototherapy, systemic or biological therapy may be needed.

How to prepare for a dermatologist visit for psoriasis?

To make a dermatologist consultation as useful as possible, it is advisable before the visit to consider when the first symptoms appeared, how they have changed over time and what makes them worse or better. If possible, photographs from flare-up periods may also be prepared, especially if symptoms have improved by the day of the appointment.

Before the visit, it is useful to note:

• when the rash started and where it first appeared;
• whether similar skin diseases occur in the family;
• whether there have recently been infections, stress, skin trauma or medication changes;
• which products have already been used and whether they helped;
• whether there are nail changes;
• whether there is joint pain, swelling or morning stiffness;
• whether psoriasis affects sleep, work, relationships or emotional wellbeing;
• which medicines and dietary supplements are used daily.

This information helps the doctor make a more accurate diagnosis, assess disease severity and choose the most appropriate treatment plan.

When should you see a dermatologist?

It is advisable to see a dermatologist if psoriasis is suspected, if rashes do not go away, recur or spread, and also if previously prescribed treatment no longer helps. Early and accurate diagnosis helps to choose the most appropriate treatment and reduce the impact of the disease on everyday life.

A dermatologist consultation is especially necessary if:

• the rash is widespread or rapidly increasing;
• there is severe itching, burning, pain or skin fissures;
• psoriasis affects the face, scalp, genital area, palms, soles or nails;
• joint pain, swelling or morning stiffness appears;
• there are nail changes together with skin psoriasis;
• treatment is ineffective or causes side effects;
• the disease significantly affects wellbeing, sleep, work, relationships or emotional state;
• pustular or erythrodermic psoriasis is suspected.

Urgent medical care is needed if the skin becomes widely red and painful, there is marked peeling over a large part of the body, fever, weakness, signs of fluid loss or widespread pus-like blisters on reddened skin. These signs may indicate a severe form of psoriasis or another serious condition.

References and authoritative sources

• Latvian clinical recommendations: Psoriasis, 2024
• National Institute for Health and Care Excellence (NICE): psoriasis assessment and management
• NICE Clinical Knowledge Summaries: psoriasis in primary care
• American Academy of Dermatology Association: psoriasis clinical guidelines
• American Academy of Dermatology Association: patient information about psoriasis
• DermNet: clinical information about psoriasis, types, symptoms and diagnosis
• DermNet: treatment options for psoriasis
• DermNet: nail psoriasis
• DermNet: scalp psoriasis
• DermNet: guttate psoriasis
• DermNet: pustular psoriasis
• DermNet: erythrodermic psoriasis
• National Psoriasis Foundation: information about psoriasis, symptoms and disease impact
• National Psoriasis Foundation: psoriasis treatment and care
• British Association of Dermatologists: patient information about psoriasis
• Mayo Clinic: psoriasis symptoms and causes
• Mayo Clinic: psoriasis diagnosis and treatment
• Cleveland Clinic: psoriasis types, symptoms, causes and treatment
• EULAR recommendations for the management of psoriatic arthritis, 2024
• European Alliance of Associations for Rheumatology (EULAR): recommendations for the management of psoriatic arthritis, Annals of the Rheumatic Diseases

Medical disclaimer

The information provided in this article is intended for informational and educational purposes and does not replace medical consultation, diagnosis or treatment. In the case of skin rashes, nail changes, joint pain or suspected psoriasis, it is necessary to consult a dermatologist, and in the case of joint symptoms a rheumatologist consultation may also be needed. Self-diagnosis and self-treatment may be incorrect and can delay the start of appropriate treatment. In the event of severe, rapidly worsening or high-risk symptoms, such as widespread skin redness, painful peeling, fever, marked weakness or widespread blistering, emergency medical care should be sought immediately.

Content author

Dermatologist Dr. med. Dace Buile