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Psoriasis: Disease course and treatment

Psoriasis is a chronic, autoimmune, inflammatory skin disease. The disease can cause more or less pronounced rashes over large parts of the body. The disease can be kept in check with proper treatment.

Psoriasis rashes often have a scaly appearance. The reason for this is that cell division in the skin takes place much faster than in healthy skin.

The fact that the disease is an autoimmune inflammatory disease means that it is the body's own immune system that has attacked parts of the skin. When the cell maturation process is disturbed in this way, it causes the skin to be damaged and scaly.

There are different types of psoriasis, but chronic plaque psoriasis accounts for 90% of cases. It is estimated that around 2% of the population has psoriasis. This makes it one of the most common skin diseases.

Most people get their first outbreak either when they are between 10-20 years old or 50-60 years old. Women often get their first outbreak earlier than men, but the incidence of psoriasis is about the same between the sexes.

Treatment consists of symptom relief in the form of moisturizing creams and anti-inflammatory agents.

Treatment from a dermatologist via messaging service

Our dermatologists treat many of their patients based on the patient's description and sharp images of the problem area. Maybe your skin problems can also be solved so easily. 

Why do you get psoriasis?

There is no single reason why someone develops this skin disease. Still, there are some things the medical profession agrees on.

We know that heredity plays a role in the development of the disease. If you have a close family with psoriasis, there is a greater risk that you will also develop the disease. If both parents have psoriasis, there is a 40-50% chance that the child will also have problems with this.

In addition, we know that various external factors can cause one to develop psoriasis. Such external factors are environmental factors that stress and strain the body.

These factors can trigger or worsen psoriasis rash. Such factors include:

  • Sunlight
  • Hormones
  • smoking
  • Mental stress
  • Stress
  • Infections (especially in the upper respiratory tract)
  • High alcohol intake
  • Certain drugs (chloroquine, lithium, NSAIDs and beta-blockers)

Particularly well known is the association between pharyngeal infections caused by b-hemolytic streptococci and psoriasis. If psoriasis flares up, consider whether it may be related to starting or increasing the dose of medication, including antihypertensive medications (angiotensin converting enzyme inhibitors and beta-blockers), antimalarial pills (hydroxychloroquine), progesterone, lithium and after abrupt discontinuation of high-dose prednisolone therapy.

Some women may experience worsening of psoriasis during hormonal changes during puberty, pregnancy and menopause.

The physiological cause of psoriasis is that the cells in the epidermis divide much faster than normal. The rapid cell division is accompanied by a lack of cell maturation. This leads to severe scaling. The rapid cell division and deficient cell maturation are due to neurotransmitters that the white blog bodies release.

Symptoms and course of the disease

Depending on the type of psoriasis you have, you can have different symptoms, and the symptoms can affect different places on the body. Psoriasis can also affect nails or joints. The former is called nail psoriasis and can cause the nails to become discolored, hollow, brittle, thicker and / or looser. If the joints are affected, it is called psoriatic arthritis. About 10-20% of those with psoriasis are affected by this.

Psoriatic arthritis will most often debut when the patient is around 30-40 years old. Patients with psoriatic arthritis tend to first get inflammation of the tendon attachments in the tendons before the joints are affected. Rheumatologists can help with the examination of psoriatic arthritis.

Many people are affected by a combination of different types of psoriasis, and may therefore have several different symptoms.

Unfortunately, there is also a link between psoriasis and the risk of developing obesity, diabetes, high blood pressure and high cholesterol (collectively referred to as metabolic syndrome). The relationship seems to be related to the severity of psoriasis. Screening for the above should therefore be performed among all psoriasis patients, and is especially important in those with severe psoriasis.

For the same reason, psoriasis patients should be motivated to a healthy lifestyle, including exercise and no smoking.

An increased incidence of psoriasis has also been demonstrated in patients with inflammatory bowel disease (Crohn's and ulcerative colitis).

Finally, an increased incidence of anxiety and depression is described.

These are the different types of psoriasis

Plaque psoriasis

As mentioned, this is the most common type of psoriasis, and around 90% are affected by this form.

Symptoms consist of clearly defined rashes on the skin. The rash is red, with dry, white shells that make the skin thicker. The rash can vary in size, but most often appears on the elbows, knees and scalp.

Some people with this type of psoriasis do not get the typical rash with shells, but rather eczema-like rashes. Many people are affected by itching of the skin to varying degrees.

Guttate psoriasis

Boy psoriasis accounts for about 5% of cases, and is therefore the second most common type.

Many children and young people are affected by this type, and the rashes are small and teardrop-shaped. They often cover large parts of the body.

The outbreaks often occur quickly, and often disappear on their own or with short treatment. New outbreaks can occur, but often in a milder form.

Inverse psoriasis

Inverse psoriasis usually occurs in sensitive skin areas and where the skin is thin. The rash is red, but has no scales.

Typical affected areas are skin folds, armpits, under the breasts and in the abdomen.

Pustular psoriasis

With this variant, blisters (pustules) appear filled with pain. Depending on where on the body blister occurs, we can distinguish between palmoplantar pustulosis and generalized pustular psoriasis.

In palmoplantar pustulosis, blisters appear on the hands and under the feet. The blisters usually change color and dry over time.

In generalized pustular psoriasis, blisters appear on larger areas of the body. These are often sore and can cause a lot of itching. This condition usually requires treatment and follow-up by a dermatologist due to the severity.

Erythroderm psoriasis

Erythroderm psoriasis causes severe red and scaly rashes on large parts of the body. Use of cortisone tablets or certain anti-malarial drugs can trigger the rash.

This form of psoriasis requires hospitalization for treatment and follow-up, and is the most severe type of psoriasis.

Diagnosis and treatment

Since psoriasis is a chronic disease, it can not be treated so you will be completely healthy. Proper treatment can still give good results.

As with many other skin conditions, you can experience both good and bad periods. Some may have few or no symptoms for a long time, while others have major ailments.

To get the right diagnosis and treatment, it is important that you consult your dermatologist. You should do this if:

  • Suspected of having psoriasis, for example due to a rash with scales.
  • Know you have psoriasis and develop symptoms in the joints.
  • Is being treated for psoriasis, but is experiencing side effects or that the treatment does not give the expected results.

The doctor will usually make the diagnosis based on the patient's medical history and the recognizable appearance of the rash. If the rash is atypical, it is common to take a tissue sample to be able to make a definite diagnosis.

Treatment can provide good symptom relief and will often consist of a combination of self-treatment and the use of different medications.

Because the symptoms and severity may vary, treatment should be tailored to each patient. It is also common for the patient to carry out different treatments at different times.

Self-treatment

Since we know that certain environmental factors can trigger or worsen psoriasis, it is important that you conduct your own treatment in the form of avoiding the triggering factors as much as possible.

To prevent, you should therefore

  • Avoid smoking.
  • Moderate alcohol intake.
  • Avoid stress as much as possible (important with enough sleep).
  • Take good care of your nails to limit or avoid nail psoriasis.
  • Many people have a good effect of sun and salt water, while for some this worsens the condition.

In addition to avoiding triggering environmental factors, you can prevent and relieve symptoms with moisture treatment and relieving itching.

Moisture treatment

Moisture treatment is very important when you have psoriasis. This prevents the skin from drying out, which will also reduce itching and possible worsening.

Therefore, it is also important to use a good moisturizer, even in good periods. This will prevent new outbreaks.

You can also apply moisturizer on the rash to reduce the symptoms.

A good moisturizer should be oily and contain moisturizers. There are many suitable creams for this purpose, and some examples are:

  • Canoderm (contains Urea)
  • Apobase (several types with slightly different functions)

To get the best effect from the moisture treatment, you must also be careful about using soap. In the shower, it is recommended to use a shower oil, rather than shower gel. Do not shower too often and avoid using too hot water.

If you want a more intensive treatment, you can apply a thick layer of moisturizer and cover it with plastic wrap overnight. This only needs to be done in small areas at a time.

Relief of itching

Because psoriasis can cause troublesome itching of the skin, it is also important to relieve the itching. You can do this by:

  • Lubricate yourself with moisturizer daily, preferably one that is specially adapted for itchy eczema skin.
  • Avoid scratching the skin - keep your nails short and wear cotton gloves at night.
  • Wear light clothing to avoid getting hot and sweaty as this may aggravate the itching.
  • Over-the-counter itching medicines can be used, but often have a weaker effect than other measures.
  • Klibad can relieve itching, but should not be carried out if you have an inflamed rash.
  • Wet bandages can be used on the whole, or parts of, the body. Before attempting this yourself, you should have received instructions from medical personnel.

Video consultation with a dermatologist

If you want to talk to one of our dermatologists on video, you can reserve an appointment here. Our dermatologists can treat all skin diseases and ailments as well as prescribe medicines if necessary for the treatment.

Medical treatment

Although there is no cure for psoriasis, treatment can keep the disease at bay. Treatment often consists of a combination of moisturizers and medicines, as well as light treatment.

Remove shells

In order for treatment to be as effective as possible, it is important to remove shells. This is because both light treatment and drugs must reach the skin that lies under the shells.

There may be shells on both the body and the scalp. The procedure is quite similar for removing shells in both of these places, but there are a few differences.

The body:

  • Take a shower or a bath. Apply a moisturizer that has a soothing effect, use Locobase LPL or 2 or 5% salicylic acid Vaseline.
  • Wait at least 4 hours or overnight before washing.
  • If there are still shells left, repeat the treatment.

Scalp:

  • Apply either Locobase LPL or oil with salicylic acid. If you use the latter, a concentration of 5 or 10% is recommended for adults, 2% for children.
  • Leave on for at least 6 hours, or leave the product on overnight. Then cover your head with a shower cap.
  • Wash off with shampoo.
  • If there are still shells left, repeat the treatment.

Be aware that salicylic acid penetrates the skin and can have adverse effects on the body in large quantities. Therefore, use a lower concentration, for example 2%, if the whole body is to be treated.

Medicines used for psoriasis

Most medicines used for psoriasis work by suppressing inflammation, suppressing cell division and / or suppressing the immune system. The funds can roughly be divided into locally acting funds and systemic funds. The former group includes creams, ointments, liniments and so on, while the latter are taken as tablets or injections.

Which drugs you are treated with depends on a number of factors: What kind of psoriasis you have, how big the rash is, where it is located, as well as age, previous treatment and any diseases.

Psoriasis can in many cases be treated with topical agents, but around 20% of the patient group needs systemic treatment.

Local agents

Topical agents contain vitamin D3 analogues because they slow down the rapid growth of skin cells. Some preparations also contain cortisone, which is an anti-inflammatory substance.

The agents containing cortisone will also relieve itching as an indirect effect of the anti-inflammatory properties.

The drugs with cortisone are divided into four different strengths, and there are also preparations that contain fungicides or bactericidal substances or salicylic acid. These are referred to as combination preparations.

For best effect and least possible side effects when using cortisone preparations, be sure to lubricate them properly.

This is done as follows:

  • Apply on a thin layer, only on areas with rashes.
  • Wear plastic gloves when applying or wash your hands thoroughly afterwards.
  • When improving, the cortisone treatment should be gradually reduced to avoid flare-up of the rash.
  • It is recommended to have cortisone-free periods.
  • You should also apply a perfume-free moisturizer several times a day.
  • Do not apply cortisone preparations on open wounds, as this may prevent healing.

If you have psoriasis of the scalp, special shampoos or preparations with crotisone or exfoliating ingredients are used for the treatment.

Light treatment

If the treatment with topical agents is not effective, light treatment with UV radiation can help. This is done either at a dermatologist, in a hospital or with UVB home sun.

Different types of ultraviolet light can be used, possibly in combination with tablets (PUVA).

Light treatment with UVB improves psoriasis after approx. 25-30 treatments given 2-3 times a week. During the treatment period, the amount of light is gradually increased to accustom the skin to ultraviolet rays.

PUVA is another form of light therapy. P stands for psoralen, which is a substance that increases the skin's sensitivity to ultraviolet light. UVA stands for ultraviolet light of type A. During PUVA treatment, the patient must take psoral tablets before the UVA radiation. The psoriasis accumulates in the eye lens. To avoid side effects in the eye, it is recommended to wear sunglasses when staying outdoors in the sun on the day of treatment.

Solarium is not recommended due to limited power and too high UVA radiation.

Prolonged, intense exposure to ultraviolet light may increase the risk of premature skin aging and the development of skin cancer. With the knowledge we have today, it fortunately seems that the use of ultraviolet light as a treatment only increases the risk of skin cancer to a very small degree. The types of skin cancer that can occur are almost always peaceful and can be cured.

Soft X-rays can also be used to treat psoriasis. Then you use boundary beams.

Boundary rays (also called Bucky rays) are long-wavelength X-rays. They only affect the upper layers of the skin, and the treatment works by suppressing the activity of inflammatory cells.

The treatment is generally side-effect free. Like other X-rays, excessive use of bucky rays can cause side effects in the form of thin skin and in rare cases skin cancer of the same type as after treatment with ultraviolet light.

Boundary beams are used alone or in combination with other treatment agents.

Systemic drugs

Tablet treatment with methotrexate, acitretin or ciclosporin is used in severe cases of psoriasis.
Tablet therapy is used in rare cases and only for psoriasis patients who have not been adequately treated by other treatments.

acitretin is related to vitamin A. Acitretin can provide significant improvement, but this improvement is accompanied by many side effects, especially in the form of dry and flaky mucous membranes. The tablets also affect liver function and give an increase in the content of certain fats in the blood. It is therefore important that acitretin treatment is monitored regularly. Acitretin is harmful to the fetus and is slowly excreted from the body. It is therefore important that women protect themselves against pregnancy during and after treatment.

Methotrexate is a so-called cytotoxic drug. In psoriasis, methotrexate is given in such small amounts that only the immune system is affected. Methotrexate is one of the most effective remedies for treating psoriasis. The tablets are taken only one day a week. At the start of methotrexate treatment, blood samples should be taken once a week. Later you can settle for monthly blood tests.

Cyclosporine affects the body's immune system and therefore has a beneficial effect on even severe psoriasis. However, treatment with ciclosporin may increase blood pressure and decrease kidney function. Therefore, cyclosporine is not suitable for long-term treatment. Regular blood test is required during treatment.

It is usually either your dermatologist or a rheumatologist who assesses the need for this type of treatment.

The reason is that these treatments can cause several side effects because they are absorbed throughout the body.

You will get a treatment plan it is important that you follow closely. Your doctor will give you the necessary information about the medicines you are going to use or get administered.

Climate treatment

Sometimes climate treatment can be used instead of hospitalization. Climate treatment usually extends over 4 weeks and is given especially by the Dead Sea in Israel. The most important part of the treatment is the sun's rays, which especially in this place contain many UVA rays. Furthermore, patients bathe in the Dead Sea, which has a very high salt content.

Climate treatment often leads to long-term total equalization of psoriasis, but just like after other treatment, psoriasis will return at some point.

Biological treatment

Biological drugs are proteins, most often antibodies, that are specifically designed to affect the activation of the immune system in the skin.

Compared to traditional treatment, biological therapy may have fewer side effects.

Such treatment is very expensive and is only intended for patients with very severe psoriasis, where other treatment has not helped or had to be stopped due to side effects.

Your dermatologist can give you further information about this form of treatment.

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