Psoriasis – causes, symptoms and treatment

The most common cardiovascular diseases include heart attack, stroke and peripheral vascular disease. All of these conditions are much more common in patients with severe psoriasis. Psoriasis is associated with a threefold increased risk of heart attack and a reduction in life expectancy of 3-4 years. This is largely due to the so-called metabolic syndrome. Metabolic syndrome refers to a cluster of health disorders that include obesity, high blood pressure, high blood fats and high blood sugar. Metabolic syndrome is very common in patients with severe psoriasis and leads to accelerated atherosclerosis, meaning the deposition of fatty substances in the walls of blood vessels, which causes them to become blocked and ultimately leads to severe consequences such as heart attack and stroke.

Patients with psoriasis often have elevated levels of uric acid in the blood. Over time, uric acid is deposited in the joints and triggers joint inflammation, or gout. Men with psoriasis are twice as likely to develop gout. Women with psoriasis have a 1.5 times greater risk of developing gout. Men and women who have both psoriasis and psoriatic arthritis are five times more likely to develop gout.

Guttate psoriasis is common in children: small red, scaly spots on the torso, arms and legs, which often appear after a streptococcal throat infection. In young children, the lesions may also appear in the nappy area, and in school-aged children often on the scalp and behind the ears. Treatment is adapted to the age of the child and is always determined by a doctor.

The method of treatment depends on the severity of the psoriasis, the size of the affected skin area and whether the joints are affected. Treatment can be topical, when creams and ointments are applied to the skin, systemic, when medicines are taken orally or given as an injection, and phototherapy, when the skin is exposed to ultraviolet light. Treatment usually starts with a milder approach, moving to stronger treatments when necessary.

Mild and moderate forms, which are the most common, are treated with topical therapy, primarily corticosteroids and vitamin D analogues. The first line of systemic therapy is phototherapy, often combined with topical therapy. Moderate and severe forms are usually treated with medication, and patients who do not respond to these therapies may be candidates for biologic therapy.

Corticosteroids are the mainstay of local psoriasis treatment. They are the first line of therapy for mild to moderate psoriasis (most commonly when under 10% of the skin is affected) and in areas such as skin folds and the genitals, where the skin is sensitive and where other local remedies can cause irritation. They are available in the form of ointments, creams, lotions, gels, foams, sprays and shampoos, with ointment-based preparations generally having the highest efficacy. At least 80% of patients treated with topical corticosteroids experience clearance of lesions, and maximum improvement is usually achieved within 2 weeks.
Vitamin D derivatives they stop excessive keratinisation of the skin. Due to their efficacy they have become the first line of therapy for psoriasis and are often combined with topical corticosteroids. Due to potential adverse reactions, there is a limit to the skin surface area to which they may be applied, so they are used exclusively under the supervision of a specialist dermatovenereologist.
Preparations that slow down skin cell division They have been used for decades and have few side effects, but in higher concentrations can sting and irritate the skin. They are usually applied short-term, under supervision and in a hospital, for psoriasis on the limbs or trunk, as they stain everything they come into contact with, including the skin and clothes. They can be combined with phototherapy.
Coal tar – coal tar is a thick, heavy oil and probably the oldest treatment for psoriasis. It is not precisely known how it works, but it can reduce scales, inflammation and itching.
Calcineurin inhibitors They are ointments or creams that reduce the activity of the immune system and help to reduce inflammation. They are sometimes used to treat psoriasis on sensitive areas, such as the scalp, genitals and skin folds, if corticosteroid creams are not sufficiently effective.
Topical vitamin A derivatives they regulate the renewal and maturation of skin cells. They are used for treating mild to moderate forms of psoriasis when no more than 10 per cent of the skin is affected. They can cause skin irritation and inflammation of psoriatic plaques and must not be combined with phototherapy.

The skin is exposed to certain types of ultraviolet light. Phototherapy uses natural and artificial light to treat psoriasis. Artificial light therapy can be given in hospitals and some specialist centres under the supervision of a dermatologist. There are two types of phototherapy, UVB and PUVA.

• UVB phototherapy uses a wavelength of light invisible to the human eye. The light slows down skin cell production and is an effective treatment for some types of psoriasis that have not responded to topical treatments.
• PUVA – For this treatment, a tablet is first taken or a preparation is applied to the skin that increases the skin's sensitivity to light. This makes your skin more sensitive to light. Your skin is then exposed to a wavelength of light called ultraviolet A radiation (UVA). This light penetrates deeper into your skin than ultraviolet B light. This treatment may be used if you have severe psoriasis that has not responded to other types of treatment.

Systemic therapy is carried out in those patients in whom local therapy has not been effective. Systemic therapy must always be carried out under the supervision of a specialist. There are 2 main types of systemic treatment, called non-biological (usually given in the form of tablets or capsules) and biological (usually given as injections).

Correct usage depends on the medicine, the patient and the site. Ointments are most commonly used for plaque psoriasis, whilst lotions are used for the scalp. In skin-fold areas where the skin is thinner, treatments that do not cause irritation are used. The frequency of topical therapy application depends on the clinical picture and must be determined by a dermatologist. With corticosteroids, regardless of the regimen, there must be an interruption and break in the therapy to “give the skin a rest” and to avoid losing efficacy.

Patients can help themselves further in a number of ways.

• It has been shown that the Mediterranean diet, an increased intake of vegetables and fruit, and a reduction in industrially processed food can have a favourable effect on the course of the disease.
• Regular exercise and stopping smoking reduce the risk of heart attack and stroke, which are more common in patients who have psoriasis.
• Taking medications as prescribed, proper skin care and regular visits to the dermatologist can significantly influence the course of the disease.
• The sea and moderate sunbathing, combined with proper protection using sunscreens at normal times (before 11 am and after 17 pm), can be of significant help to patients suffering from psoriasis. Sunlight is the main reason why psoriasis symptoms improve during the summer (such as the phototherapy mentioned above). By sunbathing wisely, you can make the most of all the benefits. Swimming, especially in salt water, removes dead skin and improves the appearance of psoriatic lesions. For centuries, people with psoriasis and skin conditions have travelled and bathed in the Dead Sea.