ABOUT DISEASE

Psoriasis is a serious chronic skin condition characterised by abnormal epidermal proliferation (excessive growth of the epidermis). It has a strong genetic component. Psoriasis is a chronic conditions and there is no cure for it. This illness comes and goes in cycles of remissions and flare-ups. Plaque psoriasis is the most common form of psoriasis, affecting about 80 percent of patients. Plaque psoriasis typically appears as skin bumps that merge into reddened flat areas of oval patches (plaques). Plagues of various sizes, mostly red, are easily palpable.

Early diagnosis and initiation of treatment are very important in the management of psoriasis. If you notice any psoriasis-like skin lesions, you should not hesitate and visit a dermatologist specializing in the treatment of this skin condition. You may be referred for a skin biopsy to confirm the diagnosis. A skin biopsy is a medical test that involves collecting a small piece of affected skin. Histopathology is not necessary to diagnose psoriasis. If you are found to have psoriasis, ask your dermatologist about your health status, which can be determined using either of the following scales: PASI, DLQI, and BSA. It is important to identify the scale of your disease to choose the best treatment and to be able to determine if it works.

The disease may begin at any age. However, psoriasis often first appears between ages 15 and 25. This condition may as well occur in young children and elderly patients. In the beginning, psoriasis is manifested by characteristic bumps on the skin, all of which merge together to form psoriatic plaques, fluctuating in extent and severity. Skin manifestations of psoriasis most commonly affect the: scalp, elbows, knees, lumbar or sacral region of the spine, hands, and feet. Psoriatic plaques can also be present on fingernails. Psoriasis types are typically identified by their hallmark appearances, sites of involvement, and the degree of severity. 

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TREATMENT

Phototherapy (light therapy) has been known and used since ancient times. Exposing the skin to light slows the growth of affected skin cells and improves the condition of the skin in psoriasis. In the majority of patients, sun radiation proves favourable and visibly reduces the skin manifestations. Interestingly, phototherapy can also be used in patients in whom exposure to sun light may make the symptoms worse. PUVA is the only treatment method for psoriasis that combines a light-sensitizing medication psoralen (administered orally) and ultraviolet light A (UVA). UVB phototherapy (either broadband or narrowband ultraviolet light) in psoriasis is  safer than PUVA and can be recommended for patients with psoriasis and concomitant liver or eye problems.

The conventional systemic therapy is used if topical treatments are unsuccessful. Systemic therapy can be delivered using injections or tablets that have a general effect on the body. Conventional systemic therapies are highly effective, but they also involve a higher risk of side effects. Systemic medications are recommended for patients with moderate to severe psoriasis. Patients on systemic therapy are required to have their blood and blood pressure tested at regular intervals. Widely used medications are: cyclosporine, methotrexate and retinoids. Cyclosporine is an organic chemical compound administered in tablets. When cyclosporine was found to suppress the activity of the immune system. Methotrexate is a cytostatic and immunosuppressing agent. It is used in injections or tablets. retinoids normalise skin cell production and scaling. Retinoids are vitamin A derivates, which can normalise skin cell production and scaling. 

Biologic agents (biologics) are a breakthrough in the management of psoriasis that brings back hope to affected patients.  Biologic therapies modify the immune reactions of the body and can mimic the functions of antibodies. Biologic therapies target the immune system. Unlike other forms of immunosuppressive agents, biologics only target the sites where psoriasis develops and are suitable for long-term use. Biologics are administered either by subcutaneous injection or intravenous infusion. In Poland, there are 4 biologics authorised for use. (1) Adalimumab is a recombinant human monoclonal antibody specific for human necrosis factor alpha, TNF-α. It is a powerful anti-inflammatory agent. (2) Etanercept is a recombinant human tumor necrosis factor receptor (p75) Fc fusion protein. (3) Infliximab is a chimeric anti-tumour necrosis factor alpha (TNF-α) monoclonal antibody, administered by intravenous infusion. (4) Ustekinumab is a monoclonal antibody that binds specifically to two types of proteins involved in processes that cause psoriasis.

Using home remedies to alleviate the symptoms of psoriasis can bring comfort and relief for skin affected by the disease. Dead Sea salt bathing: Using Dead Sea salt effectively supports traditional therapy of psoriasis. There is also an increasing number of cosmetic products containing Dead Sea salt, which regulates sebum production, has antibacterial properties, and improves the condition of the skin.

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    • Advice #1
      A person diagnosed with psoriasis may feel insecure. When visible areas of the skin are affected by psoriasis, patients may experience social stigma. If any of our friends or relatives suffers from psoriasis, it is important to learn more about psoriasis and how to support patients. Certainly it is important to inform people who live or work with a person affected by psoriasis that this skin condition is not contagious, despite the fact that it may cause serious symptoms.
    • Advice #2
      Psoriasis is not just dry flaky "scales" on the skin; individuals who suffer from psoriasis are afraid of rejection or lack of personal and family life, of having a hard time finding a job, and of psoriasis-related complications that can ultimately lead to disability. Unpleasant psoriasis symptoms and the widespread negative social attitude to psoriasis can have an extreme negative impact on the patient's self-esteem; patients may feel misunderstood, marginalised, or stigmatised. For all these reasons, patients with psoriasis should carefully monitor their emotional state. Successful management of psoriasis largely depends on whether patient can rely on their family and friends to support him/her in difficult moments.
    • Advice #3
      Using a swimming pool is not contraindicated in psoriasis. However, the skin areas affected by psoriasis are more sensitive and susceptible to drying, especially when exposed to water with chlorine. You can be asked unpleasant questions or hear comments from people you meet at the swimming pool. Some patients feel their symptoms improve during the summer because of more sun exposure, other patients feel better during the winter season. If your symptoms worsen during the warm season, you should reduce sun exposure. Wear loose and comfortable clothes to allow air circulation and evaporation of sweat. Make sure you get enough rest and eat a healthy diet. Ask your doctor if your need a seasonal influenza vaccine.

    Patient stories

    • Wojciech Wilkowski
      Wojciech Wilkowski (Poland) "Today people worship beauty, and psoriasis makes life really difficult."
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    • Małgorzata Miszewska
      Małgorzata Miszewska (Poland) "How can I accept my disease when, according to cosmetics commercials, it is the skin that makes women beautiful?"
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    • Andrzej Grządka
      Andrzej Grządka (Poland) "Nobody can help you better in your psoriasis than other patients. You should meet them, talk to them, and share experiences because the power to fight the disease is within you."
      Read more

    Videos

    Harald's story "Diagnosis: psoriasis" Psoriasis