Psoriasis is one of the most common chronic, inflammatory skin diseases in Germany. About 2 million people are affected, which means that 2 out of 100 people suffer from this disorder.
According to today's understanding, special genetic factors must be present to develop psoriasis. Many genes are involved, and not the disease itself, but the disposition to the minting of psoriasis is genetically determined.
First symptoms usually appear before 40 years of age, men and women are about equally frequently affected. Psoriasis is also a common disorder in children and adolescents.
Symptoms of psoriasis can be triggered by various factors (so called). To this day not all such factors have been clearly identified. Trigger factors include infections of the palatine tonsils and naso-pharingitis and play an important role especially for a first disease manifestation in children. But also certain medications and stress can lead to relapses of the disease.
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Psoriasis can occur at any age. The effect of the above factors (such as infections of the upper respiratory tract, certain medications, or stress) together with the genetic predisposition leads to symptoms of the disease.
There are two types of psoriasis:
Type 2 manifests in late adulthood and family members are usually not affected.
Psoriasis is individually very different, typically relapsing. There is a large range of individual variations of the disease so that the course is impossible to predict. There are cases in which it is only a unique thrust of the disease; in other cases the skin symptoms remain constantly present. Or the disease varies in its characteristics over time.
The most prominent feature is a pronounced inflammatory reaction. This leads to an increased speed of cell division of the epidermis and results in redness, thickening and scaling of the skin.
Typically, the scalp, elbows and knees, as well as the belly button and the fold of the buttocks are affected. These areas are referred to as "predilection" of psoriasis.
In addition to the skin, the finger - and toenails may be affected. Pathological changes of the nail matrix (place where the nail plate is made) and the nail bed can occur. Nail matrix psoriasis results in crumbling of the nail plate, pitting or onychodystrophy.
When lesions are present in the nail bed yellowish brownish spots shine through the nail plate and are referred to as „salmon drops”.
Psoriasis arthritis is an inflammatory disease of joints. In contrast to rheumatoid arthritis affecting primarily the joint cartilage and synovia psoriasis arthritis starts at the sites where ligaments and tendons insert into the bone.
Approximately every fifth patient with skin lesions develops psoriasis arthritis. Often but not always there are skin lesions first. Joint changes may occur many years after the emergence of the skin lesions.
Typical symptoms of psoriasis arthritis include morning stiffness of joints that takes longer than 30 minutes. Often joint pain occurs under resting conditions and improves during movement. It can cause swelling and inflammation of joints of fingers or toes but also of individual large joints like shoulders or knees. About 40% of affected patients have deep seated back pain symptoms which also occur when resting or at night.
Another peculiarity of psoriatic arthritis is the inflammation of tendons such as the Achilles tendon.
An early diagnosis of psoriasis arthritis is important to prevent irreversible joint damage. Therefore, the treating physician should be informed about joint discomfort as soon as possible.
To confirm the diagnosis of psoriatic arthritis, dermatologists often consult a rheumatologist. Rheumatologists are doctors who specialize on the diagnosis and treatment of joint diseases and are familiar with the symptoms of psoriatic arthritis.
Psoriasis is a skin disorder, in which other diseases occur more frequently than in the general population. These are referred to as Comorbidities.
Most important comorbidities include obesity, arterial hypertension, diabetes mellitus, blood lipid disorders, inflammatory bowel disease and depressive/anxiety disorders.
Psoriasis/psoriasis arthritis and obesity are closely related. Obese people have a significantly higher risk to develop psoriasis/psoriasis arthritis.
In some studies could be found that patients can achieve an improvement of the skin disease and a better therapy response of drugs with a known psoriasis through weight loss.
Obesity is determined by the "body mass index" (BMI) easiest. BMI takes into account body weight and body size. You can determine your BMI yourself by dividing your body weight (in kg) by the square of your height (in m2). It is medically feasible to reach a value of between 18.5 and 25. Higher or lower values are considered unhealthy.
There is no special diet for psoriasis. The nutrition for the disease is often made responsible for chronic diseases. This is not the case with psoriasis. The general recommendations are a balanced diet and healthy living conditions. If there is excess weight, this should be reduced.
Yes, all three factors can cause worsening of skin symptoms and should be avoided. The amount of nicotine and alcohol affects the severity of psoriasis. Thus, healthy living conditions for patients with psoriasis are important.
Patients with psoriasis tend to suffer from cardiovascular disease and high blood pressure. For this reason smoking cessation and minimizing stress is an important measure.
We know that psoriasis is a disease that cannot be cured today. However, with targeted therapy the symptoms of psoriasis can be treated very well so that a complete freedom of appearance is possible.
A broad range of topical drugs, light therapy and systemic medications are available for treatment. Which therapy procedure in detail is right for you needs to be discussed with your dermatologist.
In addition, patients themselves can help improve their skin conditions.
A good skin care is also called basic therapy of psoriasis. The regular use of care products can restore the impaired skin barrier for psoriasis and prevent the occurrence of new stoves. All commercially available products such as creams, lotions and body milk can be used.
The proper skin care should be selected according to skin type. High-fat products are suitable for very dry skin. Less fatty products (e.g., creams, body milk) are more suitable for oily skin. Your treating dermatologist can give advice about the appropriate individual care.
Please click to enlarge (zitiert nach Nast et al., Journal der Deutschen Dermatologischen Gesellschaft, März 2012: 10 Suppl2: S1-95).