Psoriasis - Find a Specialist and Get Information

Psoriasis is one of the most common chronic skin diseases. It almost always follows a chronic course.

In Germany alone, 2–3 out of every 100 people are affected by psoriasis. The condition affects women and men in roughly equal numbers.

Typical symptoms include red, sharply defined patches of skin covered with silvery-white scales. It is not uncommon for those affected to experience itching in these areas.

In medicine, a distinction is made between different forms of psoriasis. The most common form is psoriasis vulgaris (common psoriasis).

The distinction is based on the location of the affected skin areas as well as their appearance.

The three main forms are:

1. Common psoriasis
2. Pustular psoriasis (psoriasis pustulosa)
3. Psoriasis affecting the joints

Common psoriasis

Plain psoriasis accounts for about 80 percent of cases. The inflammatory lesions are small at first but can grow to the size of the palm of a hand as the disease progresses.

The most commonly affected areas of the body are:

• Elbows
• Kneecaps
• Head
• The creases of the buttocks

A typical characteristic of the affected skin areas is that they constantly flake and are often itchy.

The course of psoriasis vulgaris varies in severity. While some people experience only mild symptoms, others are affected by severe symptoms.

In extreme cases, the plaques cover large areas of the body. When the entire body is affected by psoriasis, the condition is referred to as psoriatic erythroderma.

In 50 percent of all cases, psoriasis also spreads to the nails. The condition may be limited to slight indentations, but it can also lead to the complete destruction of the nail.

Doctors classify common psoriasis into Type I and Type II:

1. Type I: Appears as early as ages 10 to 25. This form is characterized by intense flare-ups and a severe course of the disease. About 60 to 70 percent of all psoriasis patients suffer from this form. Genetic predisposition plays an important role.
2. Type II: Usually begins between the ages of 35 and 60. The course of this form is milder and less influenced by genetic predisposition

Pustular psoriasis (psoriasis pustulosa)

A significantly rarer form of psoriasis is psoriasis pustulosa. Its characteristics include the formation of sterile pus-filled blisters.

It often appears following bacterial infections. The pustules form due to the accumulation of leukocytes (white blood cells) within the outermost layer of the skin. In extreme cases, pustular psoriasis can spread throughout the entire body.

Psoriasis with Joint Involvement

Psoriatic arthritis (also known as psoriatic arthropathy) is considered a rheumatic form of psoriasis. In this condition, the joints are also affected. It is usually associated with common Type I psoriasis.

One in five patients develops psoriatic arthritis, in which the joints swell. In addition, those affected suffer from limited mobility.

Specific forms of psoriasis include:

• Psoriasis guttata, which occurs following a strep throat infection
• Psoriasis capitis (psoriasis affecting the scalp)
• Inverse psoriasis, which appears in the armpits and behind the knees
• Exudative psoriasis
• eruptive-exanthematous psoriasis
• nail psoriasis

Psoriasis is usually caused by a genetic predisposition. However, the disease only develops when additional risk factors are present.

If both parents have psoriasis, the child’s risk of developing the condition is 60 to 70 percent.

If, on the other hand, only one parent is affected, the likelihood of developing the condition decreases to about 30 percent.

Risk factors responsible for the onset or worsening of psoriasis include:

• Respiratory infections caused by bacteria such as streptococci
• hormonal changes
• the use of certain medications such as ACE inhibitors, beta-blockers, interferon, or antimalarial drugs
• mechanical irritation, such as skin injuries or pressure
• alcohol and cigarette use
• Environmental factors
• poor diet
• emotional stress

Psoriasis involves an immune reaction by the body. In this process, the immune system attacks the body’s own tissues. The exact cause of this autoimmune reaction has not yet been determined.

Typical symptoms of psoriasis include reddish, slightly raised patches on the skin that are sharply defined. In addition, silvery-white scales appear on the affected areas of skin.

In most cases, the patches are small and dot-like. However, they can also enlarge and cause itching.

While the superficial scales can be easily scraped off, the deeper scales become embedded in the thin layer of skin. Scraping off the scale layer may cause pinpoint bleeding.

Psoriasis is not contagious. However, due to the clearly visible skin changes, those affected often suffer from psychological problems.

Psoriasis on the elbow @ SNAB /AdobeStock

Common psoriasis is diagnosed based on its characteristic skin changes. For this reason, the doctor examines body parts that are particularly frequently affected, such as the knees, elbows, scalp, or the crease of the buttocks.

Also of interest are pinpoint hemorrhages that appear after the affected layer of skin is removed. Changes in the nails are also considered an indication of psoriasis.

In some cases, taking a skin biopsy may be advisable. The sample is then examined in a laboratory.

This helps distinguish psoriasis from other conditions with similar symptoms, such as lichen planus, fungal infections, or syphilis

Based on the current state of medical knowledge, there is no cure for psoriasis. However, symptoms can be effectively alleviated through medical treatment.

In cases of mild psoriasis, treatment typically involves topical therapy to manage the symptoms. This involves the use of substances that slow the formation of scales. These substances also have an anti-inflammatory effect.

The treatments primarily consist of lotions, gels, creams, or special shampoos.

Their ingredients usually include:

• cortisone
• Vitamin A derivatives such as tazarotene
• Vitamin D3 derivatives such as calcitriol, calcipotriol, or tacalcitol
• Dithranol/Cignolin

If psoriasis appears on the fingers, face, or buttocks, calcineurin inhibitors such as primecrolimus or tacrolimus may be used.

Treatment of Moderate to Severe Psoriasis

Medications are used to treat moderate or severe psoriasis. These medications work by suppressing the immune system.

Common active ingredients include:

• Methotrexate
• Ciclosporin and
• fumaric acid esters

In addition, etanercept is often prescribed. Patients can administer this medication themselves via injection. For severe cases of psoriasis, uteskinumab, infliximab, or adalimumab may also be appropriate.

Basic Skin Care

Basic skin care plays a significant role in the treatment of psoriasis.

The following are recommended:

• moisturizing oil baths
• Moisturizing ointments
• shower oils
• rich creams

They have the ability to improve the skin’s natural protective function. Topical applications containing salicylic acid and urea also have a positive effect on the skin. This basic skincare routine is beneficial even when there are no acute symptoms.

For many patients, phototherapy has a positive effect on psoriasis symptoms. This procedure involves treating the skin with light rays. 

In addition to natural sunlight, phototherapy also uses special light sources. Light rays with a wavelength of 311 nanometers have proven to be particularly effective. 

To enhance the light’s effectiveness, specialists often combine phototherapy with balneotherapy (bath therapy). The administration of psoralen medications (PUVA therapy) is also an option. Both methods can intensify the light’s effect on the patient’s skin.

As part of balneophototherapy, the patient first takes a saltwater bath. The light exposure then takes place afterward. In PUVA therapy, a cream containing psoralen is applied to the skin.

There is currently no cure for psoriasis. A healthy diet, avoiding smoking, and regular exercise