The disease of unpredictable prognosis: psoriasis

Dr. Casanovas Puigbonet is a specialist in Dermatology who currently practices at the Gabinet Mèdic de Diagnosi i Tractament in Girona and at the Centre Mèdic Montserrat in Mataró. The doctor explains psoriasis and analyzes its prognosis and symptoms.

What is psoriasis?

Psoriasis is one of the most common inflammatory skin diseases, with an average prevalence of 2% of the world population. But there are very notable differences depending on ethnicity: in Spain, the prevalence is slightly lower than the world average, from 1.4 to 2%. It is a disease of unknown etiology.

It can appear at any age, from the first months of life until after the age of eighty. However, two incidence peaks have been identified: between 20-30 years of age, with a high percentage of familial incidence, and between 50-60 years. It is estimated that 75% of those affected are over 40 years of age. In women it usually presents at an earlier age, but there is no difference in incidence between the two sexes. In general, the earlier the disease begins, the more severe it tends to be.

Signs of psoriasis

The most frequent lesions are erythematous and scaly plaques, well demarcated, preferably located on elbows and knees, also frequently affecting the lower back and scalp, although in severe forms, it can affect the entire integument, including the nails. There are different types of psoriasis. The most typical forms are well-demarcated plaques, with an erythematous base and whitish scales on the surface, which can vary in size, from droplet forms, more frequent in childhood, to generalized forms, of greater severity, which can affect the joints in 5-8% of patients with psoriasis. The impact of psoriasis on quality of life is high, due to its chronicity and prevalence. The usual signs and symptoms of concern are pruritus, scaling and visible plaques.

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In general, the prognosis of psoriasis is unpredictable. It is usual that, after a first outbreak, it is suffered in a chronic form, but there are also patients who refer to us in consultation, having suffered from psoriasis dozens of years ago and not having had more outbreaks. In fact, the evolution depends on several factors, from genetic to modulating factors such as emotional stress, trauma to the skin, the action of some drugs, to climate changes. Lately, obesity has been found to be an important risk factor, both because of the difficulty it implies for some treatments and because it is a risk factor for systemic complications.

Treatment of psoriasis

As for the treatment of psoriasis, we must say that it is very variable, as can be seen from the previous explanations. That is to say that each patient will have an individualized treatment, from topical treatments in the mildest cases and in the localized forms, which include keratolytics, tars, vitamin A and D derivatives, or topical corticosteroids. Up to systemic treatments, which are reserved for refractory forms, of great extension, due to the fact that these also carry a greater risk of side effects.