Psoriasis is a benign chronic skin disease of unknown cause. It is not contagious and tends to appear in individuals whose family members have the disease. It occurs in both sexes, particularly between the ages of 15 and 30, but can appear at any age. On the occasion of World Psoriasis Day, Dr. Lorente, specialist in Dermatology and member of Top Doctors, explains the most effective treatments to cope with the symptoms of this pathology.
Psoriasis is caused by an excessive production of skin cells that produces thickening and flaking of the skin.
Symptoms of psoriasis
The lesions caused by this pathology are salmon-pink plaques, with clear edges and abundant formation of white scales, which are poorly adherent and easy to flake off with scratching. The disease is of varying severity, as in some cases it is so mild that people do not notice it, although in other patients it is extensive and the whole body reddens with scales.
Itching is quite frequent, in addition to joint pain in a special type of arthritis that affects, above all, the smaller joints. This psoriatic arthritis affects a small percentage of patients with psoriasis. It can also affect the nails in the form of nail pitting or nail dystrophy.
Causes of psoriasis
The cause is not known, but it seems that a biochemical malfunction stimulates an exaggerated production of skin cells. In a person with psoriasis the skin renews itself every 3 or 4 days, while a normal person renews itself every 28 days.
There are known triggers of outbreaks such as physical trauma (scratching, cuts, abrasions, burns), infections (streptococcus, HIV), medications (lithium, propranolol, oral glucocorticoids), excess alcohol, climate (worsens in colder climates), endocrine factors (peak at puberty and menopause) and usually improves during pregnancy and becomes more resistant to treatment after childbirth.
Treatment to combat psoriasis
The goal of treatment is to relieve discomfort and reduce cell division. Factors influencing the choice of treatment are: age, type of psoriasis, site and extent of lesions (localized or generalized), previous treatments and associated diseases.
The treatments are:
– Local treatment:
o Emollients: creams, lubricating lotions that prevent water from evaporating from the skin, improving the patient’s appearance and controlling itching. A daily shower is recommended to remove scales without dehydrating the skin.
o Topical corticosteroids: these are the most commonly used drugs in creams, ointments and lotions. Initially more potent products may be used, which soon need to be reduced to prevent the appearance of side effects such as thinning of the skin.
o Intralesional corticosteroids: consists of injecting cortisone into the plaques with mesotherapy, it is also used for the nails.
o Calcipotriol analogous to vitamin D: they can be combined with corticoids, do not cause cutaneous atrophy and cannot be applied to more than 40 percent of the body.
o Reducing agents: the irritant anthralin cannot be applied on the face, folds and genitals; and pitches (coal tar).
– Phototherapy: Ultraviolet rays reduce the symptoms of psoriasis and also reduce the rapid skin renewal that exists in this disease. UV irradiation can be performed on the entire body surface (in generalized psoriasis with affections greater than 30 percent of the body surface) or only on some area (localized forms) with the Eximero and Dualight lasers.
In the generalized forms, the use of the following booths is possible:
o Narrowband UVB, in cases of short evolution (e.g.: in drops), thin plaques, pregnancy or lactation.
o PUVA: (UVA+ oral psovalerios) contraindicated in children, pregnant women, skin neoplasms and photosensitive diseases. Eye and skin protection is necessary for at least 8 to 12 hours after taking the medication. It is recommended in cases of long duration and in thick plaques.
– Systemic:
o Methotrexate: this drug is used in cases of severe disease that cannot be controlled by other methods, psoriatic arthritis and generalized pustular psoriasis. It can be administered in pills or injections. Contraindicated in patients with liver disease and requires regular blood tests to monitor liver function.
o Retinoids: vitamin A derivative used alone in combination with PUVA. Contraindicated in pregnancy and should be avoided until two years after treatment. It requires liver, cholesterol and triglyceride controls.
o Cyclosporine: given in psoriasis resistant to other treatments. It requires regular controls of renal function through blood tests.
o Biological therapies: the discovery of immunological phenomena in the pathogenesis of psoriasis has led to the search for new drugs that block specific steps in the formation of psoriasis plaques. There are strong data in favor of the efficacy of each of these drugs, but their side effects and high cost must be taken into account.