Psoriasis: Types and Treatments

Psoriasis is an autoimmune chronic inflammatory skin disease, causing red itchy plaques, often covered with white or silvery scales.

The ancient physician Galen was the first to mention the term psoriasis, while descriptions of patients whose lesions looked like psoriasis are also mentioned, both by Hippocrates and in the Old Testament.

“The word psoriasis comes from the Greek word psoros, which means scale. It affects men and women equally and the peak age of onset is 35 – 50 years.

10% to 30% with psoriasis will progress to psoriatic arthritis, while in 70% arthritis follows the onset of psoriasis. Cutaneous psoriasis may precede several years (up to 35), (MO: 7 years). In 15% the two diseases manifest themselves in the same year, while in 10% the arthritis precedes the psoriasis, which usually appears in the next two years”, explains Mrs. Eleni Komninou, Rheumatologist, Director of the Autoimmune Rheumatic Diseases Clinic at Metropolitan General.

About 250,000 people in Greece suffer from psoriasis.

Pathogenesis of Psoriasis
Complex immune pathways are involved:
• Excessive, aberrant inflammatory response
• Tissue damage
• Hyperplasia of skin keratinocytes
• Angioedema
• Accumulation of inflammatory cells.

A network of cytokines with special signaling pathways of the immune system is involved, resulting in the skin being vulnerable to mechanical stress and micro-injuries (Koebner effect). Environmental and genetic factors influence the onset of psoriasis.

Types of psoriasis
Plaque Psoriasis: The most common type of psoriasis, it causes dry, raised, scaly patches of skin.
Nail psoriasis (onycholysis): Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration.
Inverse psoriasis: Inverse psoriasis mainly affects the skin folds of the groin, buttocks and breast. It causes smooth patches of inflamed skin that worsen with friction and sweating.
Pustular psoriasis: Pustular psoriasis, a rare type, causes well-defined pus-filled blisters.
Erythroderma psoriasis: The less common type of psoriasis can cover the entire body in a scaly rash that can be itchy.
Guttate Psoriasis: It is answered in less than 10% of cases. It usually occurs in children or young adults after a respiratory infection (strep infection). It is characterized by multiple, small, scattered, drop-like plaques with a diameter of ˂2 cm. This type of psoriasis has a very good prognosis.

Diagnosis
The extent, number, morphology and anatomical location of the lesions are evaluated. A good history is required to diagnose possible comorbidities, while in doubtful cases the diagnosis is confirmed by skin biopsy.

Diseases associated with psoriasis
In addition to psoriatic arthritis, psoriasis has been associated with other diseases:
• Arterial hypertension
• Diabetes
• Cardiovascular diseases
• Metabolic syndrome
• Various other autoimmune diseases
• Inflammatory bowel diseases
• Psychiatric diseases and depression
• Obesity.

Psoriasis is a systemic pathological entity with serious effects on the quality of life and on the survival expectancy of patients. The aim of the therapeutic approach is not only to treat the skin lesions, but also the systemic manifestations and comorbidities.

Treatment
The choice of the therapeutic approach depends on the clinical form of the disease, its severity, the extent of the affected body, the effect on the patient’s quality of life, the possible comorbidities that exist and the co-administered drugs.

Some treatments are:

Local treatment with special formulations, application, that is, topical creams and ointments. Corticosteroids, calcipotriol, calcitriol, emollients and keratolytic drugs are most commonly used. They are a therapeutic option in cases where the damage has a limited extent, but they are also used as a complementary treatment or as a maintenance treatment.

Systemic treatment with medication. Methotrexate, cyclosporine are mainly given. Regular monitoring of the patient and frequent laboratory testing are required.

Treatment with biological agents. Their administration is preferred in severe forms of psoriasis, when classic treatments have no effect. They are a targeted and effective treatment. For example, cytokine:interleukin 23 (IL23) is variously involved in the pathogenesis of the disease.

“Medicines that inhibit its production are currently one of the most effective treatment approaches for psoriasis. Furthermore, the design and development of more selective targets, the search for ideal drugs and personalized treatment are perspectives that will lead to a more effective treatment of the disease.

It is proven that psoriasis affects many aspects of the quality of life by making daily functioning, interpersonal relationships and professional career difficult.

Although psoriasis is rarely acutely life-threatening, it has significant psychological and social implications. Due to the visibility of the disease, it can cause strong feelings of stress, anxiety, anger and depression.

As a chronic disease, regular medical follow-up is recommended in order for the disease to enter and remain in remission,” concludes Mrs. Komninou.

She writes:

Mrs. Eleni Komninou, Rheumatologist, Director of the Autoimmune Rheumatic Diseases Clinic at Metropolitan General

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