What is psoriasis?
Psoriasis, known as psoriasis, is a chronic and incurable disease and is seen in about 1-3% worldwide. Although it often begins in the thirties, it can occur at any age from birth. There is a family history in 30% of the cases. Various antigens are created by cells in the skin in psoriasis. These antigens play a role in activating the immune system. Active immune cells return to the skin and cause cell proliferation in the skin and the formation of psoriasis-specific plaques. Therefore, psoriasis is a disease that the body develops against its own tissues. Such disorders are classified as autoimmune diseases.
T lymphocyte cells of the immune system start to accumulate in the skin by activating in psoriasis patients. After these cells accumulate in the skin, the life cycle of some skin cells accelerates and these cells form the structure of the hard plaques formed. Psoriasis occurs as a result of the proliferation process of these skin cells.
Skin cells are produced in the deep layers of the skin and slowly rise to the surface and after a certain period of time, they complete their life cycle and shed. The life cycle of skin cells takes about 1 month. This life cycle can be shortened to a few days in psoriasis patients. Cells that complete their life cycle do not find time to shed and begin to accumulate on top of each other. The lesions that occur in this way can appear as plaques on the patient’s hand, foot, neck, head or face skin, especially in the joint areas.
What causes psoriasis?
The underlying cause of psoriasis has not been revealed precisely. In recent studies, it has been emphasized that factors related to genetics and immune system may jointly affect the development of the disease.
In psoriasis, which is an autoimmune event, cells that normally struggle with foreign microorganisms synthesize antibodies against the antigens of skin cells and cause the formation of characteristic rashes. It is thought that some environmental and genetic factors may trigger the development of skin cells that regenerate faster than normal. The most common of these trigger factors are:
- Throat or skin infection
- Cold and dry climate conditions
- Accompanying different autoimmune diseases
- Skin traumas
- Tobacco use or cigarette smoke exposure
- Excessive alcohol consumption
- After rapid cessation from steroid-derived drugs
- After the use of drugs used for some blood pressure or malaria treatment
To the question of whether psoriasis is contagious, it can be answered that this disease can occur in anyone and there is no such thing as transmission between people. In one third of the cases, a history of onset can be detected in childhood. Finding a family history is an important risk factor. The presence of this disease in close family members may result in an increased likelihood of developing psoriasis. Genetically transmitted psoriasis is detected in approximately 10% of individuals in the risk group. Psoriasis development is in question in 2-3% of this 10% slice.
Various studies have revealed that there may be 25 different heart regions associated with the risk of psoriasis. Changes in these gene regions can trigger T cells to behave differently than normal. In the skin occupied by T cells, rash occurs in the form of enlargement of blood vessels, acceleration of cell cycle and dandruff.
What are psoriasis symptoms and types?
Psoriasis has a chronic course and most patients have plaques and dandruff on the skin. The disease is very common in a quarter of cases. Spontaneous recovery is rare, but in some cases periods of sedation and exacerbation may be seen. Stress, alcohol, viral or bacterial infections can cause flare-ups. Tobacco use is also among the factors that can aggravate the disease.
Most of the patients have itching along with plaques on the skin. Difficulty in maintaining body temperature, chills, chills, and increase in protein consumption may occur in the common disease table. In some cases, rheumatism may develop due to psoriasis. It can be in rheumatism due to psoriasis, wrist, fingers, knee, ankle and neck joints. There are also skin lesions in these cases.
Psoriasis symptoms can be seen all over the body, but it often occurs in the knee, elbow, scalp and genital area. When there is psoriasis in the nails, tiny pits, yellow-brown discoloration and nail thickening may occur. There are different forms of psoriasis depending on the type of skin lesions:
Plaque psoriasis, or in other words, psoriasis vulgaris, is the most common subtype of psoriasis and constitutes approximately 85% of patients. It is characterized by a gray or white rash on thick red-colored plaques. Lesions most commonly occur on the knee, elbow, waist, and scalp. These lesions, which vary in size between 1 and 10 centimeters, may reach a size to cover a part of the body in some people. Trauma caused by actions such as scratching on intact skin can trigger lesion formation in that area. This condition, called the Koebner phenomenon, may indicate that the disease is currently active.
Detection of punctate bleeding in samples taken from lesions in plaque psoriasis patients is called Auspitz sign and is important for clinical diagnosis.
Guttate psoriasis creates lesions in the form of small red circles on the skin. Plaque is the second most common psoriasis subtype after psoriasis and is present in approximately 8% of patients. Guttate psoriasis generally tends to start during childhood and young adulthood.
The lesions formed are small, separated from each other and drop-shaped. More common rashes on the trunk and extremities may also occur on the face and scalp. The thickness of the rashes is less than that of plaque psoriasis, but may thicken over time. Various triggering factors may be involved in the occurrence of guttate psoriasis. Bacterial throat infections, stress, skin injury, infection and various medications are among these trigger factors. The most common factor detected in children is upper respiratory tract infections caused by streptococcus bacteria. Guttate psoriasis is the best form of psoriasis among all subtypes.
Pustular psoriasis, one of the severe forms of psoriasis, occurs as the name suggests, red colored pustular. Lesions that can occur in many parts of the body, including isolated areas such as the inside of the hands and feet, can reach a large area. Pustular psoriasis, as in other subtypes, can cause dandruff by keeping it in the joint areas. Pustular lesions are in the form of white, pus-filled blisters.
Psoriatic arthritis is a very painful rheumatological disease that restricts the physical activities of the person, and approximately 1/3 of psoriasis patients are affected. Psoriatic arthritis is divided into 5 different subgroups depending on the symptoms. Currently, there is no drug or other treatment method that can definitively treat this disease.
Psoriatic arthritis occurs after the immune system targets the joints along with the skin in psoriasis patients, whose basis is an autoimmune disease. This condition, which can seriously affect the hand joints, can occur in any joint in the body. The emergence of skin lesions in patients usually precedes the occurrence of joint complaints.
How is the diagnosis of psoriasis (psoriasis)?
The diagnosis of the disease is mostly made by the appearance of skin lesions. The presence of psoriasis in the family helps the diagnosis. Psoriasis can be diagnosed in most cases only by physical examination and examination of the lesions. The presence of symptoms related to psoriasis is questioned within the scope of physical examination. In suspicious cases, a skin biopsy is performed.
Samples taken in the biopsy procedure, in which a small skin sample is taken, are sent to the laboratory to be examined under a microscope. The type of psoriasis can be clarified with the biopsy procedure.
Apart from the biopsy procedure, various biochemical tests can be used to support the diagnosis of psoriasis. Complete blood count, rheumatoid factor level, erythrocyte sedimentation rate (ESR), uric acid level, pregnancy test, hepatitis parameters and PPD skin test are among the other diagnostic tools that can be applied.
How is psoriasis treatment (psoriasis)?
When deciding on psoriasis treatment, the patient’s personal opinions are also taken into account. Since the treatment will be long-term, the patient’s compliance with the treatment planning is very important. Many patients also have metabolic problems such as obesity, hypertension and hyperlipidemia. These situations are also taken into consideration when planning treatment. Treatment planning is carried out according to the severity of the disease and whether it impairs the quality of life.
Appropriate skin creams are used in cases localized to a certain part of the body. Creams containing cortisone are often preferred. Creams are recommended to keep the skin moist. Pregnant women are treated with less potent cortisone creams and phototherapy. Before that, information about the inconvenience of treatment can be obtained by consulting the woman birth.
Corticosteroid-containing cream, gel, foam or spray derivative drugs may be useful in cases of mild to moderate psoriasis. These drugs, which are used daily during the exacerbation period, are used by leaving wide time intervals in the periods when there is no disease. Skin thinning may occur with long-term use of strong corticosteroid drugs. Another problem that occurs in long-term use is that the drug loses its effectiveness.
While performing light therapy (phototherapy), both natural and ultraviolet rays of various wavelengths are used. These rays can eliminate the immune system cells that have invaded the healthy cells of the skin. In mild and moderate psoriasis cases, UVA and UVB rays can have a positive effect in controlling the complaints. In phototherapy, PUVA (Psoralen + UVA) therapy is applied in combination with psoralen. The rays that can be used in the treatment of psoriasis are UVA with a wavelength of 311 nanometers and narrow band UVB rays with a wavelength of 313 nanometers. Narrow band ultraviolet B (UVB) rays can be used in children, pregnant women, breastfeeding or elderly people. The psoriasis subtype with the best response to phototherapy is guttate psoriasis.
In some cases, physicians may prefer drugs containing vitamin D. Coal tar is also among the treatment options. Creams containing vitamin D reduce the rate of renewal of skin cells. Charcoal-containing products can be used in cream, oil or shampoo forms.
In severe psoriasis cases, systemic drugs are used in addition to phototherapy and topically applied creams are added to the treatment. It is important to keep the leather moist and soft. Systemic drug therapy is preferred especially in cases with joint inflammation and nail involvement. Cancer drugs such as methotrexate, cyclosporine, vitamin A forms known as retinoids and fumarate derivative drugs are among the systemic drugs used in the treatment of psoriasis. Blood tests should be done routinely in patients in whom systemic therapy is initiated, and liver and kidney functions should be closely monitored.
Retinoid drugs suppress the production of skin cells. It should be kept in mind that psoriasis lesions may recur after the use of these drugs is terminated. Retinoid derivative drugs also have various side effects such as inflammation and hair loss on the lips. Pregnant women or women who want pregnancy within 3 years should not use drugs containing retinoids due to congenital defects that may occur.
The purpose of using chemotherapy drugs such as cyclosporine and methotrexate is to suppress the immune system response. Cyclosporine is highly effective in controlling psoriasis symptoms, but its immune system weakening effect may predispose the person to various infectious diseases. These medications also have other side effects such as kidney problems and high blood pressure. Less side effects have been observed during the use of methotrexate in low doses, but it should be kept in mind that serious side effects may occur in long-term use. These serious side effects include liver damage and disruption of blood cell production.
There are situations that trigger and exacerbate the disease in psoriasis. These include tonsillitis, urinary tract inflammation, tooth decay, skin damage by scratching, abrasions and scratches, emotional problems, painful events and stress. All of these conditions must be treated appropriately. Psychological support from psychiatrists or psychologists is among the approaches that can be beneficial.
Psoriasis is a very suggestive disease. The positive feelings of the patient that he will recover can closely affect the course of the disease. It is accepted that these methods, which are applied as an alternative to patients, can psychologically relax the patients and have a suggestive effect. For this reason, it is important for people with psoriasis to be under the control of a physician and to be able to benefit from traditional methods.
The relationship between dietary habits and lifestyle and psoriasis has not been fully elucidated yet. Getting rid of excess weight, avoiding the consumption of products containing trans or born fat, and reducing alcohol consumption are dietary changes that answer the question of what is good for psoriasis. At the same time, patients should be careful about which foods they consume put the disease into an exacerbation period.