PSORIASIS

What is psoriasis?

Around two percent of the population suffers from psoriasis, as it is also called. The disease is characterized by plaques: sharply defined, reddened, and sometimes thickened areas of skin. This is usually accompanied by severe itching. However, the nails can also be affected, showing either a yellowish-brown discoloration or small, round depressions. In some people, psoriasis also affects the joints, causing swelling and pain. Psoriasis can occur anywhere on the body. However, it is particularly common on scalps, the outsides of elbows and knees, the hands and feet, and the coccyx region. Most sufferers are affected between the ages of 15 and 25.

There is a hereditary predisposition to psoriasis. However, it is triggered by one or more triggers. Infections are one of the causes. The immune system then works not only to fight the infection, but also to attack the previously healthy skin. Injuries to the outer protective layer are considered another possible factor. Cuts and abrasions are just as conceivable as sunburn or burns. Mechanical irritation of the skin, for example, due to rubbing clothing or a belt that is too tight, can also promote the outbreak of psoriasis. Stress is also a trigger.

If hormonal changes occur in the body—be it due to puberty, pregnancy, or menopause—the risk of developing psoriasis increases if you are predisposed to it. Finally, medications, especially blood pressure lowering drugs, but also painkillers and some antibiotics, may also trigger psoriasis. Alcohol and nicotine consumption, as well as obesity, are also critical factors to consider. While psoriasis cannot be cured, with the right treatment, flare-ups can be kept as infrequent and as mild as possible.

Damaged skin in psoriasis

Our skin is composed of millions of tiny cells. In a healthy person, it renews itself every three to four weeks. In patients with psoriasis, this cycle is severely disrupted and shortened to three to four days. The cells of the uppermost layer of skin push to the surface much more quickly, resulting in shiny scales on reddened areas. These areas range in size from a coin to the palm of a hand and usually appear symmetrically on both sides of the body.

A typical accompanying symptom is severe itching. The skin is dry, sometimes very sensitive and tight. Burning or stinging are also possible symptoms of this disease. As those affected scratch themselves frequently, they damage the skin and cracks form, and bleeding cannot be ruled out. Even unaffected areas can itch. Resisting the irritation and not reacting is extremely difficult. Scratching covers the itching, at least for a moment. In the long term, however, the irritation intensifies and the skin becomes further affected. If it is damaged, it can only partially fulfill its role as the body's protective shield and pathogens penetrate more easily. Care is extremely important for psoriasis and is the prerequisite for alleviating the symptoms. The severity and frequency of flare-ups can be reduced enormously as a result.

In which parts of the body does psoriasis occur?

Psoriasis can occur on any part of the body.

• On the scalp in the genital area
• on the face – around the eyes, ears, mouth and nose on the hands and feet
• on fingernails and toenails

The right care for psoriasis

Depending on the type and severity of psoriasis, various treatment options are available. Basic daily care is always the foundation. The skin is unable to retain sufficient moisture, so it needs to be helped. Creams with moisturizing properties are essential for this. It's all about using gentle products that don't further irritate the skin. Dermaplan's range offers precisely tailored care that effectively helps with psoriasis, as well as atopic dermatitis.

All products are free from any allergenic or harmful ingredients. They do not contain fragrances, perfumes, preservatives, emulsifiers, dyes, mineral oils, silicones, polyethylene glycols, or animal ingredients. Since they were developed in collaboration with dermatologists, skin compatibility is guaranteed. Lipid Balance is recommended as basic care for dry skin prone to redness. There are three products in total, each with a different lipid content. The drier the skin, the higher the lipid content should be. This moisturizing, replenishing cream should be applied thinly in the morning and evening. Dermaplan Body Lotion is an alternative. All care products provide the skin with the moisture it needs and build up the skin barrier. The goal is to bring it into balance and maintain it there.

In severe cases, acute itching treatment becomes the focus. If this helps relieve the itching, long-term itching treatment can be used. Another important aspect of body care, Dermaplan supports cleansing with a gentle facial toner and a cleansing lotion with moisturizing properties.

All DERMAPLAN products for psoriasis are available in our online shop and in your pharmacy.

Living with psoriasis

Everyone has their own experiences with their skin, and every skin reacts differently. Therefore, there are no universally applicable recommendations; each psoriasis patient must develop their own strategies for coping with the condition over time. However, following some general advice can be very helpful for most patients.

To prevent relapses or worsening of psoriasis, you should learn to recognize the trigger factors that are important to you and, if possible, avoid them or reduce them to a minimum.

Some of these factors are easily controllable, while others are less so. However, you can learn to better cope with adverse influences such as stress or emotional strain. On the other hand, you should identify factors that favor the progression of the disease and use them specifically if you notice that doing so is beneficial for your skin. Care for and support your skin with a psoriasis cream.

Psoriasis and Psyche

Try to accept yourself and your illness. It's also important to explain the disease to others. Many people don't know that psoriasis isn't contagious. Patients who are repeatedly confronted with hostile reactions and rejection feel excluded and suffer even more from their psoriasis.

Especially during periods of high disease activity, or "relapses," many affected individuals tend to withdraw and limit their social contacts because they "can't stand themselves anymore" and are unsure whether others will accept them. This often leads to social isolation and bitterness, even depression.

Therefore, it's important for patients with psoriasis to seek out a doctor who not only treats their skin well, but also devotes time and understanding to their fears, worries, and anxieties. In individual cases, accompanying psychotherapy may be beneficial. It can help patients better understand themselves and their disease, allowing them to live with it more naturally.

The trigger factors for psoriasis include

• Infectious diseases In addition to general infectious diseases (e.g. colds, viral flu), especially infections with streptococci (e.g. tonsillitis, angina or scarlet fever) or HIV (AIDS pathogen)
• Allergies/allergic reactions
• Metabolic disorders such as diabetes mellitus (diabetes), hormonal fluctuations (puberty, pregnancy, menopause)
• Climatic conditions Seasonal fluctuations in disease activity are normal. Symptoms usually worsen in spring and late autumn.
• Medications - Certain medications can trigger and/or worsen the disease. These include lithium, antimalarials, beta-blockers, ACE inhibitors, interferon, progesterone, non-cortisone anti-inflammatory drugs, and systemic corticosteroids after discontinuation.
• Stress and strain Stress and physical or psychological strain (e.g. exam situation, relationship problems, death of a relative or problems at work)
• Environmental influences, e.g. dry air in winter or sunburn
• Injuries Open injury to the skin, e.g. cuts or injections
• Skin damage caused by physical and chemical influences, e.g. tight-fitting bracelets, belts or bras, abrasive clothing, vigorous scratching, burns, tattoos
• Alcohol - especially when consumed excessively
• Obesity - especially if you are very overweight Smoking - especially if the hands are affected
• Nutrition - certain nutritional factors appear to play a negative role in individual cases

What different types of psoriasis are there?

Plaque psoriasis

Psoriasis is a highly diverse skin disease that appears in a variety of forms. Each form has distinct characteristics. Typically, only one type of psoriasis occurs at a time, but two or more different types of psoriasis can occasionally occur at the same time. Psoriasis can also occasionally transition from one form to another.

Triggering factors can transform some forms of psoriasis, such as plaque psoriasis, into another form, such as pustular psoriasis.

Plaque psoriasis is the most common form of the disease. It affects approximately 80 percent of all psoriasis patients. It is typically found on the elbows, knees, scalp, and lower back.

Guttate psoriasis

Guttate psoriasis is a form of psoriasis that often begins in childhood or young adulthood. This form of psoriasis appears as small, red, isolated patches on the skin. Guttate psoriasis lesions typically appear on the trunk and limbs. Guttate psoriasis often appears very suddenly.

A variety of conditions such as upper respiratory tract infections, streptococcal infections, tonsillitis, stress, skin injuries, and the use of certain medications (anti-malarial drugs, beta-blockers) can trigger an outbreak of guttate psoriasis.

Moisturizers are considered the preferred treatment for guttate psoriasis. Phototherapy with UVB light, or PUVA, is also a very effective treatment for guttate psoriasis. Only in severe cases do doctors prescribe systemic treatments (oral or injected medications) for this type of psoriasis, although sometimes a short course of one of these medications leads to rapid and long-lasting improvement.

Inverse psoriasis

Psoriasis inversa (inverse means the opposite distribution pattern compared to plaque psoriasis) is when the psoriasis occurs only in the body folds, e.g. the armpits, the groin or in the deep buttock crease.

It's not so easy to detect because the characteristic scaling doesn't develop on these areas of the body due to the warmth and moisture. Inversa psoriasis also requires special treatment. This form of psoriasis occurs more frequently in overweight patients and those with deep skin folds.

Treatment can be difficult due to the sensitivity of the skin in these areas. Steroid creams and ointments are considered very effective, but they should not be covered (occluded) with bandages. Overuse or misuse of steroids, especially in skin folds, can lead to side effects such as thinning of the skin and stretch marks.

These areas are also particularly prone to fungal infections and should be specifically examined for these. The use of powder can also help dry the moist lesions associated with inversa psoriasis. Some patients use creams at night and powder in the morning.

Pustular psoriasis

This term encompasses a group of skin diseases related to psoriasis and characterized by the formation of pustules (pus-containing blisters). The very rare generalized (occurring all over the body) pustular psoriasis is characterized by superficial pustules, high fever, and generalized symptoms.

It requires inpatient treatment. Less rare are localized forms on the palms of the hands and/or soles of the feet (palmoplantar pustular psoriasis). This often results in a very long-lasting condition in which pustules develop, rupture, dry out, and lead to scales, crusts, cracks, and bleeding, usually accompanied by itching and pain. Manual work and walking are difficult, and those affected are also reluctant to reach out with the "affected" hand. Remarkably, the rest of the skin is usually healthy. It is important to note that the pustules are not caused by an infection, but by a peculiarity of the disease process.

Pustular psoriasis, like psoriasis vulgaris, cannot be transmitted, even through direct contact with the affected skin areas.

Forms of Zumbusch pustular psoriasis

The generalized form (generalized pustular psoriasis) is also called Zumbusch type. It affects the entire body and is potentially life-threatening, but is not very common. In addition to the widespread blisters, those affected suffer from severe malaise, fever, weakness and fatigue, stiff muscles, and joint pain.

Those affected must be treated in a dermatology clinic as quickly as possible. Treatment is systemic, involving the administration of retinoids, cyclosporine, corticoids, and methotrexate. In addition, topical treatments with corticoids and vitamin D analogues can also be performed. A combination with PUVA therapy is also possible. Barber's type: In palmoplantar pustular psoriasis, small yellow pustules often form on the palms and soles of the feet within a few hours. Their usually yellowish contents are not infectious.

After a few days, the pustules turn brown and eventually flake off. The surrounding skin is reddened, often developing deep and painful cracks. The condition usually lasts for several weeks or months, disappearing intermittently and then recurring. It rarely heals completely. The deep cracks in the palms of the hands and soles of the feet, in particular, often cause excruciating pain. Standing, walking, grasping, writing, and other everyday activities are difficult and significantly limit the ability of those affected to function.

Many sufferers feel excluded and shunned by their clearly visible disease. Patients with this form suffer from recurring bouts of fever and a general feeling of illness. Smokers are more likely to develop this form of psoriasis than non-smokers.

The causes of the disease are currently unknown. The connection to psoriasis vulgaris is also unclear. Certain genetic characteristics that occur more frequently in patients with common psoriasis are not found in this special form of psoriasis.

Like common psoriasis, palmoplantar psoriasis is likely an autoimmune disease. As with common psoriasis, stress and stressful life events can also contribute to the onset of palmoplantar pustular psoriasis.

Nail psoriasis

In approximately 30%-50% of all psoriasis patients, the disease also affects the fingernails and/or toenails. Typically, several nails on both fingers and/or toes are affected simultaneously.

Nail growth is usually disrupted. Typical symptoms of psoriatic nail changes are pitted nails with small, pinpoint defects in the nail plate that appear punched out. If, however, the nail bed, i.e., the skin beneath the nail plate, is affected, oil stains occur. The "oil stain" lies beneath the nail plate and usually protrudes at the edges due to constant inflammation and excessive cell growth.

The "oil stains" are usually reddish, yellow-brown, or gray in color. The third and most severe form of nail psoriasis, the crumbling nail, is fortunately rarely observed. Instead of a thin, evenly stable nail plate, a layer up to 5 mm thick develops.

Erythrodermic psoriasis

Erythrodermic psoriasis or psoriatic erythroderma is rare and the most severe form of psoriasis.

It is accompanied by inflammatory changes and extreme redness affecting most or all of the skin. Scaling is less pronounced, but the condition can be accompanied by severe itching, pain, and a pronounced feeling of illness. Furthermore, it can disrupt the body's temperature balance and cause kidney and heart problems.

FAQ Psoriasis

Psoriasis – or colloquially, psoriasis – is a chronic skin disease that manifests itself in flare-ups. There are periods of symptoms and periods when those affected experience no problems. However, even during these periods, care is strongly recommended. Questions about psoriasis often arise. Our FAQ section contains the most frequently asked questions and provides you with the corresponding answers.