Psoriasis vulgaris

What is psoriasis – also known as psoriasis vulgaris?

Psoriasis is a chronic, inflammatory, non-infectious skin disease. It is also regarded as an endemic dermatological disease because it is so common.

Round, red, raised and sometimes itchy centres of inflammation on the skin are typical of psoriasis. These are sharply delimited and covered with characteristic silvery-shiny scales. Punctiform bleeding, a thin layer of skin over the damaged skin and lamellar scales (plaques) are characteristic. The disease ranges from isolated, initially punctiform, small centres of inflammation to involvement of all the skin.

The extensor sides of the major joints are particularly commonly affected, as well as the scalp or the area around the sacrum.

The nails are often affected as well as the skin. Typical changes in the nails are pin-head sized depressions in the nail plate, changes in the nail bed that cause yellowish brown discolouration, crumbling nails and separation of the nails.

Two to three per cent of the population suffer from psoriasis in Germany. The nails are also involved in every second patient with skin psoriasis. Between 20 and 30 per cent of those affected also have joint involvement and suffer from psoriatic arthritis.

What are the causes and risks for the development of psoriasis?

Psoriasis is a member of the group of autoimmune diseases. The precise causes leading to its development are not known. In addition to a hereditary predisposition, environmental factors are also involved. These may be injuries to the skin but may also be sunburn, a change of climate, stress situations or infections.

Psoriasis develops as a result of a malfunction of our immune system. The task of this defense system is to detect dangerous pathogens (e.g. germs), foreign substances and pollutants and destroy them in a targeted fashion.

In principle, psoriasis of the skin can develop in every age group but with different frequencies. The first peak in onset of the disease is before the age of 30. This early-onset form (type 1) has a marked hereditary component and patients are at higher risk of the disease becoming severe. Some 70 per cent of patients suffer from the early-onset form. In contrast, late-onset psoriasis (type 2) has a more favourable prognosis and usually only occurs after the age of 40.

What role does lifestyle play in the development of psoriasis?

As mentioned above, psoriasis is a member of the group of autoimmune diseases. In addition to a hereditary predisposition, environmental factors are also involved. These may be injuries to the skin but may also be sunburn, a change of climate, stress situations or infections.

How is psoriasis diagnosed?

The dermatologist diagnoses psoriasis on the basis of the typical skin change and characteristics of the disease. Information about any relatives with psoriasis is also important.

How is psoriasis treated?

The prime objective of treatment in psoriasis is to reduce the increased cell division of the keratinocytes, the skin cells that form keratin.

The doctor causes the acute symptoms to subside with treatment. The inflammation is then brought under control and the frequency and severity of the acute episodes reduced.

The treatment’s aims may be achievable to a varying extent for each patient. In some cases, this may mean that already an effective improvement of the plaque formation or alleviation of the itching is regarded as a major progress.

Particular attention must be paid to the visible areas of the body, because the skin changes here impair the patient’s personal appearance and perceived quality of life.

Various therapy options are available:

  • Topical skin care that prevents the skin drying out: e.g. creams, ointments, bath additives, etc.
  • External treatment with anti-inflammatory active substances, such as corticosteroids and dithranol
  • Balneotherapy: treatment with baths from natural healing springs
  • Climatotherapy
  • UVB phototherapy and photochemotherapy: PUVA therapy
  • Systemic (internal) treatment with retinoids (vitamin A derivatives) or active substances that influence the malfunctioning immune system. Methotrexate, ciclosporin or fumaric acid esters are regarded as having a good effect on severe manifestations of the disease

Non-medicinal measures, such as the exchange of experiences in self-help groups or taking part in patient training sessions, are also gaining increasing therapeutic significance.