Plaque psoriasis is a chronic inflammatory, non-contagious skin condition. It is a very prevalent, widespread dermatological disease.
Psoriasis vulgaris is typically characterised by round, red, raised and sometimes itchy sites of inflammation on the skin. They are sharply defined and covered in characteristic shiny silvery scales. Bleeding dots, a thin covering of skin on the damaged skin and lamellar scales are typical. The disease ranges from single, initially small dots of inflammation to involvement of the entire skin.
The extensors of the large joints are affected particularly often as are the scalp or the area around the sacral bone.
Besides the skin, the nails are also frequently affected. Typical nail changes include pinhead-size retractions of the nail, nailbed changes resulting in yellowish-brown discolouration, crumbling nails and the nail separating from the finger.
In Germany, 2‑3 per cent of the population suffer from psoriasis. In every second skin psoriasis patient, the nails are affected, too. 20 to 30 per cent also have simultaneous joint involvement and therefore psoriatic arthritis.
Plaque psoriasis belongs to the group of autoimmune diseases. The exact causes for the disease are not known.
Besides a hereditary disposition, environmental factors also play a role. These may include skin injuries, sunburn, change of climate, stress or infections.
Plaque psoriasis is caused by a malfunction of the immune system. The immune system is in charge of recognising dangerous pathogens, foreign and hazardous substances and destroying them in a targeted way.
Skin psoriasis can occur at any age but different age groups are affected with different frequency. A first peak of the disease is in persons below the age of 30.
This early type (type 1) has a significant hereditary component and patients are at higher risk of a more severe course of the disease. Around 70 per cent of patients suffer from the early type. In contrast, the late type (type 2) has a better prognosis and usually occurs after the age of 40.
Dermatologists will diagnose plaque psoriasis based on the typical skin changes and characteristics of psoriasis. It is important to mention a family history of psoriasis.
Treatment of plaque psoriasis is mainly aimed at reducing the increased cell division of keratinocytes.
By treating the symptoms, doctors will achieve improvement of the acute problems. Subsequently, the inflammation is brought under control and the frequency and severity of the disease flare-ups decreased.
The therapy goals may be more or less achievable depending on the individual patient. This may mean in some cases that even effective improvement of the scaling or relief of the itchiness is significant progress.
A special focus is on the visible areas of the body as changes there have a negative impact on personal appearance and quality of life.
Different therapy options are available:
- Local skincare to prevent the skin from becoming too dry such as creams, lotions, bath essences, etc.
- External treatment with anti-inflammatory active substances such as corticosteroids and dithranol
- Balneotherapy: bathing in natural mineral springs
- Climate therapy
- UVB phototherapy and photochemotherapy: PUVA therapy
- Internal treatment with retinoids (vitamin A derivatives) or active substances that have an effect on the misdirected immune system. Methotrexate, ciclosporin or fumaric acid ester are considered very effective in severe courses of the disease.
- An increasing therapeutic significance is found in non-drug based measures such as an exchange of experiences in self-help groups or participating in patient training courses.