Psoriasis is a chronic inflammatory recurrent disease. It can occur at any age of life, often equally in both sexes, often triggered by factors that affect the individual genetic predisposition.
After onset, the disease may have alternating phases of varying duration, remission and exacerbation of skin manifestations. In general the most common onset affects the surface of the elbows and knees. In some cases, after the first onset you can go into remission for long periods.
Clinical aspects of psoriasis
The most common clinical variant of psoriasis is the so-called "vulgar", characterized by erythematous patches covered with gray-silvery scales selectively localized to the extensor regions of the body and to the scalp. The lesions are roughly oval, slightly raised on the skin, ranging in size from a few centimeters even up to a few decimetres, rarely itchy. In some cases the squamous component prevails over the erythematous one; in other cases, especially in the variants in which the disease occurs at skin folds, flaky component is minimal and prevails, however the erythematous appearance, in patches sometimes slightly exuding (we call it Inverse Psoriasis).
Scalp psoriasis has flaking gray patches and hyperkeratosis (thickened skin areas) extending to the hair without breaking it. The extension may be minimal or involve the entire scalp in a "helmet" aspect.
Psoriasis guttata is instead a variation characteristic of childhood which comes with many small erythematous desquamative (0,5-1cm) patches, that may affect both the trunk and the limbs, whose eruption is typically preceded by streptococcal angina.
Palmar-plantar psoriasis can affect variably hands and feet with minimal forms of hyperkeratosis until the extension of the entire surface of the palms and / or plants, with thick grayish scales. Sometimes the clinical picture may be complicated by painful lacerations of the skin. This form could have a big social burden (impaired prehensile capacity, embarrassment to shake hands in greeting, etc.).
Psoriasis can more or less extensively involve even the nails (psoriatic onycopathy), resulting in varied clinical pictures. The nail abnormalities are often associated with pain even at the fingertips, with severe functional limitations of the hand because of the loss of prehensile ability of small objects. The psoriatic onycopathy is often associated to the psoriatic arthritis coexistence.
Rarely psoriasis is localized to the face and mucous membranes.
The Pustular psoriasis is a rare but severe variant of Psoriasis which is characterized by the presence of pustules on erythematous skin. It may be localized, mainly to the palmoplantar areas or fingers, or generalized with involvement of almost the entire body surface.
Erythrodermic psoriasis is also a rare variant of the disease. This is typically an evolution of other clinical forms, with the extension of the injuries to the whole body surface that appears widely erythematous with large areas of flaking. It is a delicate condition because it can affect the overall state of health, requires urgent therapeutic approach and sometimes hospitalization.
When psoriasis is associated with joint involvement we talk instead of Psoriatic Arthritis (AP). The symptoms usually occur several years after the onset of psoriasis and are not correlated with the severity of the skin picture. In 10% of cases, however, the AP precedes the onset of skin manifestations.
The arthritis incidence among patients suffering from psoriasis is about 10. Morning stiffness, pain, functional limitation and the tendency to deformities are common clinical features borne by the affected joints, which in the most common form of AP appear to be those of the hands.
Psoriasis causes serious impairment of body image with consequent important effects on social life. Recently it was shown that psoriasis can be associated with a systemic metabolic disorder
("metabolic syndrome"), it may cause an increased incidence of cardiovascular disorders.
For these reasons, the treatment of psoriasis requires intervention of various medical figures: the dermatologist's role is crucial in establishing the most appropriate treatment related to the individual clinical case. Then come the rheumatologist (when it comes to psoriatic arthritis), the dietician (to establish a proper diet, a key element in the success of dermatological therapy) and sometimes the important support of the psychologist.
Depending on the extent of psoriasis, we decide to use topical therapy (application to the skin of preparations such as gels, ointments based on active ingredients) or systemic therapy (oral intake, subcutaneous, endovenous routes). In some severe cases resistant to the two therapies already mentioned, it resorts to new biological therapies, the result of scientific and pharmaceutical developments, aimed at blocking the molecular mechanisms at the origin of psoriasis. They are important therapies that have some important secondary effects, this is why they are managed by dermatological approved centers approved.
For further information or appointment, please contact our clinics in Beirut, Lebanon.