Psoriasis (psoriasis) is a chronic disease that is characterized by red-pink-colored plaques on the skin with mother-of-pearl-colored dandruff, which can also lead to joint and nail findings. It is seen in 1-3% of the world. Although it can begin at any age, it often begins between the ages of 15 and 30.
CAUSES OF PSORIASIS
The cause of the disease is not fully known. It is thought to occur in genetically susceptible individuals after exposure to triggering factors at any time in life. Physical and mental trauma, infections, climate and seasonal changes, some drugs, smoking are the main triggering factors.
SYMPTOMS OF PSORIASIS
The disease has different clinical manifestations:
Psoriasis Vulgaris: It is the most common form of the disease. On the skin, there are plaques that are oval or round, with sharp borders, red-pink, covered with mother-of-pearl dandruff. It is most commonly located on the knees, elbows and scalp. Palmoplantar Psoriasis: Redness and intense dandruff are seen on the palms of the hands and soles of the feet. It can be seen together or alone with psoriasis vulgaris.
Guttate Psoriasis: It usually occurs in children following an upper respiratory tract infection or viral infection. A drop-shaped, pink-red, raised skin rash with scaling is seen on the skin.
Inverse Psoriasis: It is seen as vivid red plaques in the folds of the body.
Pustular Psoriasis: Red, acne-like rashes that are widespread or localized to a specific area of the body.
Erythrodermic Psoriasis: The disease covers more than 80% of the body.
Psoriatic Arthritis: It usually occurs around the age of 40. Hand joints are most commonly affected. Pain, redness and swelling are observed in the joints.
Nail Psoriasis: Pinhead-sized pits on the nail surface, separation of the nail from the bed, yellowish discoloration under the nail, nail loss and thickening of the skin under the nail can be seen.
DIAGNOSIS OF PSORIASIS
There is no specific laboratory finding of the disease. Diagnosis is usually made by clinical appearance. If necessary, the diagnosis can be confirmed by performing a skin biopsy.
PSORIASIS TREATMENT
There is no permanent cure for psoriasis. The aim of treatment is to keep the disease under control and to provide long-term periods of well-being. Local treatments are usually sufficient when there are few lesions. Systemic treatments are preferred in patients with extensive psoriasis.
Local Treatment:
1-Local Corticosteroids: They are the most commonly used drugs in the treatment of psoriasis. They reduce redness and dandruff in the lesions and relieve itching. They cause thinning of the skin in long-term use. It should be used with caution, especially in areas where the skin is thin, such as the face and fold areas.
2-Keratolytics: They increase the effectiveness of other drugs by removing dandruff on the skin surface.
3-Local calcineurin inhibitors: Tacrolimus and Pimecrolimus are used for this purpose. They do not thin the skin like corticosteroids. In long-term use, they may increase the risk of lymphoma.
4-Other Local Treatment Agents: Tar, Anthraline, Calcipotriol
5-Local phototherapy: It is especially preferred in hand-foot psoriasis. Ultraviolet is given to the affected areas in 2 or 3 sessions a week.
Systemic Treatment:
1-Methotrexate: It is the most commonly used drug in common psoriasis. It is used once a week in the form of injections or pills. The most common side effect is nausea and vomiting. May increase liver enzymes; Therefore, blood tests should be done at regular intervals.
2-Cyclosporine: It is a fast-acting drug. This drug may cause impaired kidney function and high blood pressure. During use, blood tests and blood pressure measurements should be made at regular intervals.
3-Acitretin: It can be used alone or in combination with other treatments. Since its use during pregnancy will harm the baby, pregnancy should be avoided during the treatment and for the next 3 years. It can cause disorders in liver functions and high blood fats.
4-Biological Agents (Adalimumab, Etanercept, Infliximab, Ustekinumab, Sekukinumab): These are drugs specially developed for psoriasis. Since three physician reports are required, they are usually written from Faculty Hospitals.
Phototherapy: It can be applied as UVB, narrow band UVB, PUVA. It is applied as 2 or 3 sessions per week.
Psoriasis is a chronic disease with exacerbation and recovery periods. While type 1 psoriasis starting under the age of 40 is more severe, the course of the disease is milder in patients with type 2 psoriasis starting after the age of 40.
