Holistic Insights Into Managing Psoriasis: Causes, Symptoms, And Effective Treatments

Severely scaly and inflamed red skin and itching are typical symptoms of psoriasis. Nails and joints can also be affected by the skin disease. The extensive and visible skin changes mean that people with psoriasis – as psoriasis is also called – are often excluded and avoided. However, there is no reason for this because the disease is not contagious. But what are the causes behind psoriasis? What helps fight the disease, and is it curable? We clarify all questions about this widespread disease.

What is psoriasis?

In technical jargon, psoriasis is called psoriasis. Psoriasis is a chronic, inflammatory skin disease. In addition to the inflammation, the skin cells (keratinocytes) multiply more than usual.

Typically, skin cells are renewed every 28 days, but in people with psoriasis, this phase is often reduced to four to seven days. As a result, the top layer of skin thickens and becomes increasingly flaky.

Women and men are equally affected.

Psoriasis: causes and development

Many different factors play a role in the development of psoriasis. Genes that regulate the immune system are essential here since it is assumed that an immune reaction of the body triggers inflammation of the skin and stimulates the formation of horny cells for skin renewal. Such an immune reaction would typically occur, for example, in the event of a skin injury.

There is also debate as to whether psoriasis is an autoimmune disease. However, the exact formation mechanism has yet to be conclusively researched.

In addition, certain stimuli such as infections, medication, stress or skin irritation can cause or exacerbate the disease. Psoriasis is not contagious.

Possible triggers of a flare-up of psoriasis

Various so-called trigger factors can trigger a flare-up or the new appearance of dandruff. These triggers vary from person to person. In addition to drug treatment, it is essential to eliminate and avoid these factors. Trigger factors can be:

Stress
Alcohol
Nicotine
bacterial or viral infections
medication
mechanical irritation (scratching, splashing, sunburn, …)

However, these trigger factors are only triggers of psoriasis. They are not the cause of the disease. This means that flare-ups or new psoriasis patches can only be triggered by the abovementioned factors in people with psoriasis but not in healthy people. Psoriasis is caused by genetic changes, which can also be inherited.

consequences for those affected

People with psoriasis often experience social exclusion and stigmatization because of their visible disease. This usually increases their level of suffering even further.

Some diseases are more common in people with psoriasis than the general population, attributed to genetic changes and a greater susceptibility to inflammation. These diseases include:

Cardiovascular diseases ( e.g. coronary artery disease )
Diabetes mellitus
Metabolic Syndrome
chronic inflammatory bowel disease

What are the typical symptoms of psoriasis?

There are different forms of psoriasis, which can also show up through different symptoms. The most common form is psoriasis vulgaris. It manifests as skin peeling, especially on the extensor sides of the arms and legs. However, skin changes (efflorescences) can also occur on the scalp, face, external auditory canal, hands, feet, and genitals.

Beneath the desquamation are demarcated red spots caused by inflammation. Unlike eczema, the scaling is usually more extensive. The reddened spots with the overlying desquamation are also known as plaques.

Those affected often suffer from itching. If those affected scratch themselves, the mechanical irritation of the skin means that the skin changes remain or appear later on previously unaffected skin areas. This is known as the Koebner phenomenon. Psoriasis can also lead to painful tears in the skin (rhagades) on hands and feet.

If the nail bed suffers from psoriasis, nail changes such as spotted nails (minor dents in the nail), oil stains (round, yellow-brown spots on the nail) or nail detachment can also occur. The joints can also be affected by what is known as psoriatic arthritis.

To the dermatologist – how is the diagnosis of psoriasis made?

The symptoms of psoriasis are very characteristic. The dermatologist pays attention to four unique signs:

Candle drip phenomenon: The scales can be lifted off the skin as a whole.
The phenomenon of the last cuticle: When all layers of scales have been lifted off, a thin cuticle can finally be removed.
Auspitz phenomenon: If the last cuticle is removed, minor “dewdrop-like” bleeding occurs.
Köbner phenomenon: During the consultation with the patient, the doctor clarifies whether a mechanical irritation such as scratching, sunburn or tattooing triggers a psoriasis flare-up.

Usually, no tissue sampling (biopsy) is necessary to confirm the diagnosis. If a sample is examined, changes in the skin layering and the interlocking of the epidermis and dermis can be seen under the microscope. The supply of small blood vessels (capillaries) is also changed in psoriasis. They are more tortuous and more permeable to inflammatory cells.

If the doctor is sure it is psoriasis, whether other diseases often occur in connection with psoriasis must be clarified.

What to do against psoriasis?

Unfortunately, psoriasis cannot be cured. However, various psoriasis remedies are available to alleviate the symptoms and, if possible, restore an essentially normal complexion.

Even without psoriasis, gentle skin care is essential for psoriasis foci. Gentle shower gels and fatty and moisturizing creams (e.g. creams with urea ) should be used.

Diet for psoriasis

From a scientific point of view, diet does not play a significant role in psoriasis. Even so, certain foods, such as coffee, preservatives, and hot spices, can worsen skin inflammation. In addition, arachidonic acids are in many animal products such as sausage, butter, and eggs . Arachidonic acid stimulates the body to produce inflammatory substances (eicosanoids). Avoiding the foods mentioned can, therefore, help reduce the inflammation of the skin and joints in the context of psoriatic arthritis.

Omega-3 fatty acids, i.e. unsaturated fatty acids, counteract inflammation. These are mainly found in fish dishes (salmon, herring, mackerel).

Overall, a balanced diet and a healthy lifestyle are always recommended. They not only prevent diseases that can be associated with psoriasis (diabetes mellitus, coronary heart disease) but also help to maintain or achieve an average weight. Being overweight also plays a role in psoriasis and can promote it. Alcohol also hurts the psoriasis scales and should be avoided.

Which creams help with psoriasis?

A typical therapeutic approach only treats those affected locally, i.e. when the skin is visibly changed. On the one hand, attempts are made to remove the dandruff with the help of creams containing salicylic acid or urea, i.e. urea. An oil bath can also help here. Shampoos also contain salicylic acid and urea for people with scalp problems.

Creams and lotions with various active ingredients are used to combat inflammation and dandruff, which are prescribed by the doctor treating you:

Vitamin D3 analogues are the most critical drug for long-term home therapy. They slow down the proliferation of horny cells in the skin and influence the immune system.
Glucocorticoids can be combined with vitamin D. They have an anti-inflammatory effect but do not entirely heal skin damage.
Dithranol presumably causes the horny cells to die off. Due to its colouring and skin-irritating effect, it is used only as part of hospital treatment.

Light therapy – when creams no longer help

In addition to local therapy, those affected can undergo light therapy. There are different forms of light therapy:

On the one hand, UV-B radiation and local creams can be combined.
On the other hand, there is the so-called photochemotherapy (PUVA), in which the skin is first made more sensitive to light with the active ingredient psoralen and then irradiated with UV-A radiation.

Other therapy methods, such as electrotherapy, also expose the affected skin areas to light alternating current in water-filled tubs. Balneo photo therapy combines bath therapy, often performed with brine, with light therapy.

Systemic treatment with drugs

If the psoriasis still does not respond to the therapy, systemic treatment can be used. Here, the medication is no longer applied externally to the affected skin in ointments or creams but is taken as tablets or something similar.

The following list provides an overview of the most essential active ingredients:

Acitretin is particularly effective in the pustular form. For other forms, combining acitretin with light therapy, for example, makes sense. Under no circumstances should acitretin be taken during pregnancy!
Methotrexate helps with severe forms of psoriasis and psoriatic arthritis but can have serious side effects. For this reason, checks (e.g., liver and bone marrow values) must be carried out during intake, and the correct dose must be considered.
Ciclosporin A is an immunosuppressant and is also used in severe forms of psoriasis.
Apremilast has an anti-inflammatory effect.
Biologics such as etanercept and adalimum suppress certain substances (interleukins, tumour necrosis factor, and the like) that otherwise participate in the inflammatory response triggered by the immune system.
Fumarates also inhibit the immune system response. In Germany, preparations containing dimethyl fumarate and agents containing a combination of dimethyl fumarate and three salts of ethyl hydrogen fumarate are used.

Home remedies for psoriasis?

Various home remedies are said to help relieve the symptoms of psoriasis. These include sea salt baths or ingesting fish oil or apple cider vinegar. However, the effect of such home remedies has yet to be scientifically proven.

Psoriatic Arthritis: What is it?

The changes in the immune system associated with psoriasis can also lead to arthritis – i.e. inflammation of the joints. An immune reaction probably causes a change in synovial fluid. New vessels and connective tissue cells form in the joint space, which causes inflammation. Here, too, the exact formation mechanism is not yet known.

Psoriatic arthritis occurs in about one-third of people with psoriasis. Which joints are affected varies greatly. However, it usually only appears in a few joints and occurs insidiously.

The signs of arthritis are:

swelling
warmth
pressure pain
Change in joint shape (if the arthritis is long-standing)
Symptoms of soft tissue rheumatism (pain around the joint, foot pain, tendonitis, …)

The signs of soft tissue rheumatism distinguish psoriatic arthritis from rheumatoid arthritis (“rheumatism”).

Anti-inflammatory drugs are usually sufficient to treat psoriatic arthritis. However, a cure is not possible.

Classification of psoriasis: forms

A distinction is made between type I psoriasis, which begins before age 40, and type II psoriasis, which begins later. This is usually a little milder.

In addition, different course and manifestation types are distinguished. The most common form is psoriasis vulgaris. All other forms are considered particular forms of this variant in the literature. The most common skin condition is plaque-type psoriasis, which shows the skin changes described above.

Gutted Psoriasis

Instead of guttate psoriasis, the name eruptive-exanthematous psoriasis is also used. This form is mainly caused by an infection with streptococci, which often affects children and adolescents. Drop-shaped skin changes are noticeable on the skin, which can also affect the face much more frequently than in psoriasis vulgaris. A transition to psoriasis vulgaris is just as possible as healing after a few weeks.

inverse psoriasis

This is a less scaly form of psoriasis that mainly affects the flexor side of the arms and legs.

Psoriasis of the scalp (Psoriasis of the scalp)

In this type, psoriasis affects only or also the scalp. Classically, the pathological skin changes stop sharply defined at the hairline.

Psoriasis with pustulation

In an attack of psoriasis vulgaris, bumps can also appear in the plaques. Such a change is usually triggered by trigger factors such as infections or hormone fluctuations. The complexion is similar to pustular psoriasis but is much milder.

Psoriasis pustulosa

In the case of pustular psoriasis, research is currently being carried out to determine whether it is a form of psoriasis or not much more of an independent disease.

A distinction is made between a rare generalized and a localized form of the pustular type:

White plaques appear on the oral mucosa in the generalized form (pustular psoriasis generalisata). In addition, erythroderma develops, i.e., reddening of the entire skin surface and white, converging bumps all over the body. There is a risk of death for those affected.
The localized form (pustular psoriasis palmoplantaris) affects the hands and feet of the patient. Here, too, pimples can be found on reddened skin. It is not life-threatening and is common in smokers.

Rare forms of psoriasis

Other rare forms of psoriasis are:

Seborrhiasis: in regions with many sebaceous glands, more greasy than scaly
Psoriasis intertriginous: mainly affects skin folds and can be confused with skin fungi
Erythrodermic psoriasis: reddening of the entire skin, often occurring without scaling, can be fatal
Acrodermatitis suppurativa: pustular form of the fingertips and nails