Do I have psoriasis or something else? You probably put this question if you are the one among 2% to 4% population suffering from this disease. Psoriasis affects 2 to 4% of the population and as many men as women.
The disease usually occurs between 10 and 20 years for family forms and between 20 and 40 years for other forms.
Psoriasis affects men as well as women. However, it is more common in white-skinned people. Two to four percent of the Western population suffers, including two to three million people in France (where about 60,000 new cases are diagnosed each year).
Psoriasis usually starts in adolescence or in young adults. The so-called “family” forms are triggered rather in adolescents aged 10 to 20 years. Later, usually after the age of 40, we observe so-called “sporadic” forms, that is, isolated in their families.
Psoriasis is not a contagious disease, no matter how much contact you have with the patient.
Psoriasis is a chronic disease that evolves by pushing.
This disease can affect any part of the body but most often affects the elbows, knees, lumbar region, scalp and legs.
Although treatments can now relieve relapses, psoriasis remains a disease that, depending on its location and extent, can have aesthetic consequences and harm relational and professional life. Although it does not have serious health consequences, psoriasis can have a significant psychological and social impact.
A recent European survey describes the impact of psoriasis on the daily lives of people who suffer from it, their leisure activities, their emotional and sexual life, as well as their professional lives.
Psoriasis affects all these areas of their lives and the patients surveyed suffer essentially from the eyes of others, which can lead to a feeling of rejection and an attitude of withdrawal from society. Women and young people seem more affected by the impact of psoriasis on their quality of life.
The sexual life is made difficult in the case of lesions of the mucous membranes, causing pain and low libido. Thirty percent of patients surveyed said they gave up starting or continuing a relationship because of their psoriasis. Finally, for 37% of patients surveyed, psoriasis has an impact on their behavior at work where it can lead to discrimination both in hiring and in their professional development.
*** Psoriasis and Pregnancy
Suffering from psoriasis does not prevent you from having children. During pregnancy, the symptoms of psoriasis tend to subside or disappear (progesterone, the pregnancy hormone, controls the hyperactivity of the immune system).
However, because oral psoriasis medications are potentially toxic to the fetus, women who use these treatments and are of childbearing potential must use effective contraception. When pregnancy is desired, these treatments are suspended for at least two months before stopping contraception. In the months following the birth of the child, a flare of psoriasis is quite frequently observed.
I – What Is Psoriasis?
Psoriasis is a disease where the skin renews at an abnormally rapid rate (every five to six days, instead of 28 days usually). This proliferation of skin cells (keratinocytes) causes thick red patches more or less extensive, covered with white dead skin, “dander”. These lesions are most often found in the hands, elbows, knees, lower back, or on the face and scalp. These plates do not itch or little. They are not contagious, there is no risk of transmission to other people.
Psoriasis is a disease caused by genetic (familial), immune and environmental factors.
Chronic disease of the superficial layer of the skin, psoriasis is caused by the acceleration of the renewal of the cells of the epidermis.
Adult psoriasis is a chronic skin disease that is partially genetic in origin, partly immunological but also influenced by environmental factors.
These factors associated with each other make the keratinocytes, skin cells, undergo a quantitative and qualitatively abnormal proliferation.
II – Evolution and Complications of Psoriasis
Psoriasis is a chronic disease that evolves by relapses. Their duration and frequency are very variable from one person to another and difficult to predict. These outbreaks are interspersed with periods of lull, called “remission”, more or less long, during which lesions disappear partially or completely. This is called “bleaching” of the lesions.
Except for very special and rare forms, psoriasis is not dangerous to health and does not put the life of the patient in danger. Nevertheless, its psychological and social consequences justify that it be treated effectively.
Some diseases are more commonly seen in patients with psoriasis than in the general population. These psoriasis-associated diseases seem to share similar mechanisms of onset: chronic inflammation and, perhaps, genetic predisposition. Among the diseases that may proceed, be associated with or follow psoriasis:
– inflammatory rheumatism (rheumatoid arthritis and spondyloarthritis, for example);
– certain inflammatory diseases of the digestive tract (Crohn’s disease, ulcerative colitis, for example),
– vitiligo, a skin disease that results in depigmented spots (white spots),
– certain inflammations of the thyroid.
It also appears that more cardiovascular disorders (eg, myocardial infarction) and type 2 diabetes are diagnosed in patients with psoriasis.
III – Do I Have Psoriasis? Which Type?
The different forms of psoriasis are distinguished by their appearance and location.
1 – Plaque Psoriasis
Plaque psoriasis is the most common form of psoriasis. It represents more than 80% of the cases. It results in red, well-defined and thick plates, covered with a crust of white skin. This psoriasis preferably affects the scalp, elbows, and knees, as well as the lower back, usually symmetrically to the right and left of the body. When the scales are falling, the skin may be raw and bleed slightly. Lesions do not scratch or little.
Plaque psoriasis evolves in flares, interspersed with remissions. The frequency and duration of these outbreaks are unpredictable. They are most often caused by so-called environmental factors. Each push can touch a different region of the body.
2 – Psoriasis Drops
This form of psoriasis is rare (less than 10% of cases) and occurs most often in children and adolescents, in the form of very small plaques (diameter less than one centimeter). Lesions are mainly on the trunk, more rarely on the arms and legs. Psoriasis in drops sometimes evolves to the plate form. It appears most often after a streptococcal infection (eg angina).
3 – Psoriasis in Infants
Because psoriasis is a disease that can have genetic causes, an infant may have psoriasis lesions in the first few months of life. In this case, the lesions are most often located under the layers. This is called “psoriasis of nappies”. This form of psoriasis is also seen in older adults who use incontinence pads. In this form of psoriasis, the irritation of the skin due to urine and stool is the environmental factor that triggers the push.
4 – Pustular Psoriasis
In this form of psoriasis, flat, yellowish-white pustules appear on the skin and tend to fuse together. These flat pimples do not contain bacteria. This form of psoriasis sometimes appears when stopping treatment with anti-inflammatory drugs derived from cortisone taken orally or injections (to cure another disease).
When pustules are located on the palms of the hands or soles of the feet, it is called palmoplantar psoriasis (often painful and socially disabling). When the lesions are at the end of the fingers, it is called acrodermatitis continuous of Hallopeau. In this case, cracks form at the ends of the fingers. His treatment requires hospitalization.
5 – Erythrodermic Psoriasis
This form of psoriasis is very rare. In this case, the lesions are generalized over the entire surface of the body. Erythrodermic psoriasis is accompanied by fever and chills, as well as general weakness. It must be managed quickly to avoid secondary infections. Hospitalization is necessary.
Inverted psoriasis or psoriasis of folds
In this form of psoriasis, the red plaques are well defined and touch the areas of skin folds such as the groin, armpits, navel, underside of the breasts, belly or buttocks. These plates are bright red and smooth, sweating eliminating dander.
6 – Psoriasis of the Face
This form of psoriasis reaches the wings of the nose, the folds around the mouth and the edge of the scalp. It is visible and difficult to bear because of its consequences in terms of social life.
7 – Psoriasis of the Scalp
In 50 to 80% of adult plaque psoriasis cases, the scalp is affected. Irritation and dander in “flakes” are visible and very annoying for people with the disease. The plates are thick and can spread on the forehead, behind the ears and on the nape of the neck. The repercussion is important at the social level.
8 – Psoriasis of the Nail
In about half of people with psoriasis, the nails of the hands and feet grow abnormally and fade. Most often, this abnormal growth is reflected by small depressions below the surface of the nail (which takes on a so-called “thimble” appearance), loose fingernail, stains, thickenings or streaks. This form of psoriasis is inconvenient at the aesthetic and practical level because the nails become friable and fragile.
9 – Psoriasis of the Mucous Membranes
This form of psoriasis is less common than in other locations. It can reach the mouth, the tongue and the inside of the cheeks, as well as the genital mucosa (glans, vulva, vagina). In this case, psoriasis can cause disability in sex life. Sexual intercourse is not recommended during periods of stress, to avoid microtrauma that could worsen the symptoms. If it is not troublesome, mucosal psoriasis does not warrant treatment.
10 – Psoriatic Arthritis
About 8 to 10% of patients with psoriasis have chronic inflammatory rheumatism called psoriatic arthritis (or psoriatic arthritis). The symptoms are similar to those of rheumatoid arthritis or spondyloarthritis, including nocturnal pain and morning stiffness.
Psoriatic arthritis mainly affects the joints of the hands and feet (as in rheumatoid arthritis) or vertebrae and pelvis (as in spondyloarthritis). In 60 to 80% of cases of psoriatic arthritis, joint problems occur several months or years after skin problems.
In the absence of specific treatment, psoriatic arthritis can progress to a deformity of the joints causing a disability. To avoid these complications, it should be taken early by a rheumatologist. His treatments are similar to those of rheumatoid arthritis or spondyloarthritis.
IV – Causes of Psoriasis
Psoriasis is a disease of multifactorial origin, that is to say, whose appearance depends on several factors. It is the combination of these factors that trigger the onset of psoriasis flares.
1 – Genetic Factors of Psoriasis
In about one-third of people with psoriasis, there is a family predisposition (at least one family member is also affected by the disease). Several genes have been identified, their presence is associated with a higher risk of occurrence of psoriasis. This is the case, for example, of the PSORS1 gene present on chromosome 6 and which could be responsible for 10% of psoriasis cases.
When one parent has psoriasis, the risk of their child with this disease is between 1 in 10 and 1 in 20.
2 – Immune Factors of Psoriasis
The presence of many white blood cells at the level of psoriasis plaques suggests an aggravating role of the immune system, the defense system of the body. It could be that, after an injury or infection of the skin, the process of repair by the immune system goes wrong: new skin cells would then be produced at a fast pace no longer allowing the natural elimination of dead cells. This phenomenon would lead to the appearance of psoriasis plaques.
3 – Environmental Factors of Psoriasis
Several environmental factors can trigger a psoriasis flare or aggravate symptoms.
*** The Role of Drugs in Psoriasis Flares
Some medicines can trigger a psoriasis flare. This is the case for example of prescribed drugs:
– to treat or prevent malaria,
– to control high blood pressure (beta-blockers and, sometimes, angiotensin-converting enzyme inhibitors),
to treat bipolar disorders (lithium),
– to treat multiple sclerosis or hepatitis C (interferons).
In addition, abrupt discontinuation of anti-inflammatory treatment with cortisone derivatives (oral or by injection) may aggravate psoriasis.
*** The Role of Skin Irritations in Psoriasis Flares
Any skin irritation can trigger a psoriasis flare in people who suffer from it:
– injuries, punctures, scratching, repeated rubbing and irritating scars (“Koebner” phenomenon),
– sunburn or thermal or chemical burns,
– dry cold and pollution that attack the skin,
– skin infections.
*** The Role of General and Psychological State in Psoriasis Flares
Fatigue and stress can trigger psoriasis flares. In the same way, an emotional shock or an accident can be triggered. Occasionally, psoriasis may develop as a result of an infection (for example, tonsillitis and streptococcal infections, respiratory infections, HIV / AIDS).
Psoriasis outbreaks can also be linked to excessive consumption of tobacco and alcoholic beverages. Finally, it seems that obese people are more predisposed to developing relapses.
*** Psoriasis and Sun Exposure
In the vast majority of people with psoriasis, moderate and regular exposure to sunlight improves the symptoms of the disease. Only 5 to 10% of people with psoriasis have their psoriasis worsen during sun exposure.
People exposed to the sun to improve their psoriasis should follow the same cautionary recommendations as to the general population: sun protection adapted to phototype (skin type), progressive exposure avoiding the hottest hours, abundant hydration of the skin after sun exposure. Psoriasis plaques, thicker than the rest of the skin, are less susceptible to sunburn.
Attention, people who are treated by PUVA therapy or tar products must absolutely avoid exposure to the sun. It is the same for all people who take a drug on the packaging of which is a logo showing the sun in a red triangle (risk of photosensitivity).
In addition, the use of tanning booths is not recommended for treating psoriasis. The quality and quantity of ultraviolet light are not as controlled as in a dermatology practice and complications can occur.