Definition

Psoriasis is a chronic or long-term inflammatory skin disease that causes the skin to become reddish, thickened with scales, and often itchy. The thick scales result from an accelerated skin cell regeneration cycle, exceeding the normal rate by over tenfold. Psoriasis can appear anywhere on the body but is most commonly found on the knees, elbows, torso, and scalp. It is not a contagious disease. However, genetic predisposition allows individuals to develop psoriasis if there is a family history of the condition.

Currently, no cure for psoriasis offers complete remission; patients can only achieve periods of symptom relief. The tendency for recurrence is high if triggered by certain factors. Existing therapies help manage the symptoms experienced by the patient. Therefore, individuals with psoriasis must adapt to living with the disease and adopt a healthier lifestyle to improve their quality of life.

Psoriasis not only affects the skin but can also impact various organs, including the eyes and joints. Thus, it is crucial to recognize any specific symptoms in the eyes or joints in individuals with psoriasis.

Psoriasis occurs worldwide, with incidence rates ranging from 0.2% to 4.8%. Approximately 2% of the population in the United States is affected. The incidence rate in Japan is relatively low, and it is almost nonexistent among Aboriginal Australians and South American Indians. Psoriasis can manifest at any age but commonly appears initially between the ages of 15-20 and 55-60.

Causes

The exact cause of psoriasis is not fully understood. However, it is believed to be an autoimmune disease mediated by T-lymphocyte immune cells. This malfunctioning immune system causes the skin to regenerate faster than the normal cycle, leading to the accumulation of skin cells. The exact mechanism of this immune system disorder is not entirely understood, but genetic and environmental factors are thought to play significant roles in the onset of psoriasis.

Risk factor

Understanding risk factors is crucial for the prevention and treatment of psoriasis. While everyone can be at risk, certain factors more significantly determine whether an individual will develop psoriasis in the future.

Risk factors include non-modifiable ones such as having a family history of psoriasis. If one parent has psoriasis, the risk of the child developing the condition is higher; if both parents have psoriasis, the risk increases substantially.

Modifiable risk factors include stress and smoking. Emotional stress can impact the immune system's function, and high levels of emotional stress can increase the risk of developing psoriasis. Smoking not only heightens the risk of developing psoriasis but also exacerbates its severity and makes it more challenging to treat. Smoking can also trigger the onset of psoriasis. Therefore, managing stress and avoiding or quitting smoking can help prevent psoriasis. Other factors such as trauma, infection, cold weather, alcohol consumption, and certain medications can also be risk factors.

Symptoms

Symptoms experienced by psoriasis patients can vary, including:

• Thick red patches with silver scales
• Small scaly spots
• Dry skin
• Itching
• Burning sensation
• Thickened nails
• Small pits in the nail plates
• Swollen and stiff joints

Diagnosis

Diagnosing psoriasis is a clinical process, meaning that a doctor can establish the diagnosis through a detailed medical interview and general physical examination. Psoriasis diagnosis must be performed by a doctor as it requires specialized handling. It is advisable to inform the doctor if you or a family member has previously experienced psoriasis. Details such as when the symptoms first appeared will also help the doctor diagnose and determine the best treatment when the patient is first examined.

Management

Psoriasis requires comprehensive management. There are currently many treatment options available for psoriasis. The doctor will select the appropriate treatment based on the size, location, age, and overall health status of the patient.

Some treatment options include steroid creams, skin moisturizers, vitamin D derivative ointments or creams, and retinoid creams. Other therapies might include light therapy, certain oral medications, and biological injection therapies.

Complications

Psoriasis can lead to several high-risk complications, including psoriatic arthritis (an inflammatory joint disease causing pain, stiffness, and swelling around the joints), eye conditions such as conjunctivitis (inflammation of the front eye layer), obesity, type 2 diabetes, hypertension, cardiovascular disease, other autoimmune diseases like Crohn's disease (an inflammatory bowel disease), and psychological issues such as depression and low self-esteem.

Prevention

Current research has not identified specific preventive measures for psoriasis. However, recognizing your risk factors is a crucial step. The next step is to address modifiable risk factors. Here are some steps you can take:

• Eat a healthy diet: Consuming a healthy diet can reduce the risk of psoriasis and help you lose weight if needed. Increase your intake of fruits, vegetables, and high-fiber foods daily. Reduce the intake of salt, trans fats, and processed foods. Preventing obesity can facilitate remission.
• Quit smoking: Smokers should consider quitting smoking.
• Limit alcohol intake: Limiting or eliminating alcohol consumption can improve the chances of achieving at least temporary remission. Replace alcoholic drinks with water, aiming for 2 liters or 8 glasses per day.
• Exercise regularly: Engage in light exercise, especially in the morning or evening when the sun is minimal, such as light jogging or cycling. Aim for 30 minutes a day, five days a week. If you have a medical history, consult your doctor before starting an exercise routine.
• Get adequate rest: Ensure you get 6-8 hours of sleep daily.
• Manage emotional stress: Keep your emotional stress levels in check.
• Avoid triggering medications: Avoid medications that can trigger psoriasis, such as ibuprofen.
• Follow your medication regimen: Adhere to your doctor's prescribed medication regimen.

Additionally, if you have never had a general health check-up, it is advisable to do so. If conditions or diseases are found that increase your risk of psoriasis, early treatment can be started before the condition worsens and the risk increases.

When to see a doctor?

If you experience symptoms resembling psoriasis that become more severe and widespread, causing discomfort and pain, especially in the joints, and there is no improvement with certain therapies, it is advisable to seek further examination from a dermatology specialist (SpKK or SpDV). The doctor will conduct a medical interview, physical examination, and specific supporting tests to establish an accurate diagnosis and appropriate treatment.

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