Psoriasis

Psoriasis is a chronic, relapsing inflammatory skin condition that develops from changes in the immune system. Although seen most often on the elbows, knees, scalp, lower back and nails, it can affect any part of the body.

The most typical finding is sharply bordered red plaques covered with silvery-white scales. Itching can occur but is not present in every patient. In some patients only the scalp or nails are affected, while others develop more widespread skin involvement. Changes such as pitting, thickening, discolouration and separation of the nail from its bed can be seen in the nails.

Psoriasis is not contagious and does not pass from person to person by contact. Genetic predisposition plays an important role in its appearance. Factors such as infections, stress, some medications and skin trauma can cause the condition to start or flare.

Psoriasis is not a condition that affects the skin alone. Some patients develop joint involvement called psoriatic arthritis. In addition, certain systemic conditions such as obesity, diabetes, hypertension, high cholesterol and cardiovascular disease can be more common than in the general population. It is therefore important that patients are assessed holistically — not only for their skin findings but also for their general health.

The diagnosis is usually made by dermatological examination. Where needed, dermoscopic examination or a skin biopsy may be used to support the diagnosis.

Treatment is planned individually according to the extent, location and severity of the condition, its effect on quality of life and any accompanying diseases. Topical treatments may be sufficient in mild cases, while phototherapy, systemic medications and biologic treatments may be used in more widespread or resistant cases. Thanks to the biologic agents developed in recent years, very successful results are being achieved in patients with moderate-to-severe psoriasis.

Although psoriasis is not a condition that can be eliminated entirely, thanks to today's treatment options the condition can be kept under control for long periods in the great majority of patients and quality of life markedly improved. Psoriasis can present with many different clinical appearances and can mimic eczema, fungal infections and some other skin conditions; for this reason, the correct diagnosis is the most important step in planning appropriate treatment.