P.or who have a clear inkling of it, but psoriasis can be dramatically affecting. The disease has in fact strong repercussions on the life, professional and personal choices of patients who do not always accept their appearance. The scales covering the skin they can become source of embarrassment, especially during adolescence and the growth stages of boys. The latter in particular feel discomfort in discovering parts of the body and become bullied.
Psoriasis, what is it
Psoriasis is a chronic inflammatory disease of the skin which can arise at any age. It is estimated that about 10% of the world population has a genetic predisposition to develop the disease, but only a part of it develops the disease. It is not clear what the triggers are, but considerable weight is attributed to environmental factors such as physical trauma, infections, stress, overweight, alcohol abuse and smoking.
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What happens to the skin?
Psoriasis plaques are caused by one immune system dysfunction. An inflammatory process that stimulates the proliferation of keratinocytes (skin cells), accelerates their natural turnover. The keratinocytes they reach the superficial layer of the epidermis in just 4 days (in normal conditions it would take 24-27 days) and they accumulate producing the characteristic scales. The skin appears red, thickened and flaky in the affected areas.
What are the therapies?
The patients with mild manifestations can be treated with topical therapies, or creams predominantly based on cortisone, and phototherapy (exposure to artificial ultraviolet rays emitted by specific lamps in a hospital environment or specialized centers). For cases of more extensive and advanced psoriasis there are systemic drugs, in particular acitretin, cyclosporine, methotrexate And dimethyl fumarate.
And biologics?
The arrival of biological drugs, used for inflammatory diseases, has profoundly revolutionized the approach to the disease. There first class of monoclonal biologicals used in psoriatic patients, versus the named molecule TNF-alpha, it was introduced in Italy in 2004. Drugs belonging to this class do generally administered subcutaneously, once a week to once every 4 weeks. More recently introduced are the monoclonal biologics direct versus the interleukins (so-called anti interleukins 17 and 23), pro-inflammatory molecules at the center of the pathological process of psoriasis. The latter drugs, especially those more recently included in the psoriasis therapeutic protocol, are generally much more effective than anti-TNF-alpha on the skin. Furthermore the dosing interval is longer (8 to 12 weeks) and longer lasting results. “Targeted drugs like these” – he concludes – “they will change the quality of life of patients more and more in the future“.
Plaque psoriasis
Plaque psoriasis is the form far more common and is characterized by red, swollen patches covered with a layer of dead skin cells. Plaques form on the scalp, knees, elbows and in the sacral area. They are often associated with itching, pain, can sometimes crack and bleed. In skin folds (behind the knees, under the breasts, in the armpits or in the groin), psoriasis manifests itself in reverse with red patches in which the skin appears smooth and shiny (inverse psoriasis).
Pustular and erythrodermal psoriasis
Very serious but rare forms are there pustular psoriasis, characterized by white pustules surrounded by red skin, mainly localized on palms and soles, and the erythrodermal psoriasis, in which beyond the80 percent of the skin surface is covered with erythema and fine peeling. In this situation the skin no longer performs the function of protection against infections, body temperature control and electrolyte balance, causing the patient serious problems.
Guttate psoriasis
Shape guttataFinally, it comes in the form of small punctate lesions that they often appear within a few days after a tonsillitis. It is indeed crazy from an infection streptococcus: “It mainly affects children and adolescents” – explains Dr. Francesco Cusano, president of the Association of Italian Hospital Dermatologists Venereologists and of Public Health (ADOI) – “he was born in’unique shape of psoriasis often self-resolving“.
How is it diagnosed?
Patient assessment is predominantly clinical. “There are no particular diagnostic tests” – he says – “only in the most ambiguous cases you can use one biopsy“. It can be confused with other dermatoses with erythema, that is, redness of the skin, and peeling, especially in less extensive cases, much more rarely with eczematous dermatitis, since the latter usually manifests itself with blistering, or bubbles and crusts on the skin: “There can be people affected by both diseases“- he explains -” sometimes some drugs to control psoriasis can make the dermatitis worse “.
Who does it affect and at what age?
They tend to be affected in equal measure men and women. The incidence in Italy fluctuates between 2.5 and 3%. “There are two peaks of onset“- he says -” at a young age, around 20 years, and in mature age, between 40 and 50“.
Why does it reactivate or go into remission?
Psoriasis, like other inflammatory diseases, does not have a constant course. Its evolution is unpredictable and fluctuating between phases of exacerbation, improvements and sometimes important relief of symptoms. They contribute to worsening the stress and other factors, such as the overweight and the use of particular drugs“- he explains -” on the contrary, other factors such as theexposure to the sun, can favor its temporary disappearance “.
Does it facilitate the appearance of other inflammatory diseases?
Exist “Complex relationships” between psoriasis, arthritis, uveitis (inflammation of the intermediate layer between the sclera and retina) e Crohn’s disease. The risk of association between these diseases is one in 4 patients: «They share common molecular mechanisms»- he affirms -« and probably also genetic mutations“. Patients with psoriatic arthritis represent up to 25% of patients with psoriasis while patients with psoriasis have an almost 4 times greater risk of developing inflammatory bowel disease, especially Crohn’s disease.
How much does the psychological aspect weigh on patients?
The actual “objective” severity of psoriasis does not generally correspond to patients’ perceptions of subjective severity. The an “aesthetic” problem causes psychological and social discomforts that are sometimes disabling in people, with serious consequences on interpersonal relationships, on the performance of daily activities and on the quality of life. «The presence of the plates and scales provokes insecurity, loss of self-esteem and depression in psoriasis patients, especially in women “- he concludes -” in some cases patients they seek isolation because of their appearance “.
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