Psoriasis
Psoriasis is a chronic inflammatory multisystem disease characterized skin rash of sharply demarcated (distinct border) red (erythematous) plaques with whitish scale, and joint involvement.
In this article:
- What Is Psoriasis?
- Mental stress
- Hypertension
- Obesity
- Diabetes
- Locations and Types
- Plaque psoriasis
- Guttate psoriasis
- Pustular psoriasis
- Inverse psoriasis
- Erythrodermic psoriasis
- What are the signs and symptoms?
- When to see a doctor
- Is psoriasis contagious?
- Causes of Psoriasis
- Psoriasis triggers
- What is NEW?
- Complications
- Risk factors
- Reference
What Is Psoriasis?
Psoriasis is a chronic inflammatory multisystem disease characterized skin rash of sharply demarcated (distinct border) red (erythematous) plaques with whitish scale, and joint involvement.
The worldwide prevalence of psoriasis is around 2%–4%, but studies in developed countries have reported higher prevalence rates of on average about 4.6%. Nearly two thirds of patients with psoriasis have a mild form of the disease, with less than 3% of the skin surface of the body affected, but others have more extensive involvement of the skin. Of interest, psoriasis is associated with an increased metabolic risk in a manner that varies with the severity of psoriasis.
Psoriasis is one of the most frequent chronic inflammatory skin diseases. The prevalence of psoriasis varies with the country. Psoriasis can appear at any age. Genetic factors play a significant role in the development of psoriasis. It is believed that ethnicity, genetic background, and environmental factors affect the onset of psoriasis.
While psoriasis is a skin condition, it is tightly connected with other systemic diseases. The risk factors for psoriasis can be divided into two groups, namely, external (extrinsic) and internal (intrinsic) risk factors. Many doctors name stress and obesity as the main reasons why the number of people affected by psoriasis grows significantly.
Mental stress
Mental stress is a feeling of strain and pressure caused by internal perceptions which lead to anxiety or other negative emotions. Mental stress occurs when individuals think the demands exceed their ability to cope. Mental stress is commonly regarded as a well-established trigger of psoriasis and many patients with psoriasis and physicians believe that mental stress exacerbates psoriasis. In a past systematic review including 39 studies (32,537 patients), 46% of patients believed their disease was stress reactive and 54% recalled preceding stressful events.
Hypertension
In a meta-analysis, patients with psoriasis showed greater prevalence and incidence of hypertension. Severe psoriasis was associated with greater incidence of hypertension. Patients with psoriasis also appear to have more severe hypertension.
A multicenter noninterventional observational study including 2210 patients with psoriasis revealed that 26% of patients with psoriasis had hypertension, and the incidence of hypertension was higher when compared with the general population.
Conversely, hypertension may be associated with the incidence of psoriasis. Although psoriasis and hypertension have shared risk factors such as obesity and smoking, most studies have shown an independent association of psoriasis with hypertension after adjusting for these risk factors.
Obesity
Psoriasis is associated with obesity, and excess adipose tissue may contribute to dyslipidemia. Patients with psoriasis have a higher prevalence of dyslipidemia, which is likely to increase with the severity of psoriasis. A past study including 70 patients with psoriasis revealed that dyslipidemia was observed in 62.85% of the patients.
Diabetes
The prevalence of DM is generally influenced by ethnic origin and lifestyle factors. However, the prevalence of DM might be similar among diverse patient populations, ethnic backgrounds, and baseline therapy. A meta-analysis revealed that psoriasis was associated with DM. Other studies have also demonstrated the association between psoriasis and the risk of DM. DM is divided into two groups, namely, type 2 and type 1 DM. Patients with psoriasis have a significantly higher risk of type 2 DM.
Locations and Types
Plaque psoriasis
Approximately 90 percent of affected patients have plaque psoriasis, characterized by well-defined round or oval plaques that differ in size and often coalesce. Plaque psoriasis lesions occur on the extensor surfaces of the arms, legs, scalp, buttocks, and trunk. Nails are frequently involved. One of the commonly affected sites is a scull. At the same time, plaques rarely go to the face and eyelid, which differentiates it from eczema.
Guttate psoriasis
Guttate psoriasis is more common in patients younger than 30 years, and lesions are usually located on the trunk. It accounts for only 2 percent of psoriasis cases. Classical findings include 1- to 10-mm pink papules with fine scaling. Guttate psoriasis may present several weeks after group A beta-hemolytic streptococcal upper respiratory infection.
Pustular psoriasis
The localized form of pustular psoriasis consists of pustules on the palms and soles, without plaque formation. A severe, acute form (the von Zumbusch variant) can cause life-threatening complications.
Inverse psoriasis
Inverse psoriasis is less scaly than the plaque form and occurs in skin folds such as flexor surfaces and perineal, inframammary, axillary, inguinal, and intergluteal areas. Heat, trauma, and infection may contribute to its development.
Erythrodermic psoriasis
Erythrodermic psoriasis is characterized by widespread generalized erythema and is often associated with systemic symptoms. It may develop slowly from long-standing psoriasis or appear abruptly in patients with mild psoriasis.
What are the signs and symptoms?
It is all complicated – some scientists say that psoriasis is just the skin condition. Others link it to other health problems in the body, such as joint disease, nail disease and cardiovascular system involvement. Noone doubts that central nervous system is involved too, as people have high rates of the depression and sleep-related issues.
At the same time, we consider certain conditions to be triggers of psoriasis. So, what is first – chicken or egg?
Nail disease (psoriatic onychodystrophy) occurs in 80 to 90 percent of patients with psoriasis over the lifetime. Fingernails are more likely to be affected than toenails (50 versus 35 percent). Abnormal nail plate growth causes:
- Pitting
- Subungual hyperkeratosis
- Onycholysis
Psoriatic arthritis is a seronegative inflammatory arthritis with various clinical presentations. It develops an average of 12 years after the onset of skin lesions. The prevalence ranges from 6 to 42 percent of patients with psoriasis, with men and women equally affected.
When to see a doctor
Even if you think you know what is going on, it is important to get a professional opinion about your diagnosis. Why? Because there are plenty other diseases that can look very similar. Here is a small list of skin and systemic diseases that have rashes psoriasis-alike.
| DIAGNOSES | WHAT IS DIFFERENT FROM PSORIASIS | |
|---|---|---|
| Atopic dermatitis | Predominant symptom of pruritus and typical morphology and distribution (flexural lichenification in adults and older children; facial and extensor papules and vesicles in infancy) | |
| Contact dermatitis | Patches or plaques with angular corners, geometric outlines, and sharp margins dependent on the nature of the exposure to the irritant or allergen | |
| Lichen planus | Violaceous lesions and frequent mucosal involvement | |
| Secondary syphilis | Copper-coloured lesions and frequent involvement of palms and soles | |
| Mycosis fungoides | Irregularly shaped lesions with asymmetric distribution, peculiar colour, and wrinkling due to epidermal atrophy | |
| Tinea corporis | Fewer lesions with annular configuration | |
| Pityriasis rosea | Tannish-pink, oval papules and patches with “Christmas tree” configuration on trunk with sparing of the face and distal extremities | |
Is psoriasis contagious?
No. Psoriasis cannot be transmitted to another person, as it is not an infection. You may be curious why many family members may all be affected. This is because psoriasis has strong genetic predisposition.
Causes of Psoriasis
Psoriasis is an immune-mediated genetic skin disease. The underlying pathomechanisms involve complex interaction between the innate and adaptive immune system. T cells interact with dendritic cells, macrophages, and keratinocytes, which can be mediated by their secreted cytokines. In the past decade, biologics targeting tumor necrosis factor-α, interleukin (IL)-23, and IL-17 have been developed and approved for the treatment of psoriasis.
Psoriasis triggers
Psoriasis can have periods of improvement and worsening. Some of the knows triggers are:
- Stress
- Unbalanced diet
- Exposure to chemicals and artificial food ingredients
- Lack of sleep
- Skin trauma
What is NEW?
Aging in psoriasis vulgaris: female patients are epigenetically older than healthy controls
Published: Immun Ageing. 2021 Mar 3;18(1):10. doi: 10.1186/s12979-021-00220-5.
Pavel Borsky, Marcela Chmelarova, Zdenek Fiala, Kvetoslava Hamakova, Vladimir Palicka, Jan Krejsek, Ctirad Andrys, Jan Kremlacek, Vit Rehacek, Martin Beranek, Andrea Malkova, Tereza Svadlakova, Drahomira Holmannova , Lenka Borska
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927262/
Abstract
Background: Psoriasis vulgaris is a skin autoimmune disease. Psoriatic patients have significantly lowered life expectancy and suffer from various comorbidities. The main goal of the study was to determine whether psoriatic patients experience accelerated aging. As accelerated aging might be the reason for the higher prevalence of comorbidities at lower chronological ages, we also wanted to investigate the relationship between aging and selected parameters of frequent psoriatic comorbidities – endocan, vascular endothelial growth factor and interleukin-17. Samples were obtained from 28 patients and 42 healthy controls. Epigenetic age measurement was based on the Horvath clock. The levels of endocan, vascular endothelial growth factor and interleukin-17 were analyzed using standardized ELISA methods.
Results: The difference between the epigenetic age and the chronological age of each individual subject did not increase with the increasing chronological age of patients. We cannot conclude that psoriasis causes accelerated aging. However, the epigenetic and chronological age difference was significantly higher in female patients than in female controls, and the difference was correlated with endocan (r = 0.867, p = 0.0012) and vascular endothelial growth factor (r = 0.633, p = 0.0365) only in female patients.
Conclusions: The findings suggest a possible presence of pathophysiological processes that occur only in female psoriatic patients. These processes make psoriatic females biologically older and might lead to an increased risk of comorbidity occurrence. This study also supports the idea that autoimmune diseases cause accelerated aging, which should be further explored in the future.
Complications
Psoriasis causes significant social morbidity. In one survey, 79 percent of patients thought that psoriasis negatively affected their lives by causing problems with work, activities of daily living, and socialization. Three-fourths of these patients felt unattractive, and more than one-half were depressed. Increasing disease severity is associated with lower income, consulting multiple physicians, and reduced satisfaction with treatment.
Younger and female patients are most affected by psoriasis. Quality-of-life scores tend to improve with age, suggesting that patients may adapt to the condition over time. One survey found that more than one-half of patients with severe psoriasis thought physicians could do more to help, and 78 percent reported frustration with the effectiveness of treatment. One study found that psoriasis caused a greater negative effect on quality of life than life-threatening chronic diseases.
Risk factors
Smoking and alcohol consumption have been associated with psoriasis. A systematic review and meta-analysis revealed that patients with psoriasis are more likely to be current or former smokers. Smoking is associated with an increased risk of developing psoriasis. In addition, smoking is strongly associated with pustular lesions of psoriasis.
A trend was found toward an increased risk of psoriasis with increasing pack-years or duration of smoking. Another study also showed that there was a positive correlation between the amount and/or duration of smoking and the occurrence of psoriasis.
Alcohol consumption appears to be a risk factor for psoriasis. However, a past systematic review concluded that there was not enough evidence to establish whether the alcohol consumption was indeed a risk factor.
Various factors interact with each other and can affect the development of psoriasis directly and/or indirectly. For example, obesity, dyslipidemia, and hypertension are associated with the course of psoriasis and are also dependent on the patient’s age, lifestyle, and chronic diseases.
Moreover, the impacts of the patient’s age, lifestyle, and concomitant diseases vary among individuals. The risk factors of psoriasis are not fully understood, and future studies need to successfully establish preventive approaches for psoriasis.
Reference
Diagnosis and management of psoriasis. Kim WB, Jerome D, Yeung J.Can Fam Physician. 2017 Apr;63(4):278-285.PMID: 28404701 Free PMC article. Review.
Risk Factors for the Development of Psoriasis. Kamiya K, Kishimoto M, Sugai J, Komine M, Ohtsuki M.Int J Mol Sci. 2019 Sep 5;20(18):4347. doi: 10.3390/ijms20184347.PMID: 31491865 Free PMC article. Review.
Stress and psoriasis. Rousset L, Halioua B.Int J Dermatol. 2018 Oct;57(10):1165-1172. doi: 10.1111/ijd.14032. Epub 2018 May 4.PMID: 29729012 Free article. Review.
Trojacka E., Zaleska M., Galus R. Influence of exogenous and endogenous factors on the course of psoriasis. Pol. Merkur. Lekarski. 2015;38:169–173. [PubMed] [Google Scholar]
Wang L., Yang H., Li N., Wang W., Bai Y. Acupuncture for psoriasis: Protocol for a systematic review. BMJ Open. 2015;5:e007526. doi: 10.1136/bmjopen-2014-007526. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Gelfand J.M., Weinstein R., Porter S.B., Neimann A.L., Berlin J.A., Margolis D.J. Prevalence and treatment of psoriasis in the United Kingdom: A population-based study. Arch. Dermatol. 2005;141:1537–1541. doi: 10.1001/archderm.141.12.1537. [PubMed] [CrossRef] [Google Scholar]
Parisi R., Symmons D.P., Griffiths C.E., Ashcroft D.M. Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) Project Team. Global epidemiology of psoriasis: A systematic review of incidence and prevalence. J. Investig. Dermatol. 2013;133:377–385. doi: 10.1038/jid.2012.339. [PubMed] [CrossRef] [Google Scholar]
Ganzetti G., Campanati A., Molinelli E., Offidani A. Psoriasis, non-alcoholic fatty liver disease, and cardiovascular disease: Three different diseases on a unique background. World J. Cardiol. 2016;8:120–131. doi: 10.4330/wjc.v8.i2.120. [PMC free article] [PubMed] [CrossRef] [Google Scholar]