Treatment in Germany - see top hospital ratings and lists of best specialists, up-to-date information prices adresses and contacts
Psoriasis is a disease that causes red, flaky and keratinized rashes covered with silvery-white scales to appear on the skin.
Usually these rashes appear on the elbows, knees, scalp and lower back, but can be observed in any other places. Most people have small rashes. In some cases, they may itch or hurt.
In Europe, about 1% of the population suffers from psoriasis, often scaly lichen occurs in the indigenous inhabitants of the north. Men and women get sick equally often. The first symptoms of psoriasis often appear before the age of 30, but a later onset of psoriasis is not uncommon. The severity of psoriasis varies greatly from person to person. Psoriasis is just a little annoying for someone, while psoriasis prevents other people from leading a normal lifestyle.
Psoriasis is a chronic disease that usually has periods of remission - without symptoms or with mild symptoms, after which there are periods of exacerbation when the symptoms become more pronounced.
Psoriasis occurs when the process of reproduction of skin cells by the body accelerates. Skin cells are usually produced and changed every 3-4 months, but with psoriasis, this process is shortened to 3-7 days. As a result, there is a build-up of skin cells, which leads to the appearance of characteristic changes on the body.
The causes of psoriasis are not completely clear, it is believed that increased reproduction of skin cells is associated with disorders of the immune system. The immune system is the body's natural defense against infections and diseases, but in people with psoriasis, it mistakenly attacks healthy skin cells.
Psoriasis can be inherited, and therefore it is believed that this disease has a genetic factor. However, it is still unclear exactly what role genetics plays in the occurrence of psoriasis.
In many people, psoriasis symptoms appear or worsen after a certain event, which is called a trigger. Possible triggers for psoriasis include skin damage, throat infections, and taking certain medications. This disease is not contagious and cannot be transmitted from one person to another.
If you suspect psoriasis, you should consult a doctor. Often, a doctor can make a diagnosis based on the appearance of your skin. Usually, for the diagnosis and treatment of psoriasis, the patient is referred to a dermatologist — a specialist in skin diseases.
Although it is impossible to cure psoriasis, there are a number of treatments that can alleviate its symptoms and improve the appearance of the skin. In most cases, local treatment will be prescribed first, for example, vitamin D analogues or topical corticosteroids. In the most severe cases, when other methods of treatment do not help, systemic treatment can be used. Systemic treatment is the ingestion or injection of drugs that have a therapeutic effect on the entire body.
For some people, psoriasis is only a small problem, but sometimes it can significantly affect your life. For example, some psoriasis patients have low self-esteem due to how the disease affects their appearance. Often, also with psoriasis, painful sensitivity, pain and swelling of the joints and connective tissues appear. This is called psoriatic arthritis.
In most cases, psoriasis proceeds cyclically: every few weeks or months, the disease worsens, and then the symptoms become less noticeable or disappear, and remission occurs.
There are several different types of psoriasis. Many people suffer from only one form of psoriasis, although it is possible to have two different types of disease at the same time. One type can turn into another type or escalate. If you suspect psoriasis, you should consult a doctor.
This is the most common form of psoriasis, which accounts for about 90% of all cases. Symptoms are dry red skin formations, so-called plaques, covered with silver-white scales. They usually appear on your elbows, knees, scalp and lower back, but they can appear in any other places. Plaques may itch and/or hurt. In severe cases, the skin on the joints may crack and bleed.
Psoriasis of the scalp (seborrheic psoriasis)Psoriasis seborrheic can occur on the scalp or on adjacent areas of the skin, as well as on the back and chest. Causes reddish rashes covered with dense silvery-white scales. For some people, this type of psoriasis causes severe itching, while for others it does not cause any inconvenience. In the most severe cases, it can lead to hair loss, most often temporary.
In about half of patients with psoriasis, the disease spreads to the nails. With psoriasis, small pits or depressions may appear in your nails, they may lose color and shape. Often, nails can become loose and move away from the nail bed in which they are located. In severe cases, the nails may crumble.
With teardrop-shaped psoriasis, small (less than 1 cm) plaques appear in the form of drops on the chest, arms, legs and under the hair on the head. There is a high probability that teardrop psoriasis will completely pass in a few weeks, but in some people it turns into ordinary psoriasis. This type of psoriasis sometimes occurs after streptococcal throat infection, and children and adolescents are more likely to suffer from it.
Skin folds are affected, for example, under the arms, in the groin, between the buttocks or under the mammary glands. Large smooth rashes may appear in some or all of these areas. Symptoms worsen with friction and sweating, so they can cause particular inconvenience in hot weather.
A rarer type of psoriasis, in which pustules (bubbles with purulent contents) appear on your skin. Different types of pustular psoriasis affect different parts of the body.
Pustules occur on a large surface of the skin and develop very quickly. Pus consists of white blood cells and its appearance is not always directly related to infection. Pustules can cyclically reappear every few days or weeks. At the beginning of these cycles, von Zumbusch psoriasis can cause fever, chills, weight loss and chronic fatigue.
Pustules appear on the palms and soles of the feet. Gradually, the pustules turn into rounded brown plaques with scales, which then separate from the skin. Pustules may reappear every few days or weeks.
Pustules appear on your fingers and toes. Then the pustules burst, after which bright red areas remain, which can secrete liquid or become covered with scales. It can lead to painful deformations of the nails.
Erythrodermic psoriasis is a rare form of psoriasis that affects almost the entire surface of the skin. This causes severe itching or burning. Due to erythrodermic psoriasis, your body may lose proteins and fluid. This can lead to other complications such as infection, dehydration, heart failure, hypothermia, and exhaustion.
Psoriasis occurs when skin cells divide and renew faster than usual. The causes of psoriasis are not completely clear. The body produces new cells in the deepest layer of the skin. These cells gradually move upwards. When they come to the surface, they die off and peel off. This process normally proceeds gradually and imperceptibly for us. Skin cells are renewed every 3-4 weeks.
In people with psoriasis, this process lasts only 3-7 days. As a result, cells that are not yet fully formed quickly accumulate on the surface of the skin, causing the appearance of red, flaky and keratinized rashes covered with silvery-white scales. It is believed that in patients with psoriasis, skin cells change faster due to a violation of the immune system.
The immune system is the body's defense, which helps it fight infection. One of the main types of cells that the immune system uses is called T-lymphocytes.
T-lymphocytes usually move around the body, find an infection and fight them. In people with psoriasis, they mistakenly attack healthy skin cells. This causes the immune system to produce more T-lymphocytes, as well as to reproduce new skin cells faster than usual.
It is not completely clear what exactly causes a violation of the immune system, although it may be that some genes and environmental factors play a role in this.
Psoriasis is inherited. One in three psoriasis patients has a close relative with this disease. However, it is still unclear exactly what role genetics plays in the occurrence of psoriasis. The results of the study indicate that numerous genes may be responsible for the development of psoriasis. Most likely, their various combinations can make a person more susceptible to this disease. However, it is not psoriasis itself that is inherited, but only a predisposition to it, that is, the presence of these genes does not mean that you will necessarily develop this disease.
In many people, psoriasis symptoms appear or worsen after a certain event, which is called a trigger. If you know your triggers, it can help you avoid exacerbating your symptoms. Examples of common triggers:
Psoriasis is not contagious and therefore cannot be transmitted from one person to another.
As a rule, an external examination of the skin is sufficient to diagnose psoriasis.
Psoriatic plaque In more rare cases, a biopsy (a small skin sample) is required, which is then sent to the laboratory for examination under a microscope. This will allow you to identify a specific type of psoriasis and exclude other skin diseases, such as seborrheic dermatitis, lichen planus, simple chronic lichen and pink lichen.
As a rule, the diagnosis and treatment of psoriasis is carried out under the supervision of a dermatologist - a specialist in skin diseases. If your doctor suspects you have psoriatic arthritis, which sometimes occurs as a complication with psoriasis, you may be referred to a rheumatologist. A rheumatologist is a doctor who specializes in arthritis.
You may have blood taken for tests to rule out other diseases, such as rheumatoid arthritis, as well as X-rays of the joints affected by the disease.
It is not possible to completely cure psoriasis, however, with the help of treatment it is possible to reduce the severity and frequency of its exacerbations. Usually, the treatment of psoriasis takes place under the supervision of a dermatologist, in case of involvement of the joints in the process, a rheumatologist's consultation is prescribed. If the symptoms of psoriasis are pronounced significantly and do not respond well to treatment, the doctor may refer you to the hospital, to the department of dermatology.
One or another method of treatment is used depending on the type and severity of psoriasis and the area of the skin covered by the disease. If the symptoms of psoriasis are moderate and do not increase, the doctor may limit himself to prescribing external remedies, for example, in the form of a cream. At the stage of exacerbation, more serious treatment is usually prescribed with the help of medications taken orally.
There is a wide range of remedies for the treatment of psoriasis, but it can be difficult to determine which remedy is most effective. Talk to your doctor if you feel that the treatment is not helping or you have side effects that cause inconvenience.
Treatment methods are divided into 3 categories:
Often different methods of treatment are combined. Since psoriasis patients require long-term treatment, it makes sense to draw up a written plan of medicinal manipulations that need to be done daily. The doctor should regularly monitor your condition and, if necessary, adjust the treatment plan.
Usually, with mild to moderate psoriasis, local treatment is first prescribed. With this method of treatment, creams and ointments are applied to the skin. For some people, this is enough to control the disease. If you have psoriasis of the scalp, you may be shown a combination of shampoo and ointment.
Topical corticosteroids are often used to treat mild to moderate psoriasis of various localization on the body. Corticosteroids help to relieve inflammation. This slows down the division of skin cells and relieves itching. Topical corticosteroids are classified by strength from mild to very strong. There are various corticosteroids that differ from each other in their effect on the body.
Use topical corticosteroids only with the permission of a doctor. Stronger local corticosteroids are available by prescription and should be used only on small areas of the skin or on particularly dense plaques. Excessive use of topical corticosteroids can lead to thinning of the skin.
Vitamin D analogues in the form of a cream are often used together with topical corticosteroids or instead of them for mild to moderate psoriasis on the limbs, body and scalp. They slow down the reproduction of skin cells. They also have an anti-inflammatory effect. Vitamin D analogues include, for example, calcipotriol and calcitriol. If you do not exceed the recommended dosage, they have almost no side effects.
Calcineurin inhibitors, such as tacrolimus and pimecrolimus, are medications that reduce the activity of the immune system and help relieve inflammation. They are sometimes used to treat psoriasis on sensitive areas of the skin (scalp, genitals and skin folds) if topical corticosteroids have proved ineffective.
These medications can cause skin irritation or a burning or itching sensation at the beginning of taking, but this usually goes away within a week.
Coal tar is a thick, viscous oil that is probably the oldest treatment for psoriasis. The mechanism of operation is not completely clear, but it helps to relieve peeling, inflammation and itching. The resin can be used for psoriasis of the extremities, body and scalp, if other topical agents have proved ineffective.
Coal tar can leave traces on clothes and bedding and smells strongly. It can be used in combination with phototherapy (see below).
Ditranol has been used to treat psoriasis for 50 years. It effectively suppresses the reproduction of skin cells and it has almost no side effects. However, in too concentrated form, it can leave burns.
It is usually used for short-term treatment of psoriasis of the limbs or body under the supervision of medical personnel, as it leaves traces on everything it comes into contact with, including skin, clothing and plumbing. It is applied to the skin (with gloved hands) and left for 10-60 minutes, and then washed off. Ditranol can be used in combination with phototherapy (see below).
Natural or artificial light is used to treat psoriasis with phototherapy. Artificial light therapy can be performed in hospitals and in some specialized centers, usually under the supervision of a dermatologist. Phototherapy is not the same as a solarium.
Phototherapy with ultraviolet spectrum B (UVB) uses light with a wavelength visible to the human eye. Light slows down the reproduction of skin cells and is an effective treatment for certain types of psoriasis that do not respond to local treatment. Each session lasts a few minutes, but you may need to go to the hospital 2-3 times a week for 6-8 weeks.
PUVA therapy is the combined effect of ultraviolet rays with photosensitizers (substances that increase the sensitivity of the skin to light). With this method of treatment, you will first be prescribed a medicine from the group of furocoumarin drugs (for example, ammifurin) in the form of a tablet or cream. Then the skin is exposed to ultraviolet A. This radiation penetrates deeper into the skin than the ultraviolet of the B spectrum.
PUVA therapy can be used for severe psoriasis, which does not respond to other methods of treatment. Side effects: nausea, headache, burning and itching. You may need to wear special glasses for 24 hours after treatment to avoid the appearance of cataracts. It is not recommended to use this method of treatment for a long time, as it increases the risk of skin cancer.
The combination of phototherapy with other methods of treatment often increases its effectiveness. Some doctors use UVB phototherapy in combination with coal tar, as the resin makes the skin more sensitive to light. Combining phototherapy with ditranol in the form of a cream can also be effective (this is called Ingram treatment).
If you have a severe form of psoriasis or other methods of treatment have proved ineffective, a dermatologist can prescribe systemic treatment for you, that is, drugs that are taken orally or injected. These treatments can be very effective, but each of them has potentially dangerous side effects that need to be weighed before starting therapy.
There are 2 main types of systemic treatment, which are called non-biological (usually in the form of tablets or capsules) and biological (usually in the form of injections). They are described in detail below.
Methotrexate can help control psoriasis by slowing down the reproduction of skin cells and suppressing inflammation. Methotrexate can cause nausea and affect the production of blood cells. With long-term use, it can cause liver dysfunction. Methotrexate is forbidden to be taken by people with kidney diseases, and alcohol should not be consumed during administration.
Methotrexate can be very harmful to the developing fetus, so women should use contraceptives while taking this drug and up to 3 months after the end of the course. Methotrexate can also affect the development of sperm cells, so men should not participate in the conception of a child during treatment and for 3 weeks after the end of the course.
Cyclosporine is a drug for suppressing the immune system (an immunosuppressant). Initially, it was used to prevent rejection of the transplanted organ, but it also proved effective in the treatment of psoriasis of all types. Cyclosporine increases the likelihood of kidney disease and high blood pressure.
Acitretin is a retinoid for internal use that reduces the reproduction of skin cells. It is used to treat a severe form of psoriasis that does not respond to other systemic medications. Acitretin has a large number of side effects, including drying out of the lips and the appearance of cracks on them, drying out of the nasal canals and, in rare cases, hepatitis.
Acitretin can be very harmful to the developing fetus, so women should use contraceptives while taking this drug and for 2 years after the end of the course. However, men can take acitretin and participate in the conception of a child without restrictions.
Biological drugs relieve inflammation by acting on overactive cells in the immune system. These medications are commonly used to treat severe psoriasis that does not respond to other medications, or if other treatments are contraindicated.
Etanercept is administered as subcutaneous injections. You will be shown how to do it. If psoriasis does not begin to pass 12 weeks after the start of treatment, the course of treatment will be stopped. The main side effect of etanercept is a rash at the injection site. Since etanercept affects the entire immune system, there is a risk of dangerous side effects, including severe forms of infectious diseases. If you have had tuberculosis in the past, there is a risk that it will return. During the course of treatment, the specialist will monitor possible side effects.
Adalimumab is administered as subcutaneous injections. If, 16 weeks after the start of treatment, the symptoms of psoriasis do not begin to pass, the course of treatment will be stopped. Adalimumab can be harmful to the developing fetus, so women should use contraceptives while taking this drug and for 5 months after the end of the course of treatment.
The main side effects of adalimumab are headache, rash at the injection site and nausea. Since adalimumab affects the entire immune system, there is a risk of dangerous side effects, including severe forms of infectious diseases. During the course of treatment, the specialist will monitor possible side effects.
Infliximab is administered through an intravenous drip in the hospital. If your psoriasis does not start to pass 10 weeks after the start of treatment, the course of treatment will be stopped. The main side effect of infliximab is headache. Since infliximab affects the entire immune system, there is a risk of dangerous side effects, including severe forms of infectious diseases. During the course of treatment, the specialist will monitor possible side effects.
Ustekinumab is administered as an injection. If there is no effect after 16 weeks after the start of treatment, the course of treatment will be stopped. The main side effects of ustekinumab are infectious diseases of the throat and a rash at the injection site. Since ustekinumab affects the entire immune system, there is a risk of dangerous side effects, including severe forms of infectious diseases. During the course of treatment, the specialist will monitor possible side effects.
For some people, psoriasis is only a small problem, but it can significantly affect the quality of life. If you have psoriasis, the following tips may be helpful for you.
Self-help is an integral part of your daily life. This means that you are responsible for your own health and well-being with the support of people taking part in your treatment. Self-help implies that you take care of yourself and maintain good physical and mental health, avoid diseases and injuries, and pay more attention to the treatment of both minor and chronic diseases.
Self-help can be of great benefit to people with chronic diseases. They will be able to live longer, experience less pain, anxiety, depression and fatigue, lead a more fulfilling life and be more active and independent. The treatment plan will help you organize your treatment so that it matches your lifestyle.
During treatment, it is important to follow all the doctor's instructions, even when psoriasis is already passing. Consistent treatment can help prevent repeated exacerbations. Talk to your doctor or other healthcare professionals if you have any questions or concerns about the medications you are taking or their side effects.
In most cases, psoriasis is a chronic disease, so you may need to communicate regularly with the specialists treating you. Discuss your symptoms or concerns with them, because the more they know, the better they can help you.
People with psoriasis have a slightly increased risk of diabetes and cardiovascular disease, although the reasons for this are unknown. Regular exercise and a healthy diet are shown to everyone, not just people with psoriasis, as they help to avoid many diseases. A healthy, balanced diet and regular exercise relieve stress, which eases the symptoms of psoriasis.
Because of psoriasis, the skin may look unattractive, so patients often develop low self-esteem and a sense of anxiety. This can lead to depression, especially if the symptoms of psoriasis worsen. Your doctor understands the impact psoriasis has on your psychological and emotional state, so talk to them about what is bothering or bothering you. If necessary, he can offer appropriate treatment options.
10-20% of people with psoriasis have psoriatic arthritis, which is characterized by the appearance of pain, swelling and stiffness in the joints. Most often, psoriatic arthritis affects the joints of the fingers and toes. In some cases, the lumbar and cervical spine and knees. In most people, psoriatic arthritis appears after a skin attack of psoriasis, but in about 20% it occurs before changes in the skin of psoriasis.
To diagnose psoriatic arthritis, you need information from your medical record, an external examination, blood tests, X-rays and magnetic resonance imaging (MRI). If you have psoriasis, you will probably have an examination once a year for early detection of signs of psoriatic arthritis. If you suspect psoriatic arthritis, your doctor will most likely refer you to a rheumatologist so that you can undergo treatment under his supervision.
Psoriasis does not affect the ability to fertilize, and women with psoriasis can become pregnant and give birth to healthy children. In some women, psoriasis passes during pregnancy, in others it worsens.
Consult a doctor if you are planning to have a baby. Some medications for psoriasis can be harmful to the unborn child, so you should use contraceptives while taking them. Depending on the specific medication, this may apply to both men and women. Therefore, the optimal way to treat psoriasis should be developed at the stage of pregnancy planning.
Many people with psoriasis find that participating in support groups helps them. Support groups can strengthen your self-confidence, ease feelings of isolation and give you practical advice on how to live with psoriasis.
