Psoriasis: Symptoms, Diagnosis, and Modern Skin Treatment Methods

Psoriasis is a chronic, inflammatory, multisystemic disease that affects the skin and sometimes the joints, as well as other organs [4, 7]. It is one of the most common chronic inflammatory diseases, affecting a significant portion of the population: for example, about 2 million people in Germany [3], up to 3.2% of the US population [4], and 1.3% of the Brazilian population [5]. Psoriasis has a substantial impact on patients' quality of life and is associated with serious economic consequences [3, 7, 8].

Understanding the nature of psoriasis, its symptoms, and available treatments is crucial for effectively managing this condition and improving patient well-being.

What is psoriasis and why does it occur?

Psoriasis is traditionally defined as a chronic relapsing inflammatory skin disease, but today it is viewed as a systemic condition associated with numerous comorbidities [7]. Although the exact cause of psoriasis is not fully understood, it is known to be an immune-mediated disease in which the immune system mistakenly attacks healthy skin cells, causing them to grow at an accelerated rate. In some cases, such as with Down syndrome, psoriasis may be associated with chromosomal abnormalities [1].

The disease often persists throughout life, and its clinical presentation can vary significantly in the nature of the lesions and the degree of severity [3].

Main symptoms of psoriasis

The most common clinical manifestations of psoriasis are erythematous (red), scaly plaques that can appear on any part of the body, but most frequently affect the knees, elbows, scalp, and genitals [5]. In addition to skin manifestations, psoriasis is frequently accompanied by other disorders known as comorbidities [4, 7].

• Psoriatic arthritis (PsA): Approximately one-third of patients with psoriasis develop psoriatic arthritis—a chronic, progressive, inflammatory spondyloarthropathy [2, 6]. Dermatologists play a key role in the early detection of PsA symptoms, which allows for timely therapy to be initiated and prevents further loss of function [2]. Important signs of PsA include enthesitis (tenderness and pain at the sites where tendons and ligaments attach to bones) and dactylitis (swelling of an entire digit, distinct from swelling in neighboring digits) [6]. Delaying PsA treatment can lead to irreversible joint damage and a reduced quality of life [6].
• Cardiovascular diseases: Psoriasis is an independent risk factor for the development of cardiovascular diseases and their complications, especially in young patients with severe forms of the disease [3, 5, 7].
• Other comorbidities: These include metabolic disorders, inflammatory bowel disease, ocular disorders, and psychological conditions [7, 8]. The psychosocial impact of psoriasis can be significant, affecting work capacity and overall well-being [7, 8].

Diagnosis and severity assessment

The diagnosis of psoriasis is based on the clinical presentation. Various tools are used to assess disease severity, such as the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI) [1, 4, 5]. These metrics help physicians determine the extent of involvement and select the most appropriate treatment strategy.

Special attention is given to monitoring psoriasis patients for early signs of psoriatic arthritis, such as enthesitis and dactylitis [6]. Ultrasound and magnetic resonance imaging can be used to diagnose these conditions, especially when symptoms are ambiguous [6]. Early detection of PsA by a dermatologist is crucial to prevent irreversible joint damage [2, 6].

Modern approaches to psoriasis treatment

The goal of psoriasis treatment is to achieve clear or almost clear skin and significantly improve the patient's quality of life [3]. The choice of therapy depends on the severity of the disease, its location, and the presence of comorbid conditions. It is important to follow established clinical guidelines, such as the German S1 and S3 [3], joint AAD-NPF guidelines [4], Brazilian [5], or Tuscan [7] guidelines.

• Topical therapy: Local agents such as corticosteroids, vitamin D analogs, retinoids, and others are the cornerstone of treatment for mild to moderate psoriasis [4]. Dermatologists play an important role in educating patients on the proper application of these agents and monitoring their efficacy and safety [4].
• Systemic therapy: Patients with moderate to severe forms of the disease require more aggressive treatment using systemic drugs capable of halting disease progression [2, 3, 7]. These include traditional immunosuppressants.
• Biologics: These innovative medications have significantly expanded the range of systemic treatments for psoriasis [3]. Biologics are highly effective, capable of leading to the complete resolution of psoriatic lesions and significantly improving PASI, BSA, and DLQI scores [1]. They can even be used in special patient populations, such as those with Down syndrome, demonstrating high efficacy and safety [1]. It is crucial for dermatologists to understand the safety, tolerability, efficacy, cost, and potential of these drugs to halt disease progression, particularly in psoriatic arthritis [2].

In addition to traditional and biological methods, alternative treatment approaches also exist, but their use should be discussed with a physician, who can inform the patient about potential benefits and risks [4].

Living with psoriasis: management and support

Psoriasis is a chronic condition that often lasts a lifetime [3]. It exerts a significant psychosocial impact on patients, affecting their self-esteem, social interactions, and professional activities [7, 8]. Comprehensive psoriasis management includes not only medical treatment, but also psychological support, as well as patient education on self-care and skin management methods [4, 8]. Dermatologists play a key role in providing this information and helping patients adapt to life with a chronic illness.

Sources

1. Down syndrome and biologic treatment in dermatology: efficacy and safety in our real-life experience and literature review. (The Australasian journal of dermatology, 2023)
2. Psoriatic arthritis for the dermatologist. (Dermatologic clinics, 2015)
3. Psoriasis - new insights into pathogenesis and treatment. (Deutsches Arzteblatt international, 2009)
4. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine methods for psoriasis severity assessment. (Journal of the American Academy of Dermatology, 2021)
5. Consensus on the diagnosis and treatment of plaque psoriasis - Brazilian Society of Dermatology. (Anais brasileiros de dermatologia, 2019)
6. Enthesitis and dactylitis in psoriatic disease: a guide for dermatologists. (American journal of clinical dermatology, 2018)
7. Tuscan consensus on the diagnosis, treatment, and follow-up of moderate-to-severe psoriasis. (Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia, 2017)
8. Psychosocial impact of psoriasis: a review for dermatology residents. (Cutis, 2018)

The information presented in this article is for informational purposes only and does not replace professional medical advice. Always consult your healthcare provider for the diagnosis and treatment of any medical conditions.