Psoriasis: symptoms and causes, treatments (plaques, drops, inverted ..)

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Psoriasis is a chronic inflammatory skin disease characterized by thick, painful patches of skin that can be itchy.
It can develop into psoriatic arthritis with joint damage. Causes, symptoms, treatments…. All you need to know about psoriasis.
Psoriasis is a disease that affects about 8 million people in the USA, and 125 million people worldwide according to statistics National Psoriasis Foundation / USA

Definition: what is psoriasis?

Psoriasis is not a viral or bacterial disease, but a chronic inflammatory disease that develops in episodes whose duration and frequency vary from one person to another and are difficult to predict.
It is unpredictable because the lesions develop into mutations that appear spontaneously and then regress in periods of remission with fairly complete disappearance of the lesions. Contrary to popular belief, psoriasis is never contagious.

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World Psoriasis Day: October 29th

Who is at risk?

Psoriasis can affect both children and adults and men and women.
It is more common in people with white skin.
It most often begins in adolescence or young adulthood.
Familial forms tend to occur in adolescents between the ages of 10 and 30.
After the age of 40, isolated forms appear with very little family involvement.

Psoriasis in children

Childhood psoriasis is not very common, but it appears that more than a third of adult psoriasis begins in childhood, especially in adolescence. The diagnosis is simple for the doctor and does not require any examination.

All forms of psoriasis are seen in children. However, the frequency of the different forms varies according to the age of the child and some forms are specific to children, such as “diaper psoriasis”,

A large part of the consultation is aimed at explaining the disease to the child, with appropriate words, and especially to his parents.
Two forms of psoriasis are more specific to children:
guttate psoriasis: develops from the age of 3 months on the seat of the child (buttocks, vulva, folds of the groin) and can spread over the entire diaper area. Its appearance is that of a dry and limited redness of the buttocks.

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This localization is also observed in older children, but psoriasis is generally more localized, mainly in the glans and vulva.
Guttate psoriasis: is localized mainly on the trunk. In more than half of the cases, it will disappear without treatment within a few months. Children are also more often affected on the face and are more prone to pulpitis (psoriasis on the fingertips).

The diagnosis does not require any examination but is sometimes delicate, at the onset of the rash, it can be mistaken for a common “diaper rash”. The doctor may also hesitate between eczema and psoriasis.

Is psoriasis contagious?

Psoriasis is not contagious. Do not hesitate to explain it to your teacher or a sports instructor, In cases that should not be observed, do not hesitate to ask for a certificate of non-contagiousness for the nursery, school, or swimming pool.

Is psoriasis dangerous?

  • Psoriasis can be socially and psychologically disruptive
  • Psoriasis is neither contagious nor dangerous, but it can be unsightly, unpleasant and disruptive to those around you.
  • A significant social and psychological impact is possible and inevitably alters the quality of life of the person affected.
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What are the different types of psoriasis?

There are several types of psoriasis depending on the morphology of the lesions: plaque, guttate, inverted. Psoriasis can be benign and limited to the nails, elbows, knees, feet, hands or scalp, or it can be dangerous and spread throughout the body.

1- Plaque psoriasis

The typical lesion is an erythematous scaly patch, i.e. a red, well limited, rounded or oval-shaped patch covered with pieces of whitish skin that come off. The part of the skin that comes off (flakes) can be very thick. When this superficial part is scraped or scraped by treatments, redness of the skin remains.

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The size of the lesions varies from simple, small, rounded lesions – guttate psoriasis – to real, large patches – plaque psoriasis -. The number of these lesions is also variable. They are usually numerous in guttate psoriasis, whereas in plaque psoriasis there may be an isolated plaque or multiple lesions.
The most frequently affected areas are the areas exposed to friction: elbows and the outer edge of the forearm, knees, lumbosacral region (lower back), scalp and nails.

2- Psoriasis of the scalp

The scalp may be the only site of psoriasis in some people. As seen on the skin, the lesions may be well defined, rounded or oval, covered with small flakes of skin that flake [peel] off.
They are mostly located on the frontal border, the nape of the neck, behind the ears, forming like a < headband >.
They can also cover the entire scalp and form a real carapace: we then speak of psoriatic headgear. The hair is stuck in the patches and can sometimes fall or break with the scales in a transitory manner, especially in the case of scratching which is frequent in this location.

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3- Nail psoriasis

Nail psoriasis is specific. Inflammation only reaches the fingertips and forms slight desquamations with a punctiform appearance. The skin under the nail thickens. The skin under the nail becomes thicker and the fingers look like thimbles.

4- Inverted psoriasis

Reverse psoriasis (also called fold psoriasis) is a form of psoriasis in which the red (and smooth) plaques are restricted to the folded areas (armpits, groin, navel, etc.).
Reverse psoriasis owes its name to the location of the red, itchy patches: these are on the areas spared in the common form of psoriasis (submammary, gluteal and inguinal folds).

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The genital areas can be affected as well as the popliteal and axillary hollows. It is also known as fold psoriasis. The large folds are subject to the appearance of well defined, red and smooth (without scales) plaques.

Rarer forms

Reverse psoriasis or fold psoriasis

In this form of psoriasis, the location of the lesions does not concern the raised areas of friction, but predominates in the folds (inverted areas) such as the gluteal fold, inguinal folds (root of the thighs), axillary hollows (under the arms), submammary folds (under the breast) and the umbilicus. The lesions here are more inflammatory than scaly.
This form is deceptive, sometimes mistaken for a fungus.

Psoriasis of the mucous membranes

Psoriasis can affect the mucous membranes.
In the mouth, it gives an appearance of “geographical” tongue with a slightly thickened whitish painless areas. The genital areas may be the site of red patches that do not flake off. The lesions may be itchy, burning, painful during sexual intercourse or on the contrary be painless. They are often the cause of an altered quality of life.

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Palmoplantar psoriasis

This form of psoriasis is rare. Usually, the disease does not affect the palms of the hands and soles of the feet. The skin looks cracked and very thickened.

Psoriasis of the face

It is a more frequent location in children than in adults. It is generally associated with psoriasis that begins early in life, is severe and has been evolving for many years.
Scalp involvement is often present as well. While facial psoriasis is not too frequent, it particularly affects patients with psoriasis because of its social and aesthetic impact.
It manifests itself as red or pinkish patches in the center of the face and/or on its periphery that are more or less scaly.

Causes and risk factors

The precise causes of psoriasis are not yet elucidated.
Researchers believe that at least 10% of the population inherits one or more genes that predispose to the development of psoriasis.
In addition to this component, environmental factors are also believed to play a role in the onset of psoriasis. These external factors are not universal and vary from one individual to another.
Severe forms of psoriasis are associated with co-morbidities, in particular obesity and cardiovascular risk factors such as hypertension, diabetes and hypercholesterolemia.

What are the foods to avoid when you have psoriasis?

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A link with gluten

Regarding diet and psoriasis, “there are not yet many studies on the subject, however, scientific research shows that in some particular cases, there is a link with the consumption of gluten,” says the specialist. But to hope to see a result, it would be necessary to do two to three months of a very strict diet. “Dietary avenues must be explored”,

What are the foods to avoid?

The skin specialist still recommends avoiding industrial foods, such as highly processed and transformed products. Among them? Chicken nuggets, cereals, cakes.
These industrial products contain fats such as artificial trans-fatty acids and refined sugars. They could be factors aggravating the inflammation of psoriasis, the same goes for alcohol and tobacco. Raw foods and good fats such as oily fish should be preferred.

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A recent study by researchers from the University of Paris. In the report, the scientists reveal that the Mediterranean diet, consisting of olive oil, cereals, vegetables and fish or nuts, could reduce the inflammation of psoriasis. On the contrary, so-called “pro-inflammatory” foods, which contain a high content of saturated fats, could worsen the symptoms.

If red patches that may look like psoriasis appear on your skin, it is important to consult a dermatologist. Only he or she will be able to diagnose the disease and prescribe an appropriate treatment.

Diagnosis and treatment

Treatments to be managed over time

Psoriasis is a chronic disease for which there is no cure.
However, there are many effective treatments for flare-ups. Depending on the form and evolution of the disease, the doctor will use these different treatments as part of an individualized strategy shared with the patient.

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Therapeutic management is based on the use of local treatments for mild and not very disabling forms of the disease, which can be combined with general treatments reserved for moderate to severe forms. Attack treatment phases may alternate with maintenance phases during which the treatment is lightened.

The therapeutic management of psoriasis depends on its severity, location, surface area and the impact of the disease on quality of life, as assessed by specific scales.

The severity of psoriasis is evaluated according to the body surface area affected (PASI Treatment Effectiveness Evaluation Score) and/or its impact on daily life (DLQI Quality of Life Scale).

Local treatments

Local treatments are used alone in localized forms and in combination with other treatments in extended forms. They are represented by dermocorticoids and vitamin D3 analogues.

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Dermocorticoids

The use of corticoids locally helps to fight the inflammation of psoriatic skin. Ointments, creams and gels based on so-called strong corticoids are used on very thick areas and weaker corticoids on the face. Ointments are mostly used on dry lesions, creams are reserved for folds and mucous membranes, and shampoos, foams and lotions for the scalp.
They are generally used in one daily application and their duration of use is limited in time. They are one of the main treatments for plaque psoriasis if the plaques are very limited in area and number.

Vitamin D3 analogues

They act on the multiplication and maturation of keratinocytes. They are prescribed to treat plaques Calcipotriol and calcitriol are applied twice a day and tacalcitol once a day.
the analogous combination of vitamin D3 (calcipotriol)-dermocorticoids
It is a very effective combination used in one daily application during the first month, then as a maintenance treatment with one application on the weekend each week to avoid recurrences.

Other topical treatments

Baths and moisturizing products

Wheat starch or oil-based baths and moisturizing products have the property of calming inflammation, softening and smoothing the skin and calming itching.

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Salicylic acid and urea

Salicylic acid and urea have a keratolytic effect, i.e. they are substances capable of dissolving the superficial (or horny) layer of the epidermis. They are used in mixture with a fatty excipient (Vaseline, cold cream) to strip very scaly lesions, prior to the application of any other local treatment; the concentration is usually limited to 10%.

Tazarotene

It is a topical retinoid, i.e. topical application, which can be irritating which limits its use, it is contraindicated in case of pregnancy, it is only used for very localized psoriasis.

Phototherapy

Total body phototherapy is used in extensive forms (> 30% of the body surface area) and local phototherapy can be used when psoriasis is limited to the hands and/or feet.

There are two types, puvatherapy, and UVB phototherapy.

PUVAtherapy

It consists of exposure of the subject to UVA in a booth, it is necessary to take two hours before the session, a medication called psoralen which will increase the effectiveness of the phototherapy (photosensitizing agent either in tablet form or locally).

Dark goggles should be worn during the session for 8 hours after the session. You should not expose yourself to the sun after the psoralen has been absorbed.

UVB phototherapy

It uses ultraviolet rays UVB. No prior medication is necessary.

This is the most widely used technique today.

In both cases, the duration of the sessions is adapted to the skin type. As a general rule, an attack treatment is carried out over a period of 2 months at a rate of 3 sessions per week. It makes it possible to “whiten” the lesions, i.e. to make them disappear.

In both cases, the duration of the sessions is adapted to the skin type. As a general rule, an attack treatment is carried out over a period of 2 months at a rate of 3 sessions per week. It makes it possible to “whiten” the lesions, i.e. to make them disappear.

Phototherapy treatments are effective and are often considered as first line treatment. On the other hand, their use is limited in time due to the increased risk of skin cancers caused by too many sessions (more than 200 sessions).

General oral treatments

They are used in case of severe forms, either because of the skin surface affected and/or the repercussions on daily life, or in case of forms resistant to local treatments.

There are four families of drugs:

retinoids (derivatives of vitamin A synthesis: acitretin)
They are administered orally on a daily basis. They are formally contraindicated in young women without effective contraception because of the risk of serious malformations in the foetus in case of pregnancy. In addition, contraception must be continued for two years after discontinuation of acitretin therapy.

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Methotrexate

It is a drug that prescribes at low doses and has anti-inflammatory and immunosuppressive properties useful in the treatment of psoriasis.

It is also used in certain chronic rheumatic conditions (notably rheumatoid arthritis). At very high doses, it has an anti-proliferative effect, i.e. it prevents the multiplication of cells and is therefore used in the treatment of certain cancers (notably lymphomas).

It is taken once a week either in the form of tablets or subcutaneous injections. It is a long-term treatment that will be adapted according to the therapeutic response.

Regular monitoring of liver enzymes and white blood cells by blood sampling is necessary.

cyclosporin

It is an immunosuppressive drug used during transplantation to avoid the phenomenon of graft rejection.

It has also been shown to be effective in psoriasis, it is a drug that is taken orally every day, but its administration is limited in time because of the risk of kidney damage if taken over a long period of time.
Its prescription requires blood pressure and kidney function to be monitored by taking a blood test (creatinine) once a month.

Apremilast

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It is a molecule that reduces the production of inflammatory signals in cells involved in the formation of psoriasis lesions, it is taken daily in two oral doses, does not require special biological monitoring. It is contraindicated in pregnant women.
At the beginning of treatment, diarrhea and nausea are possible, most often transient. Suicidal thoughts and behavior have been reported with this treatment.
Although uncommon, it is important to tell your doctor if you are being monitored for depression or if you experience such symptoms.

Biotherapies

This new family of drugs intervenes on very specific stages of psoriasis inflammation. The use of biotherapies in psoriasis is reserved for moderate to severe forms of psoriasis that have not responded or have a contraindication to at least two other prior treatments, including phototherapy, methotrexate and cyclosporine.

These are new and expensive treatments that require a certain number of tests to be performed before prescription, to eliminate the existence of latent tuberculosis, as well as a blood test to eliminate hepatitis or any other severe viral infection in progress.

All vaccinations must be updated before starting this type of treatment, as well as before starting methotrexate or cyclosporine, in order to limit the risk of infection from these immunosuppressive drugs.

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Tips for the care of psoriasis plaques

Short and regular exposure to the sun can alleviate a psoriasis attack. Apply an adequate sunscreen (minimum SPF 15) beforehand.

Take a bath every day to allow the plaques to desquamate naturally. Add bath oil, colloidal oatmeal or Epsom salts to the water. Soak for at least 15 minutes. Avoid hot water. Use a mild soap;
Avoid using irritating toiletries, such as those containing alcohol.

After bathing or showering, apply a moisturizing cream to wet skin (this is especially important in winter).

Avoid scratching and rubbing the affected areas. If necessary, during the night, wrap the skin with plastic wrap after applying an emollient cream or ointment.
See also our Dry Skin fact sheet.

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Psoriasis: symptoms and causes, treatments  (plaques, drops, inverted ..)
Psoriasis: symptoms and causes, treatments (plaques, drops, inverted ..)

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