Psoriasis: Understanding the Disease and its Treatment
By: Jhoser Bermúdez Guerrero
October 29, 2023
In conversation with Dr. Néstor Sánchez, professor and head of the Department of Dermatology at the School of Medicine of Ponce Health Sciences University, regarding World Health Day Psoriasis, we were able to delve deeper into psoriasis, its treatments, and more curiosities about this autoimmune skin condition that affects 2-3% of the global population, according to official figures.
Psoriasis is a chronic disease that so far has no cure. It can be painful, interfere with sleep, daily activities, and make it difficult to concentrate. It usually occurs in cycles and with outbreaks that last a few weeks or months and then subside.
Psoriasis vulgaris, the most common of all
Psoriasis vulgaris is one of the most frequent manifestations of this condition and according to Dr. Sánchez: “It is characterized by the presence of scaly patches in the extensor area of the skin, that is, on the elbows, knees, and head, although occasionally it can be generalized, but the elbows, knee and head are the anatomical parts most affected by the psoriasis.”
The diagnostic process of psoriasis and the Auspitz sign or phenomenon
The specialist in dermatology details how the diagnosis of psoriasis is made and mentions a key phenomenon or sign known as Auspitz, which presents distinctively in this disease.
“Generally, the patient presents a very particular scale, like silvery white, and when it is removed, it bleeds, which is what is known as the phenomenon of Auspitz, in which, due to the superficiality of the psoriasis, the vessels are close to the scale and when removed they bleed. That is also the way to diagnose psoriasis.”
What is the Koebner phenomenon and what is the genetic relationship between arthritis and psoriasis?
In turn, the doctor details the reason why this type of damage generally occurs in areas such as the elbows, knees, and head, mentioning another common phenomenon: the Koebner phenomenon.
“There is another phenomenon called Koebner, in which patients present the psoriasis in areas where there is trauma, such as usually the elbows and knees due to friction or the head due to combing. Another factor for worsening is stress since many times patients with psychiatric and psychological problems or disorders tend to have more psoriasis than regular patients,”
Additionally, it explains the genetic factor and the relationship with arthritis by mentioning that those patients whose parents have had psoriasis are more likely to contract it and in turn, psoriasis tends to be often associated with arthritis, especially in its variant known as psoriatic arthritis, occurring in the distal parts, being painful and more common in people aged 60 or 70 years.
“Regularly, psoriasis does not cause itching, but there are patients who do, and for this basic antihistamines such as Benadryl or Zyrtec are used, and if it is severe, hydroxyzine should be used. So, if it itches and the patient tends to scratch, it will get worse due to the Koebner phenomenon.”
Differentiating psoriasis from other skin conditions
“Psoriasis can also be confused with other conditions such as neurodermatitis, or also known as lichen simplex chronicus, which are lesions on the elbows, knees, and neck, in which the patient tends to scratch, and they do so much that they form a scaly patch.”
The specialist in dermatology also points out in the same way that psoriasis on the head should not be confused with dandruff or seborrheic dermatitis, which presents a type of scale that tends to be finer and more oily because what is affected is located where the sebaceous glands are.
Effective treatment options for psoriasis
To manage this condition, various treatment alternatives are discussed, including the use of topical steroids, a process that tends to respond quite well, although this is an inflammatory and autoimmune problem whose specific cause is not yet known.
“We generally use topical steroids, corticosteroids in lotion and cream. Treatment consists of lotions and creams. On the head, fluocinonide or betamethasone is used in lotion, to prevent the hair from being sticky, or we also use shampoo with ketoconazole or tar,” explains Dr. Sánchez.
Use of fluorosteroids in psoriasis
The specialist also warns about the dangers associated with the use of fluorinated steroids on certain areas of the skin with psoriasis and points out that: “An important factor is to never use fluorinated steroids on the face and neck because they can cause atrophy by wearing away the skin and then the process is complicated. For the face, hydrocortisone is used, never fluorinated steroids.”
Likewise, he points out that strong topicals, such as betamethasone and fluocinonide, can be used on the elbows and knees when there is no response to clobetasol, although they cannot be used for a long time because they cause atrophy in the quality of the skin. In fact, as soon as the patient improves, it is advisable to use low-potency steroids such as betamethasone and mometasone.
The importance of seeing a dermatologist if you have signs of psoriasis
Dr. Sánchez concludes by highlighting that self-diagnosis and self-medication can lead to serious problems in psoriasis, which highlights the importance of consulting an expert dermatologist to receive effective management of the condition and prevent future complications.