Psoriasis

Chronic disease with an origin due to hyperactivity of the immune system that predominantly affects the skin and nails. It usually involves periods where there are no symptoms or they are mild, followed by other periods where they are more severe, significantly impacting the quality of life. It is a common disorder estimated to have a worldwide prevalence of about 2-3%.

New skin cells generated by the body rise from the deeper layers of the skin to the more superficial layers where the older cells shed. This process, which occurs normally within a maximum of 4 weeks, is accelerated in psoriasis to 3-7 days, causing immature cells to accumulate in the superficial layers of the skin, leading to the associated symptoms.

The immune system appears to be responsible for this accelerated turnover, as it directs its response against the healthy skin cells, resulting in the production of healthy skin cells at a faster rate. The exact cause of this immune system activation is not fully understood; however, in addition to genetic contribution, various triggers or risk factors have been described that initiate flare-ups:

• Skin injuries, cuts, scrapes, insect bites, sunburns.
• Skin infections, respiratory infections, otitis, bronchitis, or throat infections specifically caused by streptococci.
• The climate, especially cold and dryness.
• Excessive alcohol consumption.
• Smoking and passive exposure to tobacco smoke.
• Stress.
• Hormonal changes, particularly in women, during puberty and menopause.
• Certain medications: lithium, antimalarials (chloroquine), antihypertensives (enalapril, propranolol), antiarrhythmics (quinidine), anti-inflammatories (ibuprofen, indomethacin). Rapid withdrawal of oral or systemic corticosteroids can also be a factor.
• Simultaneously presenting other immune disorders.

Symptoms usually appear between the ages of 15 and 35, although it can also affect children and older adults. There are several types of psoriasis: plaque psoriasis or vulgar psoriasis, the most common, primarily affecting the skin; scalp psoriasis; nail psoriasis; guttate psoriasis, sometimes triggered by throat infections caused by streptococcus; inverse psoriasis, primarily affecting the inguinal, gluteal folds, and breasts; pustular psoriasis; and erythrodermic psoriasis. Additionally, there is another condition related to psoriasis that affects the joints, known as psoriatic arthritis.

Most types of psoriasis have cycles, with flare-ups lasting weeks or months, followed by a decrease or even remission. The signs and symptoms can vary from person to person, but among the most common, depending on the type, are:

• Red patches of skin covered with thick, silvery scales.
• Small scaly spots.
• Dry, cracked skin that may bleed or itch.
• Itching, burning, or irritation.
• Thickened, pitted, or ridged nails.
• Inflamed and stiff joints.

The most commonly affected areas are the lower back, elbows, knees, legs, soles of the feet, scalp, face, and palms of the hands.

Although the exact causes that trigger psoriasis flare-ups are unknown, certain measures can be taken to reduce symptoms or even flare-ups:

• Keep the skin moisturized by using thick creams and lotions, or topical treatments for the scalp. To help remove scales, apply cream on them and then cover the area with plastic or another waterproof material. Leave it for a few hours and then remove it. Another alternative is to use humidifiers at home.
• Maintain good skin hygiene to prevent the development of skin infections.
• Avoid dry and cold weather as much as possible.
• Maintain a healthy weight through regular physical exercise and a balanced diet rich in fruits and vegetables.
• Quit smoking and avoid areas filled with tobacco smoke.
• Avoid stress.
• Moderate alcohol consumption.
• Limit skin exposure to sunlight.

It is important to try to identify the specific factors that trigger psoriasis flare-ups in each individual so that they can be avoided.