This disease is constituted by a genetically determined disposition of the skin to chronic inflammation characterised by an increased epithelium production, which appears as a response to certain external or internal impacts. At the same time, psoriasis is not simply a skin disease but, being an immune system disorder, a process unfolding in the whole body. The dermatological symptoms can be accompanied by serious discomforts, e.g. disability caused by small-joint pains and inflammations. The ugly psoriatic plaques on the skin are not only uncomfortable and itching, but they can also make the problem worse by evoking psychological issues of self-acceptance. Psoriasis is not dangerous to life, but it is one of the skin diseases that deteriorate life quality in a great degree.

Depending on the symptoms, psoriasis can be classified as of mild, moderate, or severe course. Its course is hard to predict, because as time elapses, the symptoms can grow more severe or milder, or they can even cease. This disease is widespread all over the world, in some areas it affects 1.5–3% of the population. On average, every 50th human suffers from one or another form of psoriasis. Gender makes no difference. It can appear in any age, but most frequently between the ages of 15 and 35 years. Characteristically, it makes its first appearance in puberty, beginning mostly on the scalp.

No form of psoriasis is infectious. As the susceptibility cannot be transmitted, a patient’s psoriasis is not dangerous to his or her environment. It doesn’t attack internal organs, but it can be accompanied by articular complaints (arthritis psoriatica). On the other hand, diseases of internal organs can worsen or provoke existing psoriasis.


Causes of Psoriasis

The development of psoriasis is due to innate predisposition and so-called environmental provoking factors. There are several factors that influence the appearance of the disease. Susceptibility to psoriasis is hereditary. Up to now seven genes have been found to have a role in its development. Genetic predisposition is not enough to evoke psoriasis; the disease doesn’t appear without the impact of external, environmental provoking factors that bring forth the innate susceptibility. An internal disease can also be one of these „external” impacts, just like any other influence that is able to make psoriasis appear on the skin of a patient susceptible to the disease. Psoriatic skin symptoms develop when the combined influence of predisposition and provoking factors reaches the liminal value that makes it possible for the disease to appear.


Pathophysiological Processes in the Background of Psoriatic Symptoms

By now the stages of the immunological inflammatory process appearing in the skin symptoms have been surveyed very thoroughly. The epithelial cells of our skin are normally produced in the deepest layer of the multi-layered epithelium. Later on they displace towards the surface of the skin, accumulating keratinous protein, and finally they peel off with an unnoticeable exfoliation process. In case of psoriasis, the displacement of epithelial cells takes place many times faster than it would be normal. When the skin functions normally, the nuclei are absorbed from the cells, the molecules connecting the cells disappear, but in the accelerated displacement process of psoriatic skin there is no time for this.

The white, exfoliating „plaques” consist of epithelial cells containing their nuclei and unable to separate. These changes in epithelial cells are probably triggered by immunological processes, in which certain leukocytes (activated T-cells) play a leading role. The main aim of research is that, after gaining exact knowledge of the processes on molecular level, new and effective medicines should be developed in order to stop the appearance of psoriatic symptoms.


Diagnostics, Symptoms, Appearance

Psoriasis comes forth usually between the ages of 10 and 40 years, but it can actually appear at any age. Its symptoms are so characteristic that a mere dermatological examination is sufficient for defining the disease. Biopsy is rarely necessary. Psoriasis is a chronic disease, prone to recrudesce, which distinguishably separates itself from healthy skin, shows a silvery exfoliation, and consists of one or more protuberant, red, plaquey deformations.

Psoriatic plaques are caused by an abnormally accelerated proliferation of skin cells. Generally one or more small plaques appear, at first on the scalp, elbows, knees, back, or nates. The first plaques can spontaneously subside after a few months, but they can also remain; in the latter case, they unite into larger plaques. On some patients only one or two tiny plaques appear, on others they cover large parts of skin surface. These bulky plaques can develop on the palms of hands, soles of feet, or skin folds at the genitals. Sometimes the affected skin area can be painful, but in many cases the patient is completely free of complaints.

Although these disorders don’t lead to a marked physical discomfort, they are quite conspicuous, and the patient generally finds them embarrassing. Psoriasis means a serious psychological burden, since it is a life-long disease which can sometimes cease but reappear afterwards.

Surges of the disease are more frequent in winter and after stress. The most widespread form is plaque-like psoriasis. Bulky, silvery, sometimes inflamed scales show the place of detached excessive epithelial cells.

A few infrequent types of psoriasis can have more serious consequences. Articular inflammation caused by psoriasis (arthritis psoriatica) is accompanied by articular pains and swelling. Many psoriatic patients’ nails are deformed, thickened, and contain small dot-like indentations.

In case of erythroderma psoriatica, the skin becomes red and exfoliating all over the body. In addition to exfoliation, it is characterised by rubefaction of a large part, or sometimes the whole, of the skin surface. This form of psoriasis is a grave disorder, because just like burns, it inhibits the skin’s defense function against injuries and infections. Erythrodermic psoriasis is many times accompanied by fever and pain.

Pustular psoriasis is another rare form of the disease, in which smaller or larger pus bladders (pustules) appear on the palms of hands and soles of feet. These can sometimes cover the whole body. At first they are foreshadowed by a mild flush. Later the pustules disappear with an exfoliation.

Psoriasis guttata is characterised by the sudden appearance of small red patches on the skin of the belly, back, and limbs, sometimes following a Streptococcus infection. The development of psoriasis is frequent after tonsillitis caused by Streptococcus bacteria, but it has also been registered after varicella, certain immunizations, bodily or emotional stress.


Therapies of Psoriasis

The medical treatment of psoriatic patients is conducted by a dermatologist. The level of treatment is determined according to the severity of the disease.
In milder cases a local therapy is recommended. The scales on the plaques must be removed with peelings (e.g. 10% carbamid or 5 to 10% salicylic ointment, or salt baths). Earlier there was a widespread use of tar preparations in the treatment of psoriasis, but nowadays they have become less popular. Anti-inflammatory ointments, cremes, or solutions containing steroids are applicable on the plaques. Vitamin A analogues (calcipotriol, tacalcitol) are applied in the form of ointments.

In more severe and extensive cases an internal medicine therapy can be necessary in addition to local therapy. Good results can be achieved with retinoids, i.e. synthetic derivatives of Vitamin A, which normalize the process of keratinization. Phototherapy has very good effects on psoriasis. UVA and UVB spectrum light is equally used. Special forms of phototherapy are UVA treatment after administration of photosensitizers (PUVA therapy) and narrow-spectrum UVB therapy.

This shows that a therapist of psoriasis can choose between many kinds of therapy. The above-mentioned methods can be applied in certain combinations, too. The treatment must be worked out for every single patient, taking into consideration the severity of the symptoms and the patient’s other diseases.

Special Diet

Conscious nutrition and special diet plays a key role in recovery. First of all, consumption of sugar, meat, animal fat, and alcohol must be reduced, and a strict vegetarian, gluten-free diet must be planned and observed. Doubtlessly gluten-free food types are, among others, rice, rice flour, rice bran, soybean meal, corn meal, and potatoes. Green fibre plants, sea fish and muesli should be consumed in a greater proportion. Omega 3 fatty acids can be an especially useful contribution to the healing process. Clinical surveys have proved that 10–12 g of fish oil per day administered as a nutrition supplement can bring along a considerable improvement of condition.

Stress and Acidosis

Stress plays a prominent role in the development of this disease. Many patients have reported that they had been afflicted by some kind of unusual stress in the month previous to the development of the disease. Medical literature describes a few cases in which patients have been healed by mere hypnosis. Another factor is also certain to contribute to the appearance of psoriasis: long-term saturation of the body with multiple poisonous materials, acidity, and acid-alkaline imbalance. For this reason it is important that the body should be thoroughly detoxified at the beginning of the therapy.

Physiotherapy and Baths

Several types of physiotherapy can also serve as a local treatment, e.g. 20 minutes long ultrasound therapy 3 times a week at 42-45°C, or 3 minutes long exposure to UVB 295-305 nm 2mw/cm2 ultraviolet light 3 times a week. As to baths, it is recommendable in the first place to apply sunbathing for 30 minutes per day. Skin symptoms have been soothed by special combinations of salts, too. A similar soothing effect has been experienced when these salts were used as a local pack.