identification and treatment
Red, scaly and itchy skin is a typical sign of psoriasis. When this chronic condition occurs on the face, scalp or other visible areas, it can cause a lot of suffering. Topical agents applied to the skin may relieve the symptoms.
Psoriasis is an inflammatory skin disease that is chronic in more than 90% of cases. In western industrialised countries – including Switzerland – about 1.5% to 2% of the population is affected by it.
The majority of those affected (around 80%) suffer from psoriasis vulgaris or plaque psoriasis, in which red, scaly, thickened patches of skin form on different parts of the body. An autoimmune disease, psoriasis is not contagious.
Psoriasis can occur at any age. It usually begins during puberty, and less often between the ages of 40 and 50.
Patients often suffer a great deal, especially those with moderate to severe disease and when visible areas are affected.
Typical signs of psoriasis are inflamed, scaly, sharply defined patches on the skin. Known as plaques, these are slightly raised and surrounded by a thin red border. The skin can sometimes be very itchy.
In principle, psoriasis can occur anywhere on the body. However, it is mainly found in the following areas:
- Scalp (psoriasis capitis) – sometimes associated with hair loss in severe cases
- Torso (especially near the sacrum)
- Under the chest
- Buttocks and between the buttocks
- Behind the ears
- Near the navel
- Finger and toe nails (nail psoriasis)
- Genital area
- Hands, palms
- Feet, soles of feet
- Face (e.g. nose, forehead, mouth, eyes and eyelids)
One third of those affected also develop psoriatic arthritis. This causes the joints (especially in the fingers and toes) to become inflamed, swollen, painful and sometimes stiff.
Iron deficiency can also be a sign of psoriasis, as skin cells contain large amounts of iron, which are lost with excessive flaking.
Psoriasis is also associated with possible concomitant diseases, such as cardiovascular conditions like high blood pressure, heart attack or stroke, metabolic diseases such as obesity and diabetes, and chronic inflammatory bowel diseases like Crohn’s disease and ulcerative colitis.
As with all autoimmune diseases, a misdirected immune system plays an important role. It constantly triggers inflammatory processes, attacking the cells of the upper skin and stimulating them to divide excessively. The skin becomes inflamed, thickened and scaly.
Psychosocial therapies (e.g. psychotherapy) and contact with other patients (e.g. in self-help groups) can help people with psoriasis to cope with everyday life if their suffering is debilitating. Both the disease itself and relapses may be triggered by infections, hormonal changes (e.g. due to the birth control medication or pregnancy), stress, smoking, alcohol consumption, medications or skin irritation (e.g. sunburn).
Psoriasis is diagnosed by a dermatologist. It is usually apparent on the basis of the characteristic skin and nail changes.
To confirm the suspicion, the doctor may carefully remove some flakes of skin at one site. If the skin underneath can be loosened and dots of blood appear, this indicates psoriasis.
In order to confirm the diagnosis and rule out other causes of the symptoms, a skin sample (biopsy) may also be taken and examined.
To this day, psoriasis cannot be cured with treatment. In about a quarter of cases, however, spontaneous healing occurs.
The aim of psoriasis treatment is to ensure that patients are free from symptoms. However, this does not always succeed.
Psoriasis manifests itself differently from person to person. Treatment is therefore completely customised for each individual and influenced by many factors (e.g. whether the person also has other diseases).
For mild psoriasis, topical agents that act directly on the skin are used (e.g. as ointment, cream, solution, spray or shampoo):
- Corticosteroids (“cortisone”) suppress inflammatory reactions.
- Calcineurin inhibitors also inhibit inflammatory processes.
- Vitamin D3 analogues block the growth of skin cells.
- Dithranol has an anti-inflammatory effect and inhibits the growth of skin cells.
Balneotherapy (salt baths), climatic therapy (e.g. a stay at the Dead Sea) and phototherapy (UV-B light, laser or PUVA) as well as basic care (e.g. with urea-containing lotions) are also used.
If more than 10% of the body surface is affected, this is referred to as moderate to severe psoriasis. In this case, internal (systemic) therapy – possibly in combination with some of the topical drugs mentioned above – is recommended:
- Conventional systemic therapy with acitretin, ciclosporin, fumaric acid esters or methotrexate (MTX)
- Small-molecule active substances such as apremilast
- Biologics, e.g. anti-TNF antibodies (e.g. adalimumab, infliximab) or various anti-interleukin antibodies (ustekinumab, ixekizumab, guselkumab)
Psoriasis can severely limit sufferers’ quality of life. In addition to receiving the right treatment, however, there are a number of things you can do yourself to improve your well-being:
- Look after your skin with moisturising products.
- Avoid anything that irritates your skin (such as scratchy materials).
- Eat a balanced and varied diet.
- Exercise regularly.
- Make sure you get enough rest to recover from stress. You can also use relaxation techniques such as meditation or autogenic training.
Psychosocial therapies (e.g. psychotherapy) and contact with other patients (e.g. in self-help groups) can help those affected to cope with everyday life if their suffering is debilitating.
For more information and support services, please visit:
- S3-Leitlinie der Deutschen Dermatologischen Gesellschaft (DDG): Therapie der Psoriasis vulgaris (Stand: 2021), unter: www.awmf.org (Abrufdatum: 24.11.2022)
- Kolios AG, Yawalkar N, Anliker M, Boehncke WH, Borradori L, Conrad C, Gilliet M, Häusermann P, Itin P, Laffitte E, Mainetti C, French LE, Navarini AA. Swiss S1 Guidelines on the Systemic Treatment of Psoriasis Vulgaris. Dermatology. 2016;232(4):385-406. doi: 10.1159/000445681. Epub 2016 Jun 21. PMID: 27322375.
- Universitätsspital Zürich: Schuppenflechte, unter: www.usz.ch (Abrufdatum: 28.11.2022)
- Deutscher Psoriasis Bund e.V.: Was ist Psoriasis?, unter www.psoriasis-bund.de (Abrufdatum: 28.11.2022)
- Altmeyers Enzyklopädie: Psoriasis (Übersicht), unter www.altmeyers.org (Abrufdatum: 28.11.2022)
- Freuer D, Linseisen J, Meisinger C. Association Between Inflammatory Bowel Disease and Both Psoriasis and Psoriatic Arthritis: A Bidirectional 2-Sample Mendelian Randomization Study. JAMA Dermatol. 2022;158(11):1262–1268. doi:10.1001/jamadermatol.2022.3682
- Braun-Falco, O., Plewig, G., Wolff, H.H. (1984). Eisen-, Zink- und Kupferstoffwechselstörungen. In: Dermatologie und Venerologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-00524-8_46
- Körber, A., Wilsmann-Theis, D., Augustin, M., von Kiedrowski, R., Mrowietz, U., Rosenbach, T., Meller, S., Pinter, A., Sticherling, M., Gerdes, S. and (2019), Topische Therapie bei Psoriasis vulgaris – ein Behandlungspfad. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 17: 3-14. https://doi.org/10.1111/ddg.13810