Psoriasis complications: What you need to know to better manage the condition!

What is psoriasis?

Psoriasis is a non-contagious inflammatory skin disease characterized by red plaques and scales, which are layers of dead skin cells (keratinocytes). This occurs due to an accelerated turnover of epidermal cells, renewing in just three days instead of the usual month, due to inflammation.

These plaques commonly appear in areas prone to friction, such as the elbows, knees, and lower back, as well as the scalp, genitals, hands, feet, and nails. They can also form on other parts of the body, including mucous membranes, though rarely on the face.

The main forms of psoriasis include:

1. Plaque psoriasis (psoriasis vulgaris): The most common type, featuring well-defined, sometimes itchy plaques.
2. Guttate psoriasis: Small tear-shaped lesions, often triggered by respiratory infections, particularly in children and young adults.
3. Pustular psoriasis: A rarer, often treatment-resistant form, marked by pustules on the hands and feet or across the body.
4. Erythrodermic psoriasis: A severe, generalized form that can cover the entire skin surface with red, irritated areas and scattered pustules (von Zumbusch pustular psoriasis).

Psoriasis typically begins between the ages of 20 and 40 and follows a chronic course, alternating between flare-ups and remissions. While it cannot be cured, treatments help reduce symptoms.

The exact cause remains unknown, but psoriasis is thought to result from a combination of genetic predispositions and triggering factors, which vary from person to person and over time. These include:

• Stress
• Infections, such as HIV or streptococcal infections
• Certain medications
• Climate changes
• Alcohol and tobacco use
• Minor skin injuries, such as sunburn
• Obesity

Although often benign, psoriasis can significantly affect quality of life.

What is psoriatic arthritis, a severe form of psoriasis?

In about 20% of cases, psoriasis becomes more severe, with extensive lesions or joint pain, a condition known as psoriatic arthritis.

Psoriatic arthritis is characterized by joint inflammation, causing pain, stiffness, and swelling, often in the fingers and toes, as well as the wrists, knees, and sometimes the spine (spondylarthritis). Unlike other forms of arthritis, it can cause swelling of the entire digit (dactylitis), making fingers or toes appear sausage-shaped. Without timely diagnosis and treatment, psoriatic arthritis can lead to permanent joint deformities and reduced mobility. Treatment includes anti-inflammatories, immunosuppressants, and biologics to control inflammation and alleviate symptoms.

What are the potential complications of psoriasis?

Psoriasis patients are at higher risk of developing other diseases due to common mechanisms such as chronic inflammation and possible genetic predispositions. These comorbidities include:

Skin infections

Psoriasis weakens the skin barrier, making it more vulnerable to infections. The dry, cracked skin and psoriatic lesions can serve as entry points for bacteria, leading to common infections like impetigo, folliculitis, or abscesses.

Inflammatory arthritis

Conditions such as rheumatoid arthritis and ankylosing spondylitis, which are autoimmune diseases causing chronic joint inflammation, share similar inflammatory mechanisms with psoriasis.

Chronic inflammatory bowel diseases (IBD)

Conditions like Crohn’s disease and ulcerative colitis, which involve chronic inflammation of the digestive tract, are more common in psoriasis patients due to systemic inflammation affecting both the skin and the digestive system.

Vitiligo

Psoriasis and vitiligo, a skin disease marked by depigmentation due to the destruction of melanocytes (pigment-producing cells), share similar immune and inflammatory pathways, increasing the likelihood of vitiligo development in psoriasis patients.

Thyroid inflammation

The same immune mechanisms underlying psoriasis can also cause autoimmune thyroid conditions, such as Hashimoto’s thyroiditis, where the immune system attacks the thyroid gland, leading to inflammation.

Cardiovascular diseases

Psoriasis increases the risk of cardiovascular diseases like high blood pressure, strokes, and heart attacks, largely due to the systemic inflammatory process affecting blood vessels.

Type 2 diabetes and metabolic syndrome

Psoriasis is associated with a higher risk of developing type 2 diabetes and metabolic syndrome, with patients often exhibiting insulin resistance.

How does psoriasis impact mental health?

Psoriasis affects not only the skin but also the mental health of patients. The itching, pain, and appearance of plaques can cause feelings of shame, anxiety, and depression, severely impacting quality of life and self-esteem. Moreover, stress and anxiety can trigger or worsen psoriasis flare-ups, creating a vicious cycle.

Seeking psychological support, practising relaxation techniques, and joining support groups can help patients better cope with the emotional toll of the disease.

Key takeaways

Psoriasis is a chronic condition that can lead to serious complications. Patients are at increased risk for inflammatory arthritis, digestive diseases, and autoimmune disorders. They are also more likely to develop cardiovascular and metabolic conditions.

It’s essential for patients to be informed about available treatments and seek psychological support to manage the effects of the disease. By addressing both physical and mental health, patients with psoriasis can significantly improve their quality of life.

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