Psoriasis

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in order to help and inform patients with psoriasis.

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What is
Psoriasis?

Psoriasis affects more than 125 million people worldwide, and one-third of patients have a moderate-to-severe form of the disease.

Psoriasis has a genetic background and is triggered by environmental factors, including stress, increased alcohol consumption, individual medications, infections or smoking cigarettes.

Cold weather can trigger psoriasis. Flare-ups are more common during the colder months because of the drier air, decreased exposure to sunlight and cold temperatures.

Common forms

Common forms

  • The most common form is plaque psoriasis (also called psoriasis vulgaris), affecting about 90% of patients with psoriasis, although psoriasis can present in various forms.
  • Psoriasis vulgaris is characterised by well-defined areas of erythematous and indurated plaques with overlying silvery scale. The knees, elbows, scalp and trunk are the most commonly affected skin areas.
  • Plaque psoriasis is very frequently associated with itching and pain, and plaques can crack and bleed. Psoriasis of the scalp develops in 75–90% of patients with psoriasis, and nail psoriasis may develop in up to 50%.
Symptoms

Symptoms

  • Symptoms that are shared by all types of psoriasis can include itching, burning and soreness. Most people with psoriasis experience “cycles” in their symptoms. The condition may cause severe symptoms for a few days or weeks, and then the symptoms may clear up and be almost unnoticeable. Then, in a few weeks or if made worse by a common psoriasis trigger, the condition may flare up again. Sometimes, symptoms of psoriasis disappear completely.
  • It is not possible to predict how the severity of the disease or its course over time will develop in an individual.
Other diseases

Other diseases

  • Patients with psoriasis often suffer from other diseases. These are referred to as comorbidities. They may include high blood pressure, diabetes, bowel problems, dietary and mental health problems. However, not every patient with psoriasis is affected by these comorbidities.
  • Share with your healthcare professional if you suffer from any other disease and ask about your personal risks to develop future comorbidities. He or she will determine whether comorbidities are present in your case.

How
is psoriasis
treated?

There are different treatment options for psoriasis, such as topical treatments (applied externally to the skin), phototherapy (with UV light) or systemic medications.

Current treatments improve signs and symptoms of the disease. You can consult your healthcare professional in case you have any questions regarding the available treatments.

Topical or Systemic


Mild forms
of psoriasis are traditionally treated with topical medications such as creams or ointments. Moderate-to-severe forms are usually treated with systemic medications and/or UV light therapy, since they are more effective. Different treatments may occasionally be combined to achieve better results.

Severity


Severity
is based on how much of your body is affected by psoriasis. However, the severity of psoriasis is also measured by how psoriasis affects your quality of life. For example, psoriasis can have a serious impact on one’s daily activities even if it involves a small area, such as the palms of the hands or soles of the feet.

Lifestyle Recommendations

Following a healthy diet may help ease the severity of your signs and symptoms.

This guide offers you some approaches to achieve a balanced diet:

Achieve a healthy weight: a high body mass index is associated with an elevated risk for developing psoriasis and psoriatic arthritis, as well as an increase in the severity of disease

Your weight-loss plan should do all of the following:

  • Emphasise fruits, vegetables, whole grains and fat-free or low-fat products daily
  • Include lean meats, poultry, fish, beans, eggs and nuts
  • Contain foods low in saturated fats, avoid trans fats, and limit cholesterol and salt (sodium)
  • Avoid refined sugars and processed foods

 Reduce risk of inflammation: as psoriasis is an inflammatory disease, it is recommended to avoid fatty red meats and processed or refined foods; increase the intake of fresh-water fish, fruits and vegetables.

 Keep your heart healthy: reducing inflammation and improving the health of your heart are important for psoriasis sufferers. Eating fish, lean meats, fat-free products, and decreasing sodium intake may help

Inform your doctor if you are thinking about making any changes to your diet and any additional supplements you may be taking; as well as if you suspect you can have some allergies or intolerances. He/she can advise you about the best approach

You can also achieve a healthy body weight with physical exercise, and recent studies have also shown that exercise has a positive effect in psoriasis patients. Exercise can help you maintain a healthy weight and lower your risk of heart disease and type 2 diabetes, conditions which are frequently associated with psoriasis.

Some guidelines recommend to get at least 30 minutes of moderate exercise at least five times a week, plus additional strength training. Pick an activity you enjoy and are more likely to stick with.

Practicing relaxation is also a way to address your condition, since stress is a major trigger for flares or worsening of psoriasis. Schedule time to consciously de-stress (trying to focus only on your breathing is a good exercise), try to think positively, and counter every negative thought with a positive or neutral one.

People with psoriasis may have more sleep problems or more severe sleep problems than the general population, including severe sleep apnea. Itching and pain can lead to poor sleep, and poor quality sleep can lead to exhaustion and stress, which can make psoriasis symptoms worse. Here are some tips for patients with psoriasis to get a better night´s sleep:

Get a sleep study if you are experiencing symptoms such as snoring, waking up with a headache or feeling tired during the day, particularly if you are overweight or obese

Develop good sleep habits: make sure the room is dark, wake and fall asleep at the same times each day, eliminate noise and distractions, keep the room at cool, comfortable temperature, avoid stimulants as caffeine close to bedtime, and sleep in bed instead of watching TV

The influence of smoking on psoriasis is also well studied. Cigarette smoking has been shown to be associated with as many as one in five cases of developing psoriasis; and there is a strong association between smoking and pustular lesions. Smoking has been shown to double a person’s risk of getting psoriasis, with this risk increasing with the number of cigarettes smoked per day. It has also been shown to be higher in women than in men.

Although difficult to determine how smoking influences psoriasis, it is thought to be due to the nicotine, which alters the immune system and cell growth and is directly related with skin inflammation.

Therefore, smoking is regarded as a key risk factor for the occurrence of a psoriasis episode. Permanently giving up smoking can have a positive effect on the disease.

Caution should also be applied with heavy alcohol consumption. In addition to other unfavourable effects on health, this can also trigger or exacerbate a psoriasis episode.

If you drink, it is advisable to do so in moderation—heavy drinking may trigger psoriasis, interfere with your response to treatment and prevent remission.

Because psoriasis is a systemic inflammatory disease, people with psoriasis may have an increased risk of developing or worsening other related diseases, such as cardiovascular diseases (especially in patients with a severe condition), inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis) or metabolic and psychological conditions.

Sufficient exercise, a balanced diet, and if applicable, giving up smoking and avoiding heavy alcohol consumption can help reduce these risks. (Taking your medication as advised by your doctor can help as well).

It is recommended to inform your doctor about any other medication you may be taking.

Controlled sun exposure (and always using sunscreen) may be beneficial for patients with psoriasis. Warm temperatures and UV light help improve the signs and symptoms of the disease.

Good skin care can support the treatment of psoriasis. Basic treatment can help restore the natural skin barrier, reduce symptoms such as itching and scale formation and promote faster healing.

There are some topical treatments offering several benefits:

  • Moisturisers and lotions can keep your skin moist and help control flare-ups. In general, thick, greasy lotions that trap moisture in your skin work best
  • Salicylic acid (in lotions, gels, soaps and shampoos) removes scales that appear on patches of psoriasis. It is especially helpful when used with other skin treatments since removing flakes of dead skin allows other medications to work better
  • Coal tar can help slow the growth of skin cells and make your skin look better, but it does not smell good, and it can irritate your skin and stain your clothes. So follow the instructions carefully and ask your doctor for advice

Oil baths can also be used for a mild lipid replenishment of the skin during bathing.

Sharing experiences with other people affected by psoriasis is seen as very valuable by many patients. Sharing makes it easier to cope with the disease. Self-help groups provide you with a forum in which you can communicate openly and confidently about your illness and experiences. You can also exchange tips and tricks with others.

Your doctor may also be able to help you find details of psoriasis associations.

Following a healthy diet may help ease the severity of your signs and symptoms.

This guide offers you some approaches to achieve a balanced diet:

Achieve a healthy weight: a high body mass index is associated with an elevated risk for developing psoriasis and psoriatic arthritis, as well as an increase in the severity of disease

Your weight-loss plan should do all of the following:

  • Emphasise fruits, vegetables, whole grains and fat-free or low-fat products daily
  • Include lean meats, poultry, fish, beans, eggs and nuts
  • Contain foods low in saturated fats, avoid trans fats, and limit cholesterol and salt (sodium)
  • Avoid refined sugars and processed foods

Reduce risk of inflammation: as psoriasis is an inflammatory disease, many patients have benefited from following an anti-inflammatory diet to help reduce their symptoms. Avoid fatty red meats and processed or refined foods; increase the intake of fresh-water fish, fruits and vegetables

Keep your heart healthy: reducing inflammation and improving the health of your heart are important for psoriasis sufferers. Eating fish, lean meats, fat-free products, and decreasing sodium intake may help

Vitamins and supplements: can help clear the skin and may ease joint pain. Talk with your healthcare professional before adding any vitamins or supplements to your treatment plan.

Inform your doctor if you are thinking about making any changes to your diet and any additional supplements you may be taking; as well as if you suspect you can have some allergies or intolerances. He/she can advise you about the best approach

You can also achieve a healthy body weight with physical exercise, and recent studies have also shown that exercise has a positive effect in psoriasis patients. Exercise can help you maintain a healthy weight and lower your risk of heart disease and type 2 diabetes, conditions which are frequently associated with psoriasis.

Some guidelines recommend to get at least 30 minutes of moderate exercise at least five times a week, plus additional strength training. Pick an activity you enjoy and are more likely to stick with.

Practicing relaxation is also a way to address your condition, since stress is a major trigger for flares or worsening of psoriasis. Schedule time to consciously de-stress (trying to focus only on your breathing is a good exercise), try to think positively, and counter every negative thought with a positive or neutral one.

People with psoriasis may have more sleep problems or more severe sleep problems than the general population, including severe sleep apnea. Itching and pain can lead to poor sleep, and poor quality sleep can lead to exhaustion and stress, which can make psoriasis symptoms worse. Here are some tips for patients with psoriasis to get a better night´s sleep:

Get a sleep study if you are experiencing symptoms such as snoring, waking up with a headache or feeling tired during the day, particularly if you are overweight or obese

Develop good sleep habits: make sure the room is dark, wake and fall asleep at the same times each day, eliminate noise and distractions, keep the room at cool, comfortable temperature, avoid stimulants as caffeine close to bedtime, and sleep in bed instead of watching TV

The influence of smoking on psoriasis is also well studied. Cigarette smoking has been shown to be associated with as many as one in five cases of developing psoriasis; and there is a strong association between smoking and pustular lesions. Smoking has been shown to double a person’s risk of getting psoriasis, with this risk increasing with the number of cigarettes smoked per day. It has also been shown to be higher in women than in men.

Although difficult to determine how smoking influences psoriasis, it is thought to be due to the nicotine, which alters the immune system and cell growth and is directly related with skin inflammation.

Therefore, smoking is regarded as a key risk factor for the occurrence of a psoriasis episode. Permanently giving up smoking can have a positive effect on the disease.

Caution should also be applied with heavy alcohol consumption. In addition to other unfavourable effects on health, this can also trigger or exacerbate a psoriasis episode.

If you drink, it is advisable to do so in moderation—heavy drinking may trigger psoriasis, interfere with your response to treatment and prevent remission.

Because psoriasis is a systemic inflammatory disease, people with psoriasis may have an increased risk of developing or worsening other related diseases, such as cardiovascular diseases (especially in patients with a severe condition), inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis) or metabolic and psychological conditions.

Sufficient exercise, a balanced diet, and if applicable, giving up smoking and avoiding heavy alcohol consumption can help reduce these risks. (Taking your medication as advised by your doctor can help as well).

Controlled sun exposure (and always using sunscreen) may be beneficial for patients with psoriasis. Warm temperatures and UV light help improve the signs and symptoms of the disease.

Good skin care can support the treatment of psoriasis. Basic treatment can help restore the natural skin barrier, reduce symptoms such as itching and scale formation and promote faster healing.

There are some topical treatments offering several benefits:

  • Moisturisers and lotions can keep your skin moist and help control flare-ups. In general, thick, greasy lotions that trap moisture in your skin work best
  • Salicylic acid (in lotions, gels, soaps and shampoos) removes scales that appear on patches of psoriasis. It is especially helpful when used with other skin treatments since removing flakes of dead skin allows other medications to work better
  • Coal tar can help slow the growth of skin cells and make your skin look better, but it does not smell good, and it can irritate your skin and stain your clothes. So follow the instructions carefully and ask your doctor for advice

Oil baths can also be used for a mild lipid replenishment of the skin during bathing.

Sharing experiences with other people affected by psoriasis is seen as very valuable by many patients. Sharing makes it easier to cope with the disease. Self-help groups provide you with a forum in which you can communicate openly and confidently about your illness and experiences. You can also exchange tips and tricks with others.

Your doctor may also be able to help you find details of psoriasis associations.

Disclaimer

This general information is not intended to diagnose any medical condition or to replace your healthcare professional advice. You should consult with your healthcare professional for specific advice relating to your medical questions or condition. Only your practitioner can completely and appropriately assess your situation and make conclusive decisions regarding your care.