Psoriasis is a chronic, common, non-contagious, autoinflammatory skin disease where the immune system triggers the excessive production of keratinocytes (the most numerous cells in the skin). This results in the formation of well-demarcated red plaques on the skin, covered by white to silver scales. Psoriasis rashes typically appear at friction points such as the elbows, knees, and scalp, but can affect any area of the body, as well as the nails.
Hereditary predisposition plays a significant role in the onset of the disease, but other factors also contribute, such as infections, stress, trauma, smoking, alcohol, certain medications, etc.
(Psoriasis Vulgaris) Clearly demarcated, red patches that merge to form larger plaques, covered by whitish-silver scales of varying thickness.
Small, red, scattered papules that appear suddenly, often following a streptococcal infection (e.g., of the upper respiratory tract).
(Flexural Psoriasis) Smooth, intensely red areas without scales, located in skin folds and flexural surfaces of the extremities (submammary, armpits, groin).
Plaques with well-adhered, thick scales, sometimes accompanied by itching. Alopecia (hair loss) is rare.
Diversity of lesions on fingernails and toenails, not necessarily on all at the same time (e.g., pitting (pinpoint depressions), thickening, discoloration, onycholysis (nail separation), etc.). It usually accompanies the cutaneous disease and is an indication of systemic involvement.
Affects the palms and/or soles and appears with scaly hyperkeratosis and scattered pustules.
Inflammatory involvement of the joints. It is estimated that a significant percentage of patients with psoriasis develop arthritis at some stage of the disease. The presence of nail psoriasis increases the likelihood of developing psoriatic arthritis. It causes stiffness, pain, and swelling in the joints, particularly in the hands, knees, or spine.
In psoriasis, the life cycle of keratinocytes is reduced from 311 hours to just 36 hours, resulting in a 28-fold increase in epidermal cell production. The therapeutic regimen is tailored to the severity and type of psoriasis.
For mild to moderate forms, the predominant methods are topical treatments:
• Corticosteroids, Vitamin D analogues (e.g., calcipotriol).
• Topical retinoids, salicylic acid, as well as various combinations thereof.
• Specific topical medications (e.g., anthralin and coal tar preparations) also play a role in managing psoriatic lesions.
Furthermore, phototherapy (controlled exposure to UV light) and systemic medications (including methotrexate, cyclosporine, acitretin, as well as older and newer biological agents) are used in more severe cases.
In parallel, daily bathing with gentle cleansers, followed by intensive moisturizing (e.g., petroleum jelly, rich-textured creams), and avoidance of irritants are recommended to reduce inflammation.
