Psoriasis is a chronic disease that usually rashes the skin. The cause is a too-rapid growth of skin cells and inflammation of the skin. The rash can disappear for long periods with the help of various treatments. Psoriasis does not infect.

Psoriasis often occurs in so-called forests. This means periods with little or no inconvenience and periods with more inconvenience and major consequences.

Different forms of psoriasis

There are several different forms of psoriasis and they are:

  • plaque psoriasis
  • guttate psoriasis
  • inverse psoriasis
  • nail psoriasis
  • pustulosis palmoplantar.

Some people may also have pain in the joints, so-called psoriatic arthritis.

Symptoms of psoriasis

The various forms of psoriasis give slightly different symptoms.

Plaque psoriasis

The most common form of psoriasis appears as round, a few centimeters large red scaly rashes, so-called plaques. It is therefore called plaque psoriasis.

The rash can sit anywhere on the entire body, but usually on the elbows, knees, lower back and scalp. Plaque psoriasis usually sits on both sides of the body, for example in the same place on both the right and left elbows. It is common for the rash to settle in scars. New rashes can itch a lot.

Gutted psoriasis

Gutted psoriasis is most common during puberty. It often appears as red dots large as drops on the skin. This form often breaks out in connection with throat flux and it is common to get rashes over large parts of the body. After a few weeks to months, the symptoms of gutted psoriasis usually go away, but sometimes gutted psoriasis can turn into plaque psoriasis.

Inverse psoriasis

Inverse psoriasis produces blushing rashes with a glossy surface in the wrinkles. Common places are in the groin, armpits, navel and under the breasts. Inverse psoriasis does not scale.

Nail psoriasis

Symptoms of nail psoriasis are round pits in the upper sides of the nails, and the outermost part of the nails sometimes loosen.

Pustulosis palmoplantar

Pustulosis palmoplantar gives rise to the palms and soles of the feet. It often starts with yellow blisters which then turn brownish. They dry in and a crust is formed which becomes detached. The skin in the palms and soles of the feet may turn red. It can itch and feel tender, especially when new blisters come.

When and where should I seek care?

If you think you have psoriasis, contact a health care provider. You can contact many receptions by logging in.

You can usually get help at the health center, but if you have severe problems you may need a referral to a dermatologist to get the right treatment.

Treatment for Psoriasis

You often need regular treatment if you suffer from your psoriasis. You can get one or some of these treatments of psoriasis:

  • Bath and softening cream.
  • Prescription creams and ointments containing cortisone with or without the vitamin D-like substance calcipotriol.
  • Light treatment.
  • Medicines containing methotrexate, acitretin or apremilast.
  • Biological drugs.
  • Bucky treatment of psoriasis also called soft X-ray.
  • Rehabilitation abroad.

It is common to try one type of treatment at a time to see if that particular treatment helps. Most may start with creams and ointments. You may receive light treatment if cream or ointment does not produce enough effect. Medicines that you swallow and syringes affect the entire body and are more effective, but produce more side effects. You can get biological drugs if other medicines are not effective or if they are not suitable for you. However, biological drugs can have a good effect.

There may be a risk of side effects if you receive the same treatment for a long time. Therefore, it may be good to vary between different treatments of psoriasis.

Although psoriasis cannot be cured, the treatment usually causes the symptoms to decrease significantly or disappear for long periods.

Treatment with bath and softening cream

The easiest treatment is to take a sauna or a bath for 20 to 30 minutes. You can do that when you feel the need for it. Then flakes come off the outer layer of the skin. The bath also makes the skin easier to lubricate and more susceptible to light treatment.

You can remove the scales by lubricating with a thick layer of softening cream or ointment regularly several times a week. You can use cream or ointment that contains, for example, salicylic acid or urea.

Regular foot baths in combination with cream or ointment can be good if you have psoriasis on your feet. You may need medical foot care if you have severe psoriasis on your feet.

In mild psoriasis, it may be sufficient to bathe and lubricate the skin regularly.

Treatment with prescription creams and ointments

You may want a more effective treatment if you have large parts of the body or if the rash is clearly visible. You can then get cream or ointment containing cortisone. Cream and ointment with the vitamin D-like substance calcipotriol are also used. There is also ointment, gel or foam containing both cortisone and calcipotriol.

Strong cortisone acts quickly and does not discolor the skin. But after treatment, the rash returns after only a couple of weeks. The skin can become thin if you use strong cortisone for several years. Weak cortisone does not usually help with psoriasis.

Calcipotriol does not appear as fast as cortisone. But they have few side effects and do not make the skin thinner when used for a long time. The effect lasts as long as cortisone.

For the scalp, it is common to use a peeling shampoo or a solution that contains strong cortisone.

To alleviate the hassle, you need to treat regularly for several weeks. Bathing a few times a week and lubricating yourself every day usually works well without affecting everyday life too much.

Creams or ointments containing the active substances pimecrolimus or tacrolimus do not make the skin thinner. Therefore, they can be used on sensitive skin, for example on the face. The drugs can also be used in inverse psoriasis.

Phototherapy

In addition to baths, creams, and ointments is a light therapy that suppresses inflammation. You get the treatment in a light cabin with ultraviolet light, UVB light. You receive the treatment three to four times a week for a period of six to eight weeks. In the beginning, you will be in the light booth for 20 to 30 seconds and at the end about four minutes. Ideally, remove scales with baths or lubrication prior to light treatment to make it more effective. Candles in combination with prescription creams or ointments can speed up healing.

Long treatment times with UVB light increase the risk of skin cancer. Therefore, you receive a limited number of treatments. Children do not usually receive light therapy.

Light therapy is not suitable for a rare form of psoriasis called photosensitive psoriasis, as the disease is aggravated by sunlight and light therapy.

You can get light treatment at skin clinics, some health centers and at the Psoriasis Association’s treatment facilities.

Medicines containing methotrexate, acitretin or apremilast

There are medicines for psoriasis that contain methotrexate, acitretin or apremilast. They can be used if the disease is not widespread and if you have not been better off by treatments that affect the skin from the outside. Treatment is often simpler and more effective, but the risk of side effects is greater. 

Methotrexate

Methotrexate has been used for psoriasis for many years and is the drug most commonly used. Methotrexate is a cell-inhibitory and attenuates inflammation. There are tablets, such as Metotab, and syringes, such as Metoject.

You take the medicine at a low dose. A typical dose is two to six tablets a week. You take the syringes once a week. One side effect that can occur is that the liver is affected. By having blood tests regularly, any liver effects can be detected early.

Methotrexate can harm the fetus. Therefore, you should use safe contraceptive methods throughout treatment and at least six months after you discontinue treatment. This applies to both women and men. Breastfeeding should be avoided during treatment.

acitretin

Acitretin primarily inhibits cell growth but also ensures that the cells in the epidermis grow clearly. Then the scaling decreases. Acitretin is available as capsules in, for example, the drug Neotigasone.

The treatment becomes more effective if acitretin is combined with prescription creams or ointments and light therapy. Blood fat levels may increase slightly and need to be monitored during treatment.

Acitretin can harm the fetus. Acitretin remains in the body for a long time after you have finished treatment. Women who may become pregnant should use safe contraceptive methods during treatment and at least three years after discontinuing treatment.

If you drink alcohol when you take acitretin, a substance that is very fetal damaging and that remains even longer in the body is formed. Women who can become pregnant should, therefore, abstain from alcohol during treatment and also during the first two months after treatment is completed.

Apremilast

Apremilast helps reduce inflammation and is available as tablets. You may receive apremilast if other medicines or light therapy have not worked.

Apremilast is the active substance in Otezla.

You should not use apremilast if you are pregnant or breastfeeding.

Biological drugs

Biological drugs are proteins that are so large and complex that they cannot be chemically produced. They must be produced in living cells, which is why they are called biological.

Biological drugs usually consist of so-called antibodies. They bind to a protein in the body that causes inflammation and blocks its activity. Then the inflammation decreases.

The medicines are available as syringes that you take yourself. Treatment with biological drugs is sometimes combined with other drugs, especially methotrexate.

You should not use biological medicines if you are pregnant or breastfeeding with the exception of Cimzia.

Examples of biological drugs are the following:

  • Benepali
  • Cimzia
  • Cosentyx
  • Enbrel
  • Erelzi
  • Humira
  • Inflectra
  • Kyntheum
  • Remicade
  • Remsen
  • Stelara
  • Taltz
  • Tremfya.

Buckybehandling

You can get a soft X-ray called Bucky treatment if you have difficult-to-treat psoriasis in certain parts of the body. You will then be treated with a weak X-ray. Only the outer layer of the skin is affected. The method can be used, for example, if you have psoriasis on small skin surfaces, for example in the scalp, on the ears or in the abdomen. You are treated at a skin clinic once a week for a period of six weeks. To avoid side effects, you rarely receive treatment for more than a total of eight periods.

Climate Care

Normal sunlight and bathing in saltwater usually have a healing effect on psoriasis. It suppresses the inflammation and the excessive growth of cells in the skin. Climate care means that you stay at least three weeks in a warm and sunny climate with a care team. It gives the skin a natural light treatment. You will also learn how to improve your living habits.

Right to information

The health care provider should tell you which treatment options will be of interest to you. They should make sure you understand what the different options mean, what side effects are available and where you can get treatment. This way you can help decide which treatment is right for you.

Your lifestyle habits affect – psoriasis and togetherness

Everyone feels good about healthy living habits like moving, eating more fruits and vegetables and less processed food. For example, it is ready-made foods and meats that have been processed by, among other things, salting or smoking, such as sausage and ham. Although the scientific evidence is limited, people with psoriasis appear to be extra sensitive to unhealthy living habits.

Some so-called lifestyle diseases are more common in people with moderate to severe psoriases, such as type 2 diabetes, high blood pressure, depression, obesity, and obesity. It’s called complacency. The co-morbidity is probably related to inflammation in the body. This means that people with psoriasis benefit greatly from a healthy lifestyle, both psoriasis and any other illness is improved.

You may feel dejected and abandoned when you have a forest. Then you may more easily isolate yourself and fall into an unhealthy lifestyle. Maybe you move less, smoke more and drink more alcohol. But try to keep in mind that a healthy lifestyle can improve your troubles.

Physical activity is important

Physical activity is important because it has positive effects on both the body and the psyche. It can help you feel better mentally if you move.

The physical activity recommendation is at least 150 minutes per week with moderate intensity or 75 minutes per week with high intensity. The activity should be spread out over the week and be at least 10 minutes at a time. You may not be used to moving or have impaired mobility. Then you should start with a shorter time and gradually increase to what is recommended or to the level you can handle. It’s good not to sit still for too long.

You may come to a lifestyle reception

In some county councils, there are special lifestyle receptions for people with psoriasis. There you can get advice on physical activity and diet, such as eating lots of fruits and vegetables, eating less fat, sugar and salt, as well as any weight loss. You can also get advice on how to reduce the stress and use of tobacco and alcohol if you need to.

Investigations

A doctor can often determine if you have psoriasis through a simple examination. The doctor usually examines the entire body to see if the rashes are located in the places that are typical of psoriasis. To see what the skin looks like during the rash, the doctor usually scraps a little light on the rash to release the scales. If you have psoriasis, the area where the mountains have been bright red. Sometimes small dot-shaped bleeding is also seen.

You can tell your doctor when and where the symptoms appear and if psoriasis is present in the genus.

Often the doctor can immediately see that it is psoriasis, but sometimes they need to take a sample from the skin to be sure.

What happens in the body?

The skin consists of several different layers and has the task, among other things, of protecting the body against ultraviolet radiation and infestation of bacteria and viruses. The skin also helps maintain the right body temperature.

The outermost layer of skin is called the epidermis. The outer layer of the epidermis is the horn layer, which consists of dead skin cells. From below, new skin cells are constantly being formed, replacing old cells that are loosening at an even pace. This skin cell turnover takes six to seven weeks.

The other layers of skin are called leather skin and subcutaneous skin.

The skin becomes inflamed

In psoriasis, cells in the epidermis are formed faster than usual. A normal horn layer is not able to form and the cells no longer detach one by one but in large flakes. In addition, there is inflammation in the epidermis and in the outer parts of the leather skin, there are layers of skin under the epidermis. Inflammation increases blood circulation which causes the skin to redden and warm.

Why does psoriasis occur?

Both inheritance and the environment are important for whether or not a person gets psoriasis. Exactly how psoriasis is inherited is not clear but the risk of getting the disease increases if someone in one’s biological family has the disease. Although psoriasis is hereditary, something often triggers it. Some factors that can trigger and worsen the hassles are the following:

  • Infections, for example, throat flux.
  • Mental stress, for example in connection with a divorce, loss of a loved one or if you become unemployed.
  • Some drugs, such as lithium and some blood pressure medications.
  • Alcohol.
  • Smoking.

The disease usually occurs at the age of 20 or 40-50, but it can occur at any age.

Psoriatic arthritis – joint problems with psoriasis

Some who have psoriasis also get psoriatic arthritis, which causes joint discomfort. Psoriatic arthritis usually develops between the age of 30-55 and the skin symptoms usually come before the joint problems. Psoriatic arthritis also occurs in the woods. Only a part of anyone with psoriasis gets joint problems. It is more common to have joint problems if you have nail psoriasis.

What is considered typical of psoriatic arthritis is that the trouble is often in a single finger or a single joint. For example, it may be a finger or a toe that can become red, swollen and hurt. A knee, ankle or wrist may also be affected. Sometimes psoriasis arthritis sits in the back end of the joints between the sacrum and pelvic bone. It is not usually in the same joints on both body halves if the trouble settles into several joints.

It also happens that bone membranes, tendons, and eyes become inflamed in psoriatic arthritis.

Individuals can have a more severe form of the disease in several joints at the same time, which can cause disabilities.

Contact your doctor if you have psoriasis and have pain in one or more joints.

You can get support

It may take time to accept that you have a chronic illness and to learn how to live with it. For some, the problems can be so great that they affect the entire social life.

Be sure to get support and answers to the questions you have. Good support might be to talk to your doctor or other healthcare professional. It is good to have regular contact with healthcare professionals who have specialized knowledge of the disease.

There are also patient associations such as the Psoriasis Association, where you can, for example, talk to support persons with their own experience of living with psoriasis. There is also an association with young people.

Influence and participate in your care

You can seek care at any medical center or open specialist clinic you want throughout the country. Sometimes a referral to the open specialized care is required.

You should understand the information

In order for you to be involved in your care and treatment, it is important that you understand the information you receive from the healthcare staff. Ask questions if you don’t understand. For example, you should receive information about treatment options and how long you may have to wait for care and treatment.

Ehtisham Nadeem

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