There comes a time in some people’s lives when they find out they have psoriasis. Why do experts say that these patients need to be prepared to go on a journey with many different destinations?
Psoriasis is a chronic, non-contagious, inflammatory skin disease, which, despite significant public awareness in recent decades, can still be mistaken for scabies or even leprosy. It affects about 1.5-3% of the general population and can start at any age, but is most common in people between the ages of 20-30 and in the 50-60 age group. Both sexes are equally offended and the white race more than the others.
It is characterized by the appearance of clearly defined erythematous plaques, which are covered by silvery scales with the most likely localization points being the elbows, knees, scalp and nails, without this of course meaning that it cannot affect any other part of the body. The point of onset of the symptoms of the disease as well as their morphology distinguish psoriasis into drop-shaped, pustular, erythrodermic, with plaque psoriasis being the most common.
The reasons that motivate the appearance of psoriasis are many, however, genetic predisposition and heredity seem to be the main causes. The factors that can aggravate it are stress, skin injuries, the use of certain drugs (lithium, antimalarials, interferon etc.), infections (streptococcus), excessive alcohol consumption, smoking, certain hormonal and seasonal factors.
Until recently, it was thought that psoriasis only affects the skin. However, as knowledge about its pathophysiology has increased, in recent years the systemic nature of the disease has begun to be strongly emphasized, in the context of which quite frequent diseases seem to be involved, such as psoriatic arthritis (in a percentage of the order of 10-30%), the metabolic syndrome (hypertension, diabetes mellitus, hyperlipidemia and obesity) and depression. Also psoriasis, and especially the severe form of the disease, which appears from a young age, as well as psoriasis that remains untreated for long periods of time, has been significantly associated with an increased predisposition to cardiovascular diseases (myocardial infarction, etc.). All of the above have as a natural consequence the negative effect on the patients’ quality of life.
People with psoriasis encounter difficulties from their daily activities to their personal and social relationships, while an additional negative impact can also lurk in the field of work valued at reduced productivity, more days off with possible subsequent voluntary or even forced departure from work.
In conclusion, we would conclude that psoriasis is indeed a journey with many and different destinations, since on the one hand it can lead to manifestations related to the disease (eg: psoriatic onychomycosis, psoriasis of the scalp), but also on the other hand to co-morbidities with more frequent psoriatic arthritis and depression. Because of this, patients with psoriasis, initially it would be useful to receive a proper information from their treating doctor about the disease, its chronicity, possible remissions and exacerbations, as well as about its general effects in the short and long term.
What patients with psoriasis should clearly know is that timely, and always in collaboration with the treating dermatologist, personalized treatment can “slow down” not only the progression of psoriasis but also all the other accompanying diseases mentioned above. The treatment options are many and are distinguished according to the severity and extent of the psoriasis as well as the presence or not of arthritis, starting with local treatment, phototherapy, the classic systemic treatment (acitretin, cyclosporine, methotrexate) but also the newest generation of drugs such as biological treatments.
Biological therapies have indeed revolutionized the treatment of the disease, they are administered as an injection subcutaneously or intravenously and are given upon contraindication, intolerance or failure of classical systemic therapies. They have the highest efficacy and satisfactory safety profile.
In our country, the preparations Adalimumab, Etanercept, Infliximab, Ustekinumab, Secukinumab and Apremilast are currently available. It is also considered important to highlight the need for holistic follow-up of the patient by specialties related to the disease such as: by rheumatologists (for psoriatic arthritis), by psychologists or even psychiatrists, pathologists, etc.
At this point it should be emphasized that now the therapeutic quiver for the treatment of the disease is very rich and the treating doctors have many alternatives. Personalized treatment, adapted to the needs of each patient, can provide a significant and excellent long-term result with the ultimate goal of improving the patient’s quality of life at all levels.