Psoriasis is an inflammatory skin disease affecting various parts of the body in the form of very dry skin with a high risk of redness or white discoloration. The onset of the disease can occur at any age, but most often it occurs in the early stages of adulthood between 16-22 years of age or later between 57-60 years of age.In addition to skin damage, approximately 20-30% of people suffering from psoriasis experience joint inflammation (psoriatic arthritis). Psoriasis can also be connected to a number of other conditions such as Crohn's disease, ulcerative colitis (chronic intestinal mucosa disease), and Type 2 diabetes mellitus (diabetes).
Several different forms of psoriasis are classified based on the position of occurrence, symptoms, and appearance of the affected sites. Psoriasis is a systemic disease affecting the quality of life of the affected person. The symptoms of this disease can be treated by a correct treatment plan, a healthy lifestyle, and a positive attitude to life.
Psoriasis and its developmentPsoriasis is a multifactorial disease that is affected by many factors. However, the development of Psoriasis is not fully understood. Based on a number of scientific studies, the immune system together with a genetic predisposition and environmental factors play an important role in the development of psoriasis. In addition to abnormalities in the development of the skin cells (keratinocytes), increased neovascularization of the blood capillaries (angiogenesis) and the development of inflammation occur as well.
Psoriasis and genetic predispositionPsoriasis shows polygenic inheritance. Thus, its development is conditioned by the simultaneous influence of several genes, but whether the symptoms manifest is given by external factors which cause the development of the disease. Therefore, if an individual is at an increased risk of developing psoriasis due to an inborn predisposition (i.e. a positive family history or being a carrier of a genetic change), it does fully determine that the individual may develop the disease.
According to research, it is estimated that, if one of the parents suffer from psoriasis, the chances of developing the disease in children is 10-16%. When both parents suffer from psoriasis, the risk increases to 40-50%. If none of the parents suffers from psoriasis, but the child develops the disease, the 6-8% chance of developing psoriasis also apply to the sibling.
The likelihood of psoriasis in the Caucasian population is estimated at 3.6%, in blacks at 1.9%, in Hispanics at 1.6%, and in others at 1.4%.
The major medical factors in the development of psoriasis are specific immunity (white blood) cells and Th1 lymphocytes producing cytokines. Factors leading to the activation of Th1 cells remains unclear, but their role is very important for the development of psoriasis. The trigger factors thus affect not only whether psoriasis develops, but they also determine when and with what intensity it occurs. Through complex molecular processes, Th1 cytokine levels are increased, a number of cells in the immune system are activated, and inflammation develops. The increased production of keratinocytes (skin cells) and their desquamation (peeling) manifests in dry, scaly skin and are associated with an impairment of the immune system.
Psoriasis is markedly affected by stress load. As the individual is exposed to more of the stress stimulus and falls into emotional imbalance, the symptoms worsen.
The triggering factors thus activate an immune response which is unusually increased due to genetic variation.
The disorder of white blood cells leads to a 7-fold quicker maturation of keratinocytes than is usual. Keratinocytes mature in four days, instead of the normal 28-30 days which is manifested by the accumulation of skin cells and the formation of variably large bounded white or red sites with a scaly surface.
Factors affecting the development of psoriasisThere are numerous factors that incite the development of psoriasis including bacterial and viral infections, drugs, emotional stress, low temperature, hormonal changes, skin injuries, and the disruption of the skin barrier due to surgery or cosmetic intervention.
The nicotine contained in tobacco smoke has been linked to immune system damage in individuals suffering from psoriasis. Nicotine is also connected with pathological changes in DNA molecules which may contribute to the development of this disease. Together, these factors can activate keratinocytes to their rapid maturation and lead to the development of skin inflammation.
Treatment options for psoriasisThe basic principle of treating psoriasis is an individualized approach. The treatment must be comprehensive and should be chosen based on the extent and intensity of the symptoms of psoriasis. A combined approach involving several treatment options is often chosen to maximize the improvement in the skin condition and maintain long-lasting phases without the symptoms while minimizing the negative effects and improving the individual’s quality of life.
Topical drugs (emollients, corticosteroids, analogs, and Vitamin D3 derivatives), immunomodulators suppressing the activation of Th1 lymphocytes, and various types of salt baths along with phototherapy are used in psoriasis treatment. Currently, biological therapy is used which concentrates on a particular body area and provides targeted suppression of inflammation in the early stage of the disease. A better understanding of the mechanisms interacting between the cells of the immune system and keratinocytes and the identification of key cytokines and genes will help identify specific new targets for biological therapy.