Psoriasis Awareness Month – Sensibilisation et Solutions!

Psoriasis is more than just a skin condition!

Psoriasis—Not Contagious!

Psoriasis is known as a chronic condition where skin cells multiply too quickly due to an overactive immune system. While all body parts may be affected, the scalp, elbows, or knees are the most common areas where scaly, inflammatory skin patches appear.

Facts about psoriasis

Psoriasis is not contagious.
Psoriasis usually progresses in relapses.
The individual course of the disease varies from person to person.
Women and men are affected about equally often.
The emotional impact on life quality

Psoriasis symptoms often appear in cycles, with flare-ups lasting a few weeks or months, followed by periods of remission or subsidence. Factors associated with such flare-ups are called

Triggers.

Some patients experience aggravation of the disease when they

are emotionally stressed
are exposed to cool and dry air (air conditioning)
consume tobacco or alcohol
suffer from skin injuries like cuts or burns
suffer from bacterial or viral infections
start taking certain medication such as ß-blockers
suffer from obesity

Although the exact cause of psoriasis has not yet been clarified, scientists know that a combination of genetic and environmental factors plays a role. Children of affected mothers or fathers have a higher risk of developing psoriasis. Some gene variants of the HLA tissue and immune system characteristics have been associated with psoriasis.

Psoriasis Treatment—A Holistic Task!

Psoriasis can be treated in a variety of ways, and the extent, severity, and type of the disease will determine the treatment plan. While moderate and severe psoriasis may necessitate pills, injections of biologic antibody medicine, or UV light treatments, mild psoriasis can frequently be effectively controlled with creams or ointments. Controlling typical triggers, such as stress and skin damage, can also aid in symptom management. However, like other autoimmune conditions, there is no definite cure for psoriasis.

The effects of psoriasis, however, extend far beyond the skin, according to 21st-century research—and need to be taken into account when choosing the best treatment strategy.

Psoriasis—Its Impact on Well-Being

The visible, relapsing, and remitting nature of the disease often leads to social stigmatization, loss of confidence, feelings of hopelessness, psychological distress, anxiety, depression, and even suicidal tendencies. Psoriasis also may lead to loss of working days and loss of wages and adds to the financial burden, which in turn lowers the quality of life of the patients—as shown in studies measuring quality of life with scientifically established questionnaire tools. When compared to other chronic disorders, the emotionally debilitating effect of psoriasis is as high as diabetes, cardiovascular disease, and even cancer.

Emotionally stressful social situations, especially in conditions where patients need to expose their body, as in swimming, sexual intercourse, and situations that do not give adequate privacy, negatively impact psoriasis patients lives and raise the likelihood of disease progression—a vicious circle. Lack of control over the disease, lack of a cure, and unexpected relapses significantly impair not only daily activity but also plans for the patient’s future.

Biologics as a treatment have been a game changer in the management of psoriasis. They have the added advantage of long-term remissions and better disease control and have shown significant improvement in the quality of life of patients with psoriasis despite the added cost and side effects.

Psychological support, particularly Cognitive Behavioral Therapy (CBT), can help those affected in managing stress, anxiety, and negative thought patterns related to psoriasis. In addition, techniques like mindfulness, meditation, and deep breathing exercises are helpful for self-managing.

Connecting with others who understand the challenges of psoriasis can reduce feelings of isolation and provide a sense of community. The Emirates Dermatology Society promotes awareness projects and support groups for psoriasis.

Find more information in our blog https://theknowhow.ae/psoriasis-awareness-and-support/.

Psoriasis Is Inflammation Skin Deep

Psoriasis is sometimes misunderstood as “just” a cosmetic skin condition. Though, it is a condition caused by an overactive immune system that can target numerous body parts. Research of the 21st century considers psoriasis a systemic inflammatory disease affecting the entire body.

Psoriasis increases the likelihood of developing certain other illnesses—”comorbidities.” For instance, up to 33% of individuals with psoriasis also have psoriatic arthritis, a typical comorbidity of psoriasis.

According to the recent Joint AAD-NPF Guidelines of Care for the Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities, other comorbidities of psoriasis include:

Obesity
Nonalcoholic fatty liver disease
High blood pressure
High blood cholesterol
Insulin resistance and diabetes
Cardiovascular disease (CVD)
Chronic kidney disease
Mental health impacts, including depression and anxiety
Inflammatory bowel disease
Uveitis (inflammation of the eye)
Chronic obstructive pulmonary disease (COPD)
Cancer
Sleep apnea

Inflammatory immune cells and the substances they release are created in excess in psoriasis. When they circulate through the body via the bloodstream, they produce widespread inflammation that results in the development of comorbidities of inner organs.

The Body’s Defenses Gone Wrong

Inflammation is typically caused by a group of immune cells attempting to combat an infection or virus. The immune system has developed to trigger an inflammatory response by sending immune cells to affected body parts and releasing immunological factors for a widespread defense reaction.

However, this natural defense has gone astray in psoriatic disease. The overly active immune cells target inappropriate locations. Visibly, they create psoriatic plaques on the skin. However, they may also

affect the joints and result in painful psoriatic arthritis.
start cardiovascular illness by inflaming the cells lining blood vessels. Our blood’s lipids more readily adhere to the inflamed inner artery layer. Once there, the lipid particles form atherosclerotic plaques, which can lead to a heart attack or stroke if they break off and obstruct the vessel.
enhance inflammatory reaction in the adipose tissue, mainly in the abdomen, promoting feelings of hunger and additional weight gain as well as contributing to the development of diabetes.
induce depression through a neuroinflammatory component.

For doctors, find more recent scientific information here: https://di.aerzteblatt.de/int/archive/article/240189
https://www.jaad.org/article/S0190-9622(18)33002-0/fulltext
https://www.isahd.ae/content/docs/Ejada%20KPIs%20and%20Recommendations_Psoriasis_2024.pdf

The Impact of Psoriatic Disease Comorbidities

Psoriasis and its comorbidities can shorten life. People with psoriasis tend to live a few years less than those without the condition. This is particularly true for those with severe psoriasis disease. It is not the psoriasis that’s shortening life span, but the heart attacks, strokes, and other comorbidities it can cause. The following numbers demonstrate how significant these comorbidities are.

Cardiovascular Disease

CVD is by far the deadliest comorbidity of psoriatic disease, and CVD risk begins early on in people with psoriasis. People with severe disease have a two-fold increase in the rate of first heart attack between the ages of 40 and 50 and a 44 percent increase in stroke compared to people without psoriasis.

Obesity, Metabolic Syndrome, and Diabetes

Obesity is the most common comorbid condition in people with psoriasis. And it sets the stage for insulin resistance and type 2 diabetes. Insulin resistance means the body is less able to move glucose, a type of sugar our body uses for energy, from the blood into cells. Glucose builds up in the blood and begins the processes that cause type 2 diabetes, another risk factor for heart disease and stroke.

Depression and Anxiety

Depression as well as anxiety are prevalent in psoriasis patients. Up to 62 percent of people with psoriasis have depression, according to some studies. The number of individuals with mental health concerns for psoriasis is likely even larger over a lifetime due to the impact of the condition and because often many do not seek treatment or care. Depression undermines quality of life, can make it harder to engage in a healthy lifestyle, and is a well-recognized trigger for psoriatic disease flares.

Treating Psoriatic Disease Is Key

The notion that psoriasis is a skin condition that may be cured with creams and ointments is no longer valid. Many connections to psoriasis are now known, and more and more therapies are available. The scientific and medical view of the disease has fundamentally changed. The effect of some new therapies differs fundamentally from that of older drugs. Modern therapies intervene in the inflammatory process in a targeted manner and interrupt it, for example by inhibiting certain messenger substances of the immune system.

The advances in psoriasis are also reflected in the treatment guidelines. The guideline for psoriasis states freedom from symptoms as a fundamental therapeutic goal. Which treatment is suitable for achieving the therapeutic goal depends primarily on the severity of the psoriatic disease.

Therapy of Moderate to Severe Psoriasis

Biologics therapy (pens or injections)

Biologics are biotechnologically produced psoriasis medications. They specifically interfere in the misguided reaction of the immune system by blocking messenger substances that play a central role in the inflammatory process and interrupting this inflammatory process. In this way, the inflammation and the accelerated skin renewal process can be stopped.

Conventional internal (systemic) treatment

In conventional internal (systemic) treatment, medication is administered as tablets or injections to treat psoriasis. They influence the inflammatory process of psoriasis in different ways. The internal treatment of psoriasis must be carried out with particular care so that possible side effects are avoided or recognized at an early stage. Regular check-ups with the doctor are therefore necessary. Immunosuppressants, fumaric acid preparations, or retinoids are used for moderate to severe plaque psoriasis.

Physical treatment

Physical treatment of psoriasis includes UV light and bath therapy. They have a physical effect on the skin. Both forms of treatment are carried out in a clinic or specially equipped dermatologist’s practice.

Therapy of Mild Psoriasis

External (topical) therapy (creams or ointments) for mild psoriasis

Supplementary Interventions

In addition to treatment, supplementary interventions like psychological support, interactions in self-help groups, or a mindful lifestyle can offer a positive boost and enhance overall well-being.

TheKnowHow Independent Second Opinion Service

Are you or a loved one suffering from psoriasis and are unsure whether your current treatment is sufficient?

TheKnowHow Independent Second Opinion Service is not intended to take you away from your treating doctor but rather provide an extra level of competence. Get an unbiased assessment from an international expert without having to travel or schedule appointments. Our impartial specialists conduct a record-based assessment of your current health state and all available treatment options, including their advantages and potential hazards.