A psoriasis flare-up is unmistakable: the skin becomes reddened and has a high blood supply, on which silvery-white scales form. There are many triggers at play here.
Red, sometimes large, itchy spots covered with shiny white scales or pustules: This is how psoriasis manifests itself. Around three percent of Germans are plagued by this chronic inflammatory skin disease. Some hardly dare to go outside because of the severe skin changes in the event of a flare-up.
As a chronic disease, psoriasis runs in phases – acute and largely symptom-free times alternate. The disease typically breaks out before the age of 40 (type 1 psoriasis). The late form (type 2 psoriasis) occurs in the second half of life and is often somewhat milder. Psoriasis is rather rare in children, neurodermatitis occurs more frequently in them.
Psoriasis patients often have comorbidities that increase the level of suffering. Obesity and inflammatory bowel diseases such as Crohn’s disease are among them. The so-called “psoriatic march” is feared: as a systemic inflammation that potentially leads to damage to vessels. The clinical picture is also often associated with insulin resistance, fatty liver, high blood pressure, and hardening of the arteries. This can mean a significantly lower life expectancy for those affected.
Psoriasis is an autoimmune disease
The skin changes in common psoriasis are caused by rapidly accelerated cell growth. In healthy people, the upper skin (epidermis) renews itself within just under four weeks: During this time, our skin forms new cells and sheds the uppermost, meanwhile keratinized cell layer. This process only runs faster when the repair mechanism kicks in after an injury – or during a psoriasis flare-up: the skin in the affected areas hardens in just three to six days.
There are many causes of psoriasis
The fact that the skin cells get out of control is in the genes of part of the population: psoriasis runs in families. However, the disease does not break out in everyone with a hereditary predisposition. The main risk factors are obesity, alcohol, and smoking. And specific triggers are suspected: skin injuries – such as tattoos or sunburn – constant skin irritation from clothing that is too tight, past severe infections, hormone fluctuations, environmental toxins, certain medications such as beta-blockers, ACE inhibitors, and a few others. Stress – whether professional or private – can unconsciously affect the skin.
Symptoms of Psoriasis
Psoriasis is unmistakable: reddened areas appear on the skin with heavy blood flow, on which silvery-white scales form. Even minimal changes are possible, for example in the ear canal, navel, and anal region. The typical scales can be lifted off with a fingernail. Often affected are areas of skin that are stretched a lot, such as elbows or knees, or areas where clothing rubs: shins and calves, belt area, buttocks, neck. The scalp is also often affected. No skin region is exempt. The spots can be scattered in dots or cover entire parts of the body over a large area. And it is not uncommon for the nails to be affected: small indentations (pitted nails) from there, which can easily be overlooked, or yellowish-brown discoloration (oil stains), which impair the appearance of many patients.
How psoriasis is diagnosed
Mild psoriasis can resemble fungal infections or eczema – these diseases can be ruled out using a blood test, the typical skin infection pattern and, if necessary, tissue samples. The distinguishing feature of psoriasis is the Auspitz phenomenon (also known as “bloody dew”): the doctor scrapes off a scale, leaving a thin, shiny membrane underneath. If you remove that too, the spot bleeds in spots.
Additional investigations in psoriatic arthritis
If psoriatic arthritis is suspected, the affected joints are examined using imaging methods (ultrasound, X-ray, magnetic resonance imaging, or scintigraphy). The images can provide an indication of the stage of the disease. Laboratory tests are not definitive because there is no specific marker for psoriatic arthritis.