Everything we know about psoriasis.
How do psoriasis lesions manifest themselves?
Psoriasis type Erythroderma
If the clinical picture is dominated by small lesions, it is described as Psoriasis Guttate.
If the lesions are the size of a coin or even the size of the palm of the hand, it is described as chronic plaque psoriasis.
Psoriasis vulgaris or commonpsoriasis
If skin inflammation is predominant, pustules are the most important sign and are described as Pustular Psoriasis.
Definition of pustule: a small, circumscribed elevation of the skin containing fluid, usually purulent.
Palmoplantar psoriasis (feet and hands) may occur with or without the presence of lesions on other parts of the body. The scales are often deep-seated and often break.
The sacral region is the favourite part of Psoriasis. And if you are wondering what the sacral region is, we remind you that it is defined as the lower part of the spine and is located between the fifth segment of the lumbar spine (L5) and the coccyx. The sacrum is a triangular shaped bone with five segments (S1 - S5) fused together. In other words, at the division of the buttocks.
Flexible regions such as armpits, knees, elbows, breasts, groin, etc.
Mucous membranes as reproductive organs
Psoriasis on the nails
Psoriasis on the fingernails is more common than on the toenails. Nail changes are more common in patients with whole body psoriasis. (Calvert et al, 1963)
Psoriasis is not expressed in a static but in a dynamic way, i.e. lesions can grow and then regress. The period is dynamic and can be considered short (weeks to months) or long (months to years). Genetic elements and the triggers of psoriasis in each person play a role in this dynamic.
Since psoriasis is partly genetically determined, this implies that there are many people with latent psoriasis which means that they already have psoriasis, but have not developed any symptoms.
Some triggers of latent psoriasis have been identified and are listed in the following table:
Dermatitis associated with Psoriasis
Kocsard (1976) reported that psoriasis is virtually absent in patients with sun-related skin cancer or solar keratosis. The prevalence of the combination of psoriasis and melanoma seems to be very low or lower than the expected number of cases (Proctor et al, 1981).
However, Halprin et al (1982) reported a high frequency of skin cancer with psoriasis in those who had undergone treatments such as: Ultraviolet rays, Metrotexate, X-rays or Corticosteroids among others.
Various types of Eczema
Diagnosing psoriasis or seborrhoeic dermatitis on the scalp or joints is very difficult. Seborrhoeic dermatitis is typically distinguished by a more yellowish and greasy appearance, sometimes accompanied by hair loss and the lesions are not as easily palpable as in psoriasis.
According to Puerschel (1973) coexistence between psoriasis lesions and atopic dermatitis is rare. He found only 3 cases of psoriasis in a group of 1,170 patients with atopic dermatitis. It is recommended to see a dermatologist for histology to determine whether it is psoriasis or atopic dermatitis.
When the skin comes into contact with a substance to which one is allergic, it causes redness and itching of the skin. In 1967 Steigleder & Orfanos reported that in most of their patients studied it was likely that the psoriasis lesion was caused by contact eczema.
Specific locations of Plaque Psoriasis
These types of pustular lesions are less common than erythroderma-type lesions (reddening of the skin). Guttate or plaque psoriasis lesions typically anticipate the appearance of pustular lesions.
Factors that trigger Pustular Psoriasis
Eruption patterns of pustular psoriasis
- Pustular Psoriasis during Pregnancy (PPPP)
- Annular (circle or round) psoriasis (EACP)
- Psoriasis vulgaris pustulosa
- Pustular Palmoplantar Psoriasis (PPP)
- Psoriasis Hallopeau
GPP - Generalised Pustular Pustular Psoriasis
Respiratory tract infections, especially streptococcal and vaccine-associated infections
Chemical, physical and mechanical factors, e.g. solar irradiation or irritating topical substances.
Hormonal changes, pregnancy, oral contraceptives, stopping corticosteroid use
Stress due to strong emotions or complicated situations such as divorce, accidents, loss of loved ones, financial situations, etc.
Medications such as lithium, beta-blockers, anti-malarials, ACE inhibitors such as ramipril or topical indomethacin.
GPPP - Generalised Pustular Psoriasis during Pregnancy
GPPP has been accepted as a variant of annular pustular psoriasis described below and occurs during pregnancy due to hormonal disruption.
Psoriasis Annulare or EACP - Erythema Annulare of the Centrifugal Pustular type)
This type of psoriasis was reported by Lapiere in 1959, and later Huriez and Degos introduced the term (EACP). This is a rare variant of psoriasis that suddenly flares up in patients with no history of psoriasis such as patients with plaque psoriasis or pustular psoriasis.
Annular (circle or round) psoriasis is characterised by erythema (redness) or discrete ring or snake-shaped plaques (curved lines). The lesions are covered with pustules and the course of these lesions causes it to arise suddenly and recede in the same way. This can happen over weeks or several months.
Psoriasis Vulgaris with postulation
This term is used when pre-existing psoriasis vulgaris develops pustules on the psoriasis plaques.
Palmoplantar psoriasis pustolosa
This psoriasis, known as PPP, was first described in 1888 by Crocker as Dermatitis repens and was associated with psoriasis until 1930.
The name comes from the French dermatologist François Henri Hellopeau (1842-1919). It has been classified as a subtype of plaque psoriasis, although it remains controversial.
Lesions typically start from an area of trauma or infection, often involving one or two fingers or toes. Pustules (reddish) are generated in the erythema; when the pustule matures, pus is generated.
This section will cover the most common treatments and the Nopsor treatment falls into the topical category and uses some of the elements described here plus a proprietary herbal blend that has made Nopsor work for most people without rebound.
Topical Treatments for Psoriasis
- Location of Psoriasis
- Severity of injuries
- Reaction to previous treatments
- Understanding the risk vs. benefit of treatment
- Cost of treatment
In order to select a topical agent for the treatment of psoriasis, it is important to understand and know what factors determine the risk and effectiveness of the agent: how the agent is metabolised in the skin, the vehicle of application, the concentration of the drug and the frequency of application.
- Vitamin D analogues
Risks of corticosteroids
Vitamin D analogues
Vitamin D is generated in the skin and can be taken as a supplement or found in food. From there it travels to the liver to make vitamin D in the blood called calcidiol. From there it goes in two directions to perform two functions. The first function is endocrine and is to maintain calcium in the body. The second function takes vitamin D from the blood and sends it to the cells of the body. And this is where it is believed that vitamin D when it binds to the receptor, it activates and modulates genes that work with epidermal proliferation, inflammation and keratinocytes.
A vitamin D analogue is a chemical compound that has the same structure as vitamin D.
Today there are 3 vitamin D analogues available for the treatment of psoriasis: Calcitriol, Tacalcitol and Calcipotriol.
Calcitriol is an active hormonal analogue of vitamin D, Tacalcitrol and Calcipotriol are synthetic vitamin D analogues.
Retinoid - Tazarotene
Tazarotene is a synthetic retinoid with an affinity for the retinoid receptor. It has been shown to cause anti-proliferation and anti-inflammation. Prolonged use is strongly discouraged as it causes skin irritation, erythema and burning.
Dithranol induces radicals in the skin that result in anti-proliferation and modulation of inflammation in Psoriasis.
Risks: The dithranol molecule is unstable, therefore standardisation of formulations is poor. There is not yet much evidence on the efficacy and risks of this treatment.
Tar is a distillate product of organic materials such as wood, shale and coal.
Coal tar, which is a type of coal, is used for psoriasis and has been used for over 100 years for this purpose. Coal tar contains hundreds of chemical compounds. Exactly how coal tar works is unknown, but it is known to help with anti-inflammatory and anti-proliferation effects. Although many studies are still lacking to corroborate its efficacy, coal tar is known to have longer-lasting effects than corticosteroids.
Risks: Staining, soiling, odour, irritation, and in some cases allergic skin reactions.
The Nopsor treatment uses coal tar in its formula.
Calcineurin is an enzyme that catalyses the dephosphorylation reaction of a phosphoprotein (protein). Its effect is to inhibit T-cell activation.
Nopsor Treatment - Describe it
Biological Treatments for Psoriasis
The term biological indicates that they are derived from biological sources such as human or animal cells and are used as therapeutic mechanisms. Most of them are made using biological engineering methods. In short, the genetic information of a protein is transferred into a cell line to induce the production of this protein.
The substances used for the treatment of psoriasis can be divided into 3 types:
- TNF alpha
- Anti-p40 antibody
Risk of biological medicines: High risk of respiratory tract and skin infections. May also reactivate tuberculosis.