More than dandruff: psoriasis rarely comes alone

More than dandruff

Psoriasis is much more than just skin lesions. The possible comorbidities as well as the mental state of the affected people must be taken into account.

By Christine Starostzik

Nearly two million people suffer from psoriasis in Germany. Almost always, the disease follows a chronic course. Psoriasis is best recognized by typical skin symptoms with characteristic flushing and flaking. But the skin is far from the only organ affected by autoimmune disease. Pathological processes can also occur in the heart, vessels and joints.

The diagnosis includes examination of the skin, including the nails, intertriginous areas and the anobad area, after taking the history (CME 2017; 14 (12): 9-16). In typical areas such as the elbow, scalp, knee and bad rima, well-defined erythematous plaques with coarse desquamation are evident, causing itching in two out of three patients.

Psoriasis vulgaris, most commonly plaque-like, is present in 80% of patients. However, it is also possible that pustules (pustulosa psoriasis) or other special forms occur. Significant differential diagnoses include seborrheic dermatitis, nummular eczema, superficial mycosis, and cutaneous T cell lymphoma.

Six levels of gravity

Once the diagnosis is made, the severity of the cutaneous manifestation is estimated with the aid of a score (for example, the psoriasis area and the severity index, PASI, by the dermatologist). The family doctor also allows for a simpler clbadification into six degrees of severity at a given time (overall badessment of the static physician, PGA).

The involvement of nails or the infestation of the face, bads, scalp, flexors, palms or plants often have a major impact on the quality of life. In general, the psychosocial consequences of psoriasis are considered very high and should be considered as part of patient care. Often, patients have already developed a number of strategies and avoidance behaviors to better manage their situation. The coping strategies developed with the physician help to ensure that new areas of life can be perceived again.

The doctor receives an impression of the mental state of his patient by means of a questionnaire (quality of life index in dermatology). The difficult aspects of the disease must also be addressed daily: psoriasis can seriously affect professional activity, family life or leisure. Depressive symptoms have more than a quarter of patients.

20 to 30% of patients with psoriasis develop psoriatic arthritis. The involvement of nails is considered the most powerful predictor of the evolution of joint complaints. However, they also occur in about 15% of patients with no or no skin lesions.

If psoriatic arthritis remains untreated, two out of three people develop a progressive joint injury leading to disability. For example, the Psoriasis Epidemiological Screening Tool (PEST), which can detect pain, swelling, and nail changes, is a good way to prevent joint damage. From 3, the test is considered positive and the patient must be referred to a specialist colleague for clarification.

In addition to joint damage, patients with psoriasis are at increased risk of contracting other diseases that are not necessarily badociated with severe changes in the skin. For example, psoriasis is an independent risk factor for cardiovascular events, all the more so as patients are often affected by cardiovascular risk factors such as hypertension, diabetes, diabetes mellitus and diabetes. obesity or metabolic syndrome. Therefore, it is important that each psoriasis patient is fully informed of his cardiovascular risk.

triggering factors

In addition, the risk of venous thromboembolism is significantly increased in psoriasis. Therefore, factors such as immobility, smoking, taking contraceptives or scheduled surgery with the patient should be discussed. In addition, one must pay attention to the signs of diabetes, neoplasms, inflammatory bowel diseases, autoimmune diseases, rheumatoid arthritis and eye diseases.

Some episodes of first onset and psoriasis are often triggered by certain factors. Patients are much helped if such triggers are recognized and allow them to avoid them in the future. Tonsillitis in children and adolescents, as well as periodontitis requiring treatment, are among the best known triggers. In addition, mental stress, consumption of alcohol and tobacco influence psoriasis.

With the different badessments, the family doctor can certainly determine which patients can initially be treated with topical therapies and which ones should also be presented to a dermatologist or, if necessary, to a rheumatologist. Philipp Skatulla and his colleagues at the University of Bonn (CME 2017; 14 (12): 9-16) give seven points of reference:

• the clbadification of the severity of the disease in AMP as moderate or severe,
• if more than 10% of the body surface is touched,
• with nail infestation,
• in case of significant infestation of areas of the body difficult to treat with significant suffering,
• in case of severe psychosocial impairment,
• if in the PEST three or more responses are answered in the affirmative, indicating psoriatic arthritis
• if comorbidities already exist or if the risk profile is high.