Psoriasis rarely comes aloneSkin psoriasis is much more than just lesions on the skin. Possible concomitant diseases and also the psychological condition of the affected person must also be taken into account.
By Dr. Christine Starostzik Published: 26.10.2018, 10:23 am
Extensive psoriasis at the hairline and on the scalp: The disease also causes psychological distress to sufferers.
Nearly two million people suffer from psoriasis in Germany. The disease almost always takes a chronic course. Although psoriasis is best recognized by the typical skin manifestations with characteristic redness and scaling, it is also known as psoriasis of the skin.
However, the skin is by no means the only organ affected by the autoimmune disease. The disease processes can also occur in the heart, vessels and joints.
After taking a medical history, the diagnosis includes a skin examination including the nails, intertriginous areas and the anogenital region (CME 2017; 14 (12): 9-16).
In typical areas such as the elbow, scalp, knee and rima ani, well-defined erythematous plaques with coarse scaling are clearly visible, causing itching in two out of three patients.
80 percent of patients have psoriasis vulgaris, most commonly of the plaque type. However, pustules (psoriasis pustulosa) or other special forms are also possible. Important differential diagnoses are seborrheic dermatitis, nummular eczema, superficial mycoses and cutaneous T-cell lymphoma.
Six degrees of severity
Concomitant diseases of psoriasis
Depressive symptoms have more than a quarter of psoriasis patients. A psoriatic arthritis 20 to 30 percent of psoriasis patients develop. Any psoriasis represents an independent risk factor for cardiovascular events. Also, the risk for VTE (venous thromboembolism) is significantly increased in psoriasis.
Once the diagnosis is made, the severity of the cutaneous manifestation is assessed using a score (for example, Psoriasis Area and Severity Index, PASI, by the dermatologist). A simpler classification into six degrees of severity is also possible by the general practitioner at a certain point in time (static Physician's Global Assessment, PGA).
Involvement of the nails or infestation of the face, genitals, scalp, bending sides, palms of the hands or soles of the feet often has a particularly strong effect on the quality of life. In general, the psychosocial consequences of psoriasis are considered to be very high, so that they must be taken into account in patient care.
Patients have often already developed a number of strategies and avoidance behaviors to cope better with their situation. Coping strategies worked out together with the physician help so that more areas of life can be perceived again.
More than every fourth patient has depressive symptoms
The physician gets an impression of the psychological condition of his patient by means of a questionnaire (Dermatology Life Quality Index).
Alternatively, the difficult aspects of the disease in everyday life should be asked: Work, family life or leisure activities can be massively affected by psoriasis. Depressive symptoms are experienced by over a quarter of patients.
20 to 30 percent of psoriasis patients develop psoriatic arthritis. Nail involvement is considered the strongest predictor of the development of joint symptoms. However, they also occur in about 15 percent of patients in whom no or no skin lesions are yet apparent.
If psoriatic arthritis is left untreated, two out of three sufferers will develop progressive joint damage resulting in disability.
In order not to overlook joint involvement, the Psoriasis Epidemiological Screening Tool (PEST), for example, is suitable, in which questions are asked about pain, swelling and nail changes. From a score of 3, the test is considered positive. The patient should be referred to a specialist for clarification.
In addition to joint involvement, psoriasis patients are at increased risk for a number of other diseases that are not necessarily accompanied by severe skin changes.
Psoriasis is an independent risk factor for cardiovascular events, as patients are often affected by cardiovascular risk factors such as hypertension, diabetes, obesity or metabolic syndrome. Therefore, it is important that every psoriasis patient is informed in detail about his or her cardiovascular risk.
The risk of venous thromboembolism is also significantly increased in psoriasis, so factors such as immobility, smoking, use of contraceptives or planned surgery should be discussed with the patient. In addition, signs of diabetes, neoplasia, chronic inflammatory bowel diseases, autoimmune diseases, rheumatoid arthritis, and eye diseases must be observed.
Both initial manifestation and psoriasis relapses are often triggered by certain factors. Patients are helped a great deal if such triggers are recognized and they are enabled to avoid them in the future. The best-known triggers include tonsillitis in childhood-. adolescence and periodontitis requiring treatment. In addition, psychological stress, alcohol and tobacco consumption have an influence on psoriasis.