‘Psoriasis’ is characterized by erythema, a symptom of redness of the skin, and silver-white scales, a symptom of white dead skin cells. The cause of the disease is not clearly identified. However, skin trauma, dry climates, drinking and stress are known to exacerbate symptoms, and it is not an infectious disease.
Symptoms often appear in areas that are frequently stimulated, such as elbows and knees, and in the buttocks, often appearing symmetrical and with clear boundaries.
Main symptoms of psoriasis
‘Psoriasis’ usually occurs symmetrically, but occurs in areas that receive a lot of stimulation, such as stretching the legs (especially the shin), elbows, knees, sacrum, and scalp.
In the beginning, small red, millet-like rashes (pimples) appear on the skin, which gradually grow to the size of walnuts or eggs. After that, a new rash like a millet develops around it, which also grows and merges together to eventually become a rash the size of an egg or a large palm. On top of it, scales like white scales are piled up.
‘Psoriasis’ usually takes the form of plaques covered with scales, and petechiae appear when the scales are removed. This is a specific symptom of ‘psoriasis’. In rare cases of pustular psoriasis, pustules usually appear.
Nail lesions are found in 30-50% of patients with psoriasis. Several lesions may appear, including nail depression*, nail detachment, nail thickening, subungual hyperkeratosis, and subungual tanning.
* Nails (爪甲): Refers to fingernails and toenails
Woman scratching her itchy skin.
Psoriasis Treatment
Treatment methods for ‘psoriasis’ can be divided into local treatment, phototherapy, and systemic treatment. Topical treatment is used for mild psoriasis, and systemic treatment or phototherapy is used for severe psoriasis.
▲ Topical treatment
Topical treatment is a treatment where drugs are applied directly to the infected area. Corticosteroids, vitamin D derivatives, and moisturizers are applied to the skin daily. However, if a strong corticosteroid drug is applied for too long, various side effects such as telangiectasia, dilatation, and skin atrophy may occur, so it should be used carefully under the guidance of a physician.
▲ systemic treatment
Systemic treatment is used for patients with severe psoriasis. When considering the side effects of the drug, it is administered after considering children, pregnant women, liver or kidney disease, and patient compliance. For systemic treatment, drugs such as synthetic derivatives of vitamin A, immunosuppressants such as cyclosporine, methotrexate, and steroids are used.
▲ Phototherapy
Phototherapy is a method of treating ‘psoriasis’ using ultraviolet light, and is mainly used for extensive ‘psoriasis’. It is treated with photochemotherapy called PUVA or long-wave or short-wave ultraviolet-B light. Recently, phototherapy using short wavelength ultraviolet B is the most commonly used.
PUVA treatment involves taking a drug called psoralen in combination with ultraviolet A therapy to improve the effectiveness of phototherapy. Although it has excellent therapeutic effects, it cannot be used for children, pregnant women, hypertensive patients, and epileptic patients.
The medicines you take during phototherapy can cause side effects such as stomach upset, nausea, and dizziness. In addition, there is the inconvenience of having to wear UV blocking glasses to protect the eyes for about 2 days after the treatment. As a result, the frequency of use has decreased in recent years.
Short wavelength UVB treatment is a convenient treatment that does not require wearing sunglasses after treatment and does not require medication. Therefore, it can be used by children and pregnant women. The effect of the treatment is almost similar to PUVA, and it is the most used recently. However, care must be taken as it can cause sunburn in the process of increasing the amount of ultraviolet rays.
More recently, excimer lasers are used to treat psoriasis. It has the advantage of being able to provide strong light immediately, but has the disadvantage of narrowing the area that can be irradiated immediately. Generally, rather than treatment alone, drugs, creams, and ultraviolet rays are used in combination. Doctors may change treatment every 12 to 24 months to prevent the treatment from becoming less effective and reduce the risk of side effects.
Precautions for patients with psoriasis
Patients with psoriasis should be careful not to injure the skin, as new sores can develop at the wound site if the skin is rubbed or scratched. For this reason, even when taking a bath, you should not push the dirt too much.
Streptococcal infections such as sore throat or tonsillitis should be avoided, and mental stress can also make psoriasis worse. You should also avoid using medicines that make psoriasis worse. ‘Psoriasis’ patients are sensitive to the season, ie to the climate. Especially in winter, it gets worse, so you need to treat it with special care.
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