▶ Kim Tae-kyun, Professor of Dermatology at Dismissal Hospital
Psoriasis is a chronic inflammatory skin disease that occurs at a young age and repeats improvement and worsening. Treatment and active management are more important than anything else because it significantly reduces the patient’s quality of life and increases the systemic inflammatory response, which is accompanied by various complications.
Q. What is the cause?
Psoriasis is caused by an overabundance of keratinocytes around the skin due to an overactive immune response. T cells involved in our body’s protective immunity play an important role, especially T cells that produce a cytokine called interleukin 17.
A genetic predisposition is associated with the development of psoriasis, and acute teardrop-shaped psoriasis is strongly associated with tonsillitis caused by a specific bacterium, and there are patients who have worsening of existing psoriasis or new development of psoriasis after treatment with immuno-cancer drugs , which has been in the spotlight recently.
Within a group of diseases known as psoriasis, various skin symptoms occur. The disease we commonly call psoriasis mainly means chronic plaque psoriasis.
Q. What are the symptoms?
Chronic plaque psoriasis is characterized by thick red skin lesions covered with silvery white keratin, and occurs mainly in areas of frequent physical friction, such as elbows, knees and buttocks. However, it can occur on any part of the body, including the scalp, face, trunk, limbs, and soles of the hands and feet.
In addition, there is teardrop-shaped psoriasis, pustular psoriasis, and erythematous psoriasis. As each has different clinical features and treatment methods, it is essential to consult a dermatologist with extensive knowledge and experience to obtain an accurate diagnosis.
Most cases of psoriasis are not severely itchy. However, psoriatic eczema-like lesions sometimes occur, which may present with itching or non-specific symptoms, and treatment may vary depending on the diagnosis, so it is essential to distinguish it from atopic dermatitis or coin-shaped eczema .
Q. What about treatment?
As psoriasis is a chronic recurrent inflammatory disease, it often occurs when treatment stops, and in some cases, it may not improve despite active standard treatment.
Therefore, for the treatment of psoriasis, treatment needs to be carried out from a long-term perspective with the hope that the patient can overcome psoriasis on his own by discussing closely with the attending physician who is well aware of the individual characteristics of each patient.
In addition, if psoriasis treatment is stopped and psoriasis is left to deteriorate, quality of life declines and the possibility of various psoriasis-related complications increases, so active treatment is needed to reduce psoriasis.
If the severity is relatively mild and the lesion is not extensive, use a topical application first. Topical application agents mainly contain a steroid component, and steroid derivative-vitamin D complexes are most often used because they have better therapeutic effects than steroid application agents alone and help to reduce the amount of steroid use.
However, if topical steroids are used continuously for a long time, consider using non-steroidal topical agents when psoriasis occurs in sensitive areas such as the face, folds and genitals.
If the severity is moderate to severe and the body surface area affected is large, the amount of topical application increases, so phototherapy and systemic oral medications should be considered.
Phototherapy can be used when there is no photosensitivity, and the treatment is performed twice a week for around 3 months and the response is evaluated to decide whether the treatment should be continued.
In patients with moderate to severe psoriasis, if the severity does not improve beyond a certain level despite the use of phototherapy and systemic oral medications for a certain period of time, injection therapy with biological agents that block certain cytokines, namely cause psoriasis. , can be considered.
Most of the patients who received biological treatment showed a significant improvement in severity, and an improvement of almost 90% compared to the severity before treatment can be expected.
Daeik Kwon Medical Specialist Reporter >
