Plaque psoriasis is a common, chronic, inflammatory condition that involves the skin and nails. Psoriasis is characterised by the presence of symmetrically distributed, red, well-defined plaques with a silvery surface scale. The scale is usually silvery white, except in skin folds where they may be smooth and shiny. Although any part of the skin can be affected by psoriasis, it most commonly occurs on extensor surfaces and scalp involvement is common4. The exact cause of psoriasis has not yet been determined, but evidence suggests that there is a strong genetic component (40-50% of patients have a family history of psoriasis)3. The basis for disease development is thought to be a complex interplay of genetic and environmental factors2. Psoriasis follows a relapsing and remitting course that can have various triggers, such as stress, trauma, smoking and alcohol.3
What is the impact of psoriasis?
Psoriasis is estimated to affect about 2-4% of the population in western countries1. Psoriasis is associated with an increased risk of cardiovascular events, metabolic diseases, including diabetes and psychological disorders, such as depression.2
How to diagnose and treat psoriasis?
Psoriasis can in most cases be diagnosed with a physical examination and a review of the medical history of the patient. The patient is examined on predilection sites like scalp, nails, elbows, shins and the anogenital area where typical psoriasis lesions can be found. In rare cases a skin biopsy is needed to confirm the diagnosis. The family history often shows a familial aggregation.5,6
Many factors like body involvement, severity of the skin conditions or challenges like itch or hard-to treat areas influence the individualised therapy. Approximately two-thirds of patients can be treated sufficiently with a topical therapy, whereas one-third require additional systemic treatment options. In both areas patients can be treated with a number of therapeutic options available in different formulations.6,7
- Parisi R, Symmons DPM, Griffiths CEM, Ashcroft DM, and the Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133(2):377–85.
- Flatz L, Conrad C. Role of T-cell-mediated inflammation in psoriasis: pathogenesis and targeted therapy. Psoriasis Targets Ther2013;1–10.
- Primary Care Dermatology Society (PCDS). Psoriasis: an overview and chronic plaque psoriasis. Availableat: http://www.pcds.org.uk/clinical-guidance/psoriasis-an-overview. Accessed April 2019.
- DermNetNZ. Psoriasis. Availableat: https://www.dermnetnz.org/topics/psoriasis/. Accessed September 2018.
- World Health Organisation. (2016). Global reporton psoriasis. World Health Organisation.
- Pathirana D, Ormerod AD, Saiag C et al. European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol 2009;23(Suppl2):5–70.
- Svendsen MT, Jeyabalan J, Andersen KE et al. Worldwide utilization of topical remedies in treatment of psoriasis: a systematic review. Dermatolog Treat. 2017 Aug;28(5):374-383.