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Psoriasis: symptoms, causes, who to consult?

Psoriasis is a common chronic inflammatory disease. It affects 1 to 5% of the world's population. It shows up as pimples (papules) covered with scales (thin flakes of skin that come away from the epidermis) and red patches. Psoriasis can also affect any area of skin, from the scalp to the nails. It is important for an online dermatologist to diagnose this condition, particularly to distinguish it from eczema.

How do you recognise psoriasis?

Psoriasis shows up as red patches on the skin; this is its most common form. Psoriasis generally develops as one or more small red patches with silvery edges. The silvery surface of the skin corresponds to the scales, thin flakes of skin coming away from the epidermis. The symptoms of psoriasis can also affect:
   • The face;
   • The scalp;
   • The elbows;
   • The back;
   • The buttocks;
   • The armpits;
   • The eyebrows;
   • Around the anus and in the fold of the buttocks;
Many patients with psoriasis also have lesions on their nails. Sometimes the symptoms of psoriasis naturally subside after a few months; other times they persist and worsen. When the red patches spread to the palms of the hands, the soles of the feet or the skin of the genitals, they are often accompanied by itching (pruritus) and pain. Even so, psoriasis is generally not a serious disease, but because of the skin symptoms, it can cause psychological distress, particularly when it affects the face or the genital area. Appropriate care is therefore a genuine public health issue. Lastly, psoriasis follows a chronic course; it can fade and reappear at another time in life. In summer, the symptoms of psoriasis often lessen under the effect of the sun. It can also be symptom-free for long periods between flare-ups.

What causes psoriasis?

The causes of psoriasis are not yet clearly known. The main hypothesis is that psoriasis is linked to a dysfunction or disruption of the immune system. The accelerated growth of epidermal cells is also thought to be behind the red patches and scales. The cause of this accelerated cell growth is not known. Many factors, in addition, may trigger a psoriasis flare-up:
   • Genetic: certain genes are associated with the onset of psoriasis;
   • Drug-related: certain treatments for multiple sclerosis, malaria, high blood pressure, hepatitis C, or lithium;
   • Injuries, irritation, scars, severe sunburn, friction, burns, pollution, a skin infection, or cold and heat;
   • Behavioural and psychological: stress, fatigue...
   • Drinking alcohol or smoking;
   • Being overweight or obese;
Psoriasis is also more common in people infected with HIV, smokers and people who are overweight.

Psoriasis treatments: creams, phototherapy...

There are currently many treatments for psoriasis, which are combined depending on the severity of symptoms. These include:
   • Topical treatments: moisturising (emollient) creams, ointments, lotions, corticosteroids combined with vitamin D, coal tar and calcipotriol. Some products are available at the pharmacy without a prescription;
   • Phototherapy (exposure to ultraviolet light);
   • Immunosuppressants: these are intended to deliberately weaken the immune system to reduce the immune response linked to psoriasis symptoms. They must be prescribed and reviewed by a doctor, because of the increased risk of infection;
   • Other medications for severe psoriasis: acitretin for pustular psoriasis, and biologic agents made from living organisms that inhibit the chemical substances behind the excessive immune response involved in psoriasis (adalimumab, infliximab, etanercept...). Most of these products are given by injection.
In all cases, the opinion of a dermatologist or general practitioner is essential, in order to diagnose the condition and benefit from effective treatment. In addition, each treatment can have possible side effects or contraindications; it is therefore important to consult a specialist before any treatment, to avoid the risk of worsening symptoms.

Consult a dermatologist to treat your psoriasis

Psoriasis is a very common inflammatory disease, the causes of which can be varied. Doctors point to a genetic component in its onset and to triggering factors (trauma, infections, certain products, etc.). The most commonly observed symptoms include:
   • Red patches covered with thin flakes of skin coming away from the epidermis (scales);
   • Papules (pimples);
   • Erythema (redness);
   • Other skin lesions (pustules, for example);
Diagnosis is important, in particular to distinguish psoriasis from eczema. In addition, treatment will depend on the number of lesions, their location and their severity. Treatments may include:
   • Topical care: salicylic acid, corticosteroids, moisturising creams, ointments...
   • Light therapy or ultraviolet phototherapy;
   • Immunosuppressants;
   • Biologic agents (immunomodulators).
If you have a skin rash, an online consultation with a dermatologist is strongly recommended, in order to investigate the causes and receive suitable treatment.