Psoriasis

Psoriasis is a common, long-lasting disease. Psoriasis may have life-long periods of exacerbation and recovery. It occurs with equal frequency in men and women, and the age of onset is usually in adulthood. It is usually distinguished by a sharply circumscribed rash with silver colored scales. It is commonly seen on the scalp, knees and elbows. Rarely, it can occur on the nails, palms, soles, genitals, and face. Lesions are usually symmetrical.

The cause of the disease is not known exactly. In a healthy person, skin cells mature in 28-30 days. In psoriasis patients, this period can be reduced to 3-4 days. Rapidly proliferating cells accumulate on the skin and cause scaling. The most important risk factor is family history. The incidence of psoriasis is increased in people with a family history of psoriasis. Apart from this, physical traumas (scratching, rubbing), infections, stress, some drugs, smoking and excessive alcohol consumption are among the factors that trigger psoriasis.

Joint involvement can be observed in some of the patients. Pain, redness and swelling are observed in the joints. Psoriasis can also be located on the nails and can even be seen only on the nails. In this form of psoriasis, nail thickening, discoloration, pitting can be seen. Physical examination and skin biopsy are used in the diagnosis of the disease.

Factors such as the age of the patient, compliance with the treatment, the extent of the disease, the location of the symptoms, the severity of nail involvement and joint involvement, and the effect of the disease on the quality of life are determinants in the choice of drug and the treatment process. The type of treatment, duration of treatment, dose of drugs are regulated by the physician. Local treatment methods are preferred primarily because of less side effects and ease of application in limited-involvement psoriasis.

The most commonly preferred drugs are; moisturizers, corticosteroids, vitamin D derivatives and phototherapy. Systemic treatments used in cases with widespread involvement and resistant to local treatments are methotrexate, cyclosporine and retinoids. In recent years, biologic drugs have also been used in cases unresponsive to the above treatments. Most of the biologic drugs are in the form of injections and are used at certain periods (such as 1 in 15 days, every 2 months, every 3 months). Generally, loading doses are administered under observation in the hospital, while subsequent doses can be self-administered. Before and during the use of the drug, examinations are made and the effect is observed with a close follow-up.

Prof. Dr. Zekayi Kutlubay

Professor of Dermatology

Cerrahpasa Medical Faculty

Department of Dermatology