Observing the major diseases of daily life ③ ‘Psoriasis’

“Psoriasis” is characterized by erythema, a symptom of reddening of the skin, and silvery-white scales, a symptom of dead white skin cells. The cause of the disease is not clearly identified. However, trauma to the skin, dry weather, alcohol and stress are known to aggravate the symptoms and it is not a contagious disease.

Symptoms often appear in areas that are frequently stimulated, such as the elbows and knees, and in the buttocks, often appearing symmetrically and with sharp boundaries.

The main symptoms of “psoriasis”

“Psoriasis” usually occurs symmetrically, but occurs in areas that get a lot of stimulation, such as extended limbs (especially the shin), elbows, knees, sacrum, and scalp.

At first, small, red, millet-like rashes (pimples) appear on the skin, gradually growing to the size of nuts or eggs. Subsequently, a new rash like millet develops around it, growing and merging with each other to eventually become a rash the size of a large egg or palm tree. Above it, scales are piled up like white scales.

‘Psoriasis’ usually takes the form of plaques covered in 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”. A variety of lesions may appear, including nail depression*, nail detachment, nail thickening, subungual hyperkeratosis, and subungual tanning.

* Toenails (爪甲): Refers to both fingernails and toenails

Woman scratching her itchy skin.

Treatment “Psoriasis”.

Treatment methods for “psoriasis” can be broadly 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 in which medications are applied directly to the diseased area. Corticosteroids, vitamin D derivatives, and moisturizers are applied to the skin every day. However, if a strong corticosteroid drug is applied for too long, various side effects such as telangiectasia, dilation and skin atrophy may occur, so it should be used with caution under the guidance of a doctor.

▲ systemic treatment

Systemic treatment is used for patients with severe “psoriasis”. In view of 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 “psoriasis” treatment method that uses ultraviolet light and is mainly used for extensive “psoriasis”. It is treated with photochemotherapy called PUVA or long or short wavelength 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 medications you take during phototherapy can cause side effects such as stomach pain, nausea, and dizziness. Also, there are inconveniences such as having to wear anti-UV goggles to protect your 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 the use of sunscreen glasses after treatment and does not require medication. Therefore, it can be used by children and pregnant women. The treatment effect is almost comparable 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 being used to treat ‘psoriasis’. It has the advantage that it can provide strong light right away, but it has the disadvantage that it narrows the area that can be irradiated at the same time. In general, rather than treating alone, drugs, ointments and ultraviolet rays are used in combination. Doctors may change your treatment every 12 to 24 months to prevent treatment from becoming less effective and reduce your risk of side effects.

Precautions for patients with psoriasis

Patients with “psoriasis” must be careful not to injure the skin, as new lesions can develop at the wound site if the skin is rubbed or scratched. For this reason, even when bathing, one should not push the dirt too hard.

Strep infections such as strep throat or tonsillitis should be avoided, and mental stress can also make “psoriasis” worse. You should also avoid using medications that aggravate “psoriasis.” Patients with “psoriasis” are sensitive to the season, that is, to the climate. Especially in winter, it gets worse, so you need to treat it with special care.

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