‘Psoriasis’ is characterized by erythema, a symptom of reddening of the skin, and silvery-white scales, a symptom of white dead skin cells. The cause of the disease is not clearly identified. However, skin trauma, dry climate, drinking and stress are known to aggravate symptoms, and it is not a contagious disease.
Symptoms often appear in areas that are frequently stimulated, such as elbows and knees, and in the buttocks, often appearing symmetrically and with clear boundaries.
The main symptoms of ‘psoriasis’
‘Psoriasis’ usually occurs symmetrically, but it occurs in areas that receive a lot of stimulation, such as the extension of the limbs (especially the shin), elbows, knees, sacrum, and scalp.
In the beginning, small red, millet-like rashes (pimples) appear on the skin, which gradually grow to the size of walnuts or eggs. After that, a new rash like millet develops around it, which also grows and merges with each other to eventually become a rash the size of a large egg or palm. On top of it, scales like white scales are piled up.
‘Psoriasis’ usually takes the form of plaques covered with 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’. Several lesions may appear, including nail depression*, nail detachment, nail thickening, subungual hyperkeratosis, and subungual tan.
* Toenails (爪甲): Refers to both fingernails and toenails
Woman scratching her itchy skin.
‘Psoriasis’ Treatment
Treatment methods for ‘psoriasis’ can be largely 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 drugs 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, dilatation, 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 consideration of the side effects of the drug, it is administered following 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 method of treating ‘psoriasis’ using ultraviolet light, and is mainly used for extensive ‘psoriasis’. It is treated with photochemotherapy called PUVA or long-wavelength 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 enhance 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 upset, nausea, and dizziness. In addition, there are inconveniences such as having to wear UV-blocking glasses to protect the eyes for regarding 2 days following 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 wearing sunscreen glasses following 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 used to treat ‘psoriasis’. It has the advantage of being able to provide strong light at once, but has the disadvantage of narrowing the area that can be irradiated at once. In general, rather than treating alone, drugs, ointments, and ultraviolet rays are used in combination. Doctors may change treatment every 12 to 24 months to prevent the treatment from becoming less effective and reduce the risk of side effects.
Precautions for patients with psoriasis
Patients with ‘psoriasis’ should be careful not to injure the skin, as new lesions may develop at the wound site if the skin is rubbed or scratched. For this reason, even when taking a bath, you should not push the dirt excessively.
Streptococcal infections such as sore throat or tonsillitis should be avoided, and mental stress can also make ‘psoriasis’ worse. You should also avoid using medications that aggravate ‘psoriasis’. ‘Psoriasis’ patients are sensitive to the season, i.e. to the climate. Especially in winter, it gets worse, so you need to treat it with special care.
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