What is psoriasis?
Psoriasis is a permanent, recurrent skin disease. It is known that 7.5 million individuals in America have psoriasis, and this number is estimated to be close to 1 percent of the population in Turkey.
Why does psoriasis occur?
Although the cause of psoriasis is not known exactly, we are getting closer to the result with new scientific researches and we can treat especially severe psoriasis and psoriasis rheumatism more effectively and without side effects with drugs that show their effect with completely different systems compared to the previous psoriasis drugs, which we call biological treatments.
Psoriasis is an immune system disease. T lymphocytes with a mission in our immune system have a valuable role in the formation of psoriasis. The complete recovery of psoriasis, especially after bone marrow transplants for other diseases, confirms this.
When the skin is damaged or a germ settles, the skin cells need to multiply more to repair it. The goal is to encourage cells to proliferate to repair the wound in a shorter time. However, in psoriasis patients, the immune system of these cells, called T lymphocytes, is out of tune and when everything is fine, they begin to secrete elements that increase skin cells.
As a result, the functions of the skin cells that multiply rapidly in reasonable areas are also impaired and increase before they are fully matured. They cannot fully establish the relationship between them and form layers that dry out and fall off.
The belief that psoriasis is a disease originating from the liver is not without fault. It has nothing to do with the food eaten.
Genetics and heredity of psoriasis (Will my children also have psoriasis?)
1/3 of psoriasis patients have psoriasis in their families. Psoriasis is more common in identical twins than in fraternal twins (Identical twins: 71%, fraternal twins: 28%)
The gene known to be related to psoriasis is PSORS1 and is located in the gene region that regulates the work of the immune system, which we call MHC. Other PSORS genes have also been identified at the same time.
The only way to identify these genes is to analyze blood from psoriasis patients. The more psoriasis patients are investigated in terms of this issue, the faster the exact cause of the disease can be reached. In fact, the National American Psoriasis Association has created a biobank for this reason.
Psoriasis is not an inherited disease. Although the rate of catching psoriasis in the children of families with psoriasis has increased by 1-2% compared to the children of the normal family, this does not mean that they will definitely catch psoriasis.
Causes that increase psoriasis
Since psoriasis is a disease related to the immune system, some infections and medications can increase psoriasis. Mental stress and climate changes also affect psoriasis.
Psychological Stress
Studies have shown that psoriasis changes especially in important life changes. In some recent studies, it has been determined that some issues that have the feature of triggering the immune system in the body increase in the blood along with stress.
Bacterial and viral infections
It is known that psoriasis flares up especially in children with streptococcal bacterial infections in the throat. For this reason, patients who have always had tonsillitis should receive a complete treatment. Often, dermatologists ask for an antibiogram test by taking a culture from the throat with a cotton swab, even if the person does not have any complaints. Apart from these, the treatment of diseases in which there is always a source of infection in the body (for example, decayed teeth) is a condition.
Climate
Psoriasis decreases in sunny climates and increases especially in winter. Again, psoriasis is less common in low altitude areas. Since the humidity is low in dry climates, patients feel more itching in the crusted areas. For this reason, psoriasis patients can be more comfortable in areas with a humid climate. Again, in winter, the air dries up with the effect of heating and stoves, and itching increases in crusting. Psoriasis patients should use plenty of moisturizer in winter.
Medicines
Drugs That Increase Psoriasis:
l Antimalarial drugs (Treatment of malaria and rheumatism): chloroquine – Chloroquine
l Lithium (Treatment of psychiatric diseases)
l Propanolol (Treatment of blood pressure and cardiovascular diseases)
l Anti-inflammatory (NSAID) drugs: Although they are thought to increase psoriasis, it has been observed that painkillers have little effect on psoriasis, so they are not restricted in psoriasis patients.
There are scientific studies showing that smoking and alcohol increase psoriasis.
Koebner phenomenon:
Injury to psoriasis-free skin can cause new psoriasis lesions to form in this area. This phenomenon is called the Köbner phenomenon. Sunburn and cuts can cause this condition. Although the sun is very good for psoriasis, sunbathing that will burn for a long time should be avoided. Psoriasis patients should not have permanent tattoos, because psoriasis can also occur in tattooed areas. Severe itching in psoriasis wounds can lead to the formation of new psoriasis wounds with the effect of Köbner phenomenon on the surrounding skin, so it should be treated. In addition, many psoriasis patients play with the crusts and break them. This situation can also cause the same problem again.
Psoriasis Treatment
Psoriasis wounds can be treated. But there is currently no formula in the world to treat the recurrence of wounds. We can collect the formulas used in the treatment of psoriasis in several categories:
Ointment treatments:
Ointments are also divided into several clusters according to the ingredients in them. We use ointments especially in limited psoriasis that does not cover the entire body.
Ointments containing cortisone:
They are drugs that are used with great fear in the middle of our patients, but whose side effects are exaggerated, especially because they contain the phrase cortisone. Treatment of drugs containing cortisone begins within a short period of time. They are very effective in passing the redness and heal the psoriasis wounds that are not heavy crusted in a short time. However, they should be used under the supervision of a dermatologist. Because psoriasis provides resistance to cortisone and does not show the beautifying effect it showed at first when used for a long time. For this reason, your medications should be changed at intervals by your dermatologist. Cortisones are not equally effective. Some cortisone ointments show a stronger therapeutic effect in a shorter time than others, but when used unsupervised for a long time, they cause more frequent side effects such as skin thinning and vascularization in the skin.
When cortisone drugs are regularly supervised by your dermatologist, they are drugs that take effect in the shortest time in the middle of treatments and take psoriasis under control. They do not cause side effects when used under physician control.
When ointments containing strong cortisone are used for a long time without the supervision of a physician and in common psoriasis, they are absorbed from the skin and may cause side effects related to cortisone treatment such as weight gain and osteoporosis.
· Humidifiers:
It is one of the most valuable elements of psoriasis treatment. The crusting in the psoriasis causes itching and creates a layer, preventing other creams from reaching the psoriasis wounds. Moisturizers reduce crusting and counteract the itching sensation of psoriasis. Moisturizers have no side effects. They can be used comfortably for long periods. The easiest and cheapest of the moisturizers is undoubtedly Vaseline.
Calcipotriol:
It is more effective in psoriasis wounds that do not progress with crusting. We can use it to maintain the state of conformity, especially in periods when the mother-of-pearl becomes beautiful. The size to be applied to the body is finite, so it is not used in common psoriasis wounds. It is not used on sensitive skin areas such as groin and armpits, genitals.
· Tar derivatives:
Tar-derived drugs correct psoriasis by suppressing the growth of skin cells. There are varieties obtained from coal and plants. There are scientific publications stating that the long-term use of charcoal without medical supervision will increase certain types of cancer. Although this side effect is not encountered in herbal tars (such as Juniper tar), it is very valuable to use them again under the supervision of a physician. Especially odors and skin dyeing cause problems when used. New drugs have tried to reduce these properties. They are not used because they cause irritation in areas where the skin is thin, such as the armpits, groin, genital area.
Tar is one of the most important drugs used by those who claim that they treat psoriasis with plants. Since more than one patient is not warned about the above issues, they think that the dry, reddened peeling skin made by the wrong treatment is normal and endures these side effects, thinking that it will get permanent results.
Anthraline:
The feature of this drug, which acts in a different way, is to regulate the treatment by leaving a reasonable period of time on the skin. If it can dye on the skin or if the patient accidentally keeps the drug on the skin for a long time, side effects such as redness, burning and burns occur. However, it is especially effective in psoriasis wounds that are resistant to treatment. Since the timing of the treatment is very valuable, it should definitely be used under the supervision of a dermatologist. It is not used in areas where the skin is thin, such as the armpits, groin and genital area.
· Pimecrolimus and Tacrolimus:
Since these newly emerging drugs do not contain cortisone, they can be used in the long-term treatment of psoriasis. They can be used for a long time, especially in areas where the skin is thin, such as the face and eyelids. Since blood cancer develops in a few patients with long-term widespread use in infants, you should definitely use it under the supervision of your physician.
· Light Therapies (Phototherapy: PUVA, Narrow Band UVB, Microphototherapy, Targeted Phototherapy and Laser):
Light therapy, in other words phototherapy, is based on copying the sun’s favorable effect on psoriasis and applying it with special devices. Ultraviolet light is the type of light that is effective on mother-of-pearl and is found in the sun. UVA is the first type of light found, UVB and Narrow Band UVB were later found and have less side effects than UVA treatment. The side effect that every patient fears in light therapy is the development of skin cancer. It turns out, as a result of a recent study at Hacettepe Faculty of Medicine, psoriasis patients treated in this center did not have time to treat skin cancer, only harmless sunspots developed.
With the advancement of technology, it has become possible to give ultraviolet light only to psoriasis wounds with fiberoptic systems (Microphototherapy, Targeted Phototherapy). In this form, only the problematic area can be treated without the entire skin receiving light. Lasers are a little more effective than other treatments, but the application costs are very high.
Light treatments can be applied in the form of cabin, hand-foot units, hair treatment unit and targeted (microphototherapy) phototherapy.
· PUVA:
PUVA therapy, which is the first of the phototherapies to be used, is a treatment that is often applied in the form of a cabin. The patient is taken into a cabinet resembling a solarium, and the cabinet is closed and ultraviolet A light is given to the patient for a reasonable period of time with the fluorescent lamps inside. In PUVA treatment, a medicine is given to the patient in pill form or a special medicine is applied to the wounds so that the ultraviolet A light is better absorbed by the psoriasis wounds. After the medication applied in pill form comes out of the treatment, the patient should go out by using sunglasses and a hat, and wearing sunscreen. The effects of the drugs will wear off after a certain period of time.
The treatment is applied 2 or 3 times a week. In general, treatment is started with 20 sessions and phototherapy is continued according to the patient’s response to treatment. Although its side effects are more than other light treatments, it suppresses the emergence of psoriasis for a long time in successful events.
· UVB – Narrow Band UVB Treatment:
This treatment is similar to PUVA, but because the fluorescents are different, the light they produce is also different. In this type of treatment, there is no need to take pills or apply a medicine to the skin beforehand.
· Targeted phototherapy, Microphototherapy:
In this newly applied phototherapy way in Turkey, the operator can give the light directly to the problematic skin areas with the special head of the device. In this way, heavy light can be given in a shorter time, and it is possible to beautify without applying medication by applying 2-3 times a week, especially in psoriasis in the border area. The period of silence after psoriasis treatment starts from 2-3 months. The advantage of this treatment is that phototherapy can be applied even if the patient does not have extensive psoriasis. This treatment can be easily applied to heart patients and patients who cannot enter the cabin. This treatment offers an alternative to patients who have applied cream for a long time, developed cortisone resistance and are bored with this treatment, and causes long-term remission (not recurring the disease).
· Laser treatments:
Excimer lasers in which ultraviolet light is aggravated or lasers that burn the vessels feeding the psoriasis are used in this type of treatment. Although they offer a slightly longer psoriasis-free time compared to other treatments, the treatment costs are quite high.
· Treatments in the form of pills and injections (Systemic treatments)
Undoubtedly, the request of each of our patients is that we recommend a medicine for psoriasis in the form of pills or injections. Because it is difficult to apply cream treatments, especially in very common psoriasis, it is not possible. But for psoriasis, a pill or injection with mild side effects has not been released so far. Below we will list the most commonly used treatments for this disease. Remember that the treatment of psoriasis is variable in each of our patients. Our desire when choosing the treatment is to provide the maximum benefit to our patient with the least side effects.
· Methotrexate:
This drug is also used in the treatment of cancer, and for this reason, more than one of our patients hesitates when using the drug in the first place. However, with the emergence of new needle forms that can be administered subcutaneously, the drug is generally used by our patients in a very comfortable form. The use case is usually once or twice a week and the dose is calculated according to the weight of the patient and the prevalence of psoriasis. Stomach and digestive system side effects may occur frequently with the use of the drug in pill form. With the use of the new subcutaneous injection form once a week, this side effect has also disappeared. Methotrexate shows its effect by reducing the immune system cells that work incorrectly in psoriasis. It can be used easily for months under the supervision of a dermatologist. What should be considered is that you have systematic analyzes recommended by your dermatologist. Apart from this, healthcare workers and those whose relatives have tuberculosis (TB disease) should be followed carefully. Patients using methotrexat should keep themselves safe when they have flu around them, and should consult their physicians without waiting for the fever to rise when complaints such as fatigue and cough arise. Methotrexate may hide the signs of an easy infection and cause an increase in the disease. Since it may cause side effects on the liver in long-term use, your doctor may request a liver biopsy in some cases. You should consult your doctor when using other medications while using methotrexate. The effect of the drug usually occurs within 1 month and continues with the newly applied doses.
· Acitretin (Neotigason):
Acitretin type drugs are obtained by replacing vitamin A. They are drugs used in pill form. The dose and duration of use are calculated according to your weight and the scale of your psoriasis. These drugs correct psoriasis by exfoliating the skin and adjusting the regeneration time of the skin. For this reason, the side effect we see in almost every patient using this drug is drying and cracking of the lips. However, it can cause peeling on the skin of the hands and feet, thinning and slight dryness in the whole body. Nail changes and hair loss are common side effects. Since the facial skin also dries out and becomes sensitive, a sunscreen with a high defense factor should definitely be used, especially in summer. The use of lenses is not recommended, as dry eye during the use of the drug will cause a problem in patients who wear lenses. Acitretin can raise your blood fats and cause increased liver function. For this reason, your doctor will ask you for some analyzes from time to time. Acitretin is a drug that can be used with confidence in the long term. The most valuable side effect of acitretin is on the baby in the womb. If pregnancy occurs in women using acitretin, there is a very high risk of giving birth to a disabled baby. For this reason, it is not recommended for women to have children while using the drug and up to 2 years after stopping it. Just like they can’t breastfeed on time. Due to this side effect of the drug, it is inconvenient for all patients who use acitretin, male and female, to donate blood, as the blood they will give may go to a pregnant woman. After the drug is started, it begins to show its full effect within 1-2 months.
· Cyclosporine:
This treatment, taken as a capsule, corrects psoriasis by suppressing the immune system cells that are effective in the formation of psoriasis. Cyclosporine is a drug that prevents rejection of the organ by the body in transplant patients. Since the drug may have side effects on the kidneys and some elements in the blood in the long term, regular analyzes should be performed while using the drug. Cyclosporine shows its smoothing effect on psoriasis in about 1-2 months.
Biological treatments:
They are the last drugs on the market in the treatment of psoriasis. While they have an effect on the cause of psoriasis, some of them have been withdrawn from the market due to the significant side effects they have created. They are treatments applied in the form of needles. Depending on the type of drug, they can be applied once a week or once every 2 weeks. Like methotrexat, they suppress the immune system, so patients using them should protect themselves against infections. As with other systemic treatments, analyzes and inspections should be carried out at reasonable intervals. Biological treatments are covered by SSI (SSK, Bağkur and Yeşilkart) with health reports issued by training and research hospitals or university hospitals in our country. In general, we use these treatments, which are quite new, in our patients who used certain drugs before and did not benefit.
Climate treatments (Balıklı lake, Dead lake and others)
The fish lake and other regions in Sivas are undoubtedly one of the most frequently asked treatments by our patients. The wisdom of the fish in the fish lake is actually to reduce the thickness of the wound by eating the mother-of-pearl shells. The patient, whose psoriasis wounds are examined, sunbathes in the open pools and actually applies the light therapy, which we do in the hospital rules, under natural conditions. The ultraviolet light in sunlight is a weak light, but it easily penetrates the wound thinned by the fish. We provide this effect by giving peelers to our patients with thick wounds before phototherapy. However, the most valuable effect of the fish lake is undoubtedly on psychology. Our patient, who thinks he is alone and alone in his world, encounters many psoriasis patients here, talks to him and shares his life. He sees patients who are worse off than himself and is grateful. Our Ministry of Health covers this treatment, which it considers as a spa treatment, with a reasonable percentage, provided that a health report is issued. The usual negative thing is hygiene. Theoretically, fish that bite wounds in crowded pools can carry disease in the midst of patients. Theoretically, although there is this risk, it has not been proven in a scientific publication. Dead Sea is a lake located in Israel and ultraviolet light is heavy in its atmosphere, thus it is beneficial for psoriasis wounds. In other words, we can provide the elements that are beneficial in climate treatments, mainly on hospital pedestals.
How does your doctor choose the right treatment for you?
The prevalence of psoriasis, your age, your gender and the resistance of your psoriasis to treatments play a major role in treatments such as Neotigason. Mostly, we apply microphototherapy and ointment treatment for psoriasis in finite areas in our hospital, and pill and needle treatments for more common psoriasis. Systemic treatments can also be used in psoriasis that has become resistant to long-term ointments.
The golden rule in psoriasis treatment: It is to come to follow-ups
It is unknown how psoriasis will progress in every patient. For this reason, after we recommend the necessary treatments to our patients, we call them for inspection. Medications given may not correct psoriasis in the first place. When we see this, we make a medication change and get one step closer to correcting psoriasis scars. For this reason, our patients should definitely follow up.
Psoriasis and Psychology
Psoriasis is a disease of sensitive and thoughtful individuals. In general, psoriasis progresses slowly and recurs frequently in people who are well-intentioned, do not reflect their feelings, and make reasonable points in daily life and lose their sleep. A psychologist to be consulted for unsolvable problems or an urgent vacation may probably be the most adequate prescription. However, the best offer for our patients who have this kind of intention structure is to be a little more “blind”.
Reach & Share Psoriasis
The most adequate way to overcome your problems and illness is to share your life with other psoriasis patients. Don’t forget to be a member of the psoriasis forums on Yalnizgilim.com and on Doktorsite.com.