What is psoriasis and what complications can it cause? Dr. Doina Ioniță, MedLife Pitesti, explains why it is important to be detected quickly
Psoriasis is one of the most common dermatological conditions encountered in dermatology offices, and the number of cases, including among children, is increasing. “In my office, two out of ten patients who present themselves have some form of psoriasis”,
testified Dr. Doina Ioniță, dermatologist at MedLife Pitesti.
Unfortunately, our country is among the first places in Europe regarding the number of patients with psoriasis, with an estimated prevalence of 2-4.9% of the adult population, i.e. approximately 400,000 people suffering from psoriasis, according to data provided by the Romanian Society of Dermatology. 20-30% of these patients also develop psoriatic arthritis, which over time leads to severe and deforming joint lesions, often causing disability.
The disease affects women and men equally, with an average onset between 15 and 30 years. Studies indicate two peaks of incidence, at 16-22 years and 57-60 years. Psoriasis most commonly occurs in adults between the ages of 50 and 60. “In children, the cases are relatively limited (in general), but now there are more cases than in other years. The number of children with psoriasis is increasing”drew the attention of doctor Doina Ioniță. Worldwide, the prevalence of psoriasis in children remains below 1% in most countries.
Why does psoriasis appear earlier?
Psoriasis is a chronic, non-contagious inflammatory condition characterized by an accelerated rate of skin cell renewal. Skin cells normally regenerate in 28-30 days, but in the case of people affected by psoriasis this process takes place in only 3-4 days. As a result, the skin develops scaly, thickened, pink plaques covered with pearly white crusts, a sign of intense immune activity.
Psoriasis is a multifactorial disease, explains the dermatologist. “There are environmental factors, the level of pollution has increased, and the lifestyle and eating habits have changed. These factors are superimposed on a genetic terrain, a genetic predisposition”, said Dr. Ionita.
The genetic component is important: “40% of patients have a family member with psoriasis”warned the dermatologist. According to genetic studies, psoriasis shows a strong family aggregation, about a third of patients having a close family member affected by the disease. Research also shows that if both parents are affected, the child's risk of developing psoriasis can reach up to 50%, and if only one of the parents suffers from the disease, the estimated risk is around 16%. In addition, twin studies show significantly higher concordance rates between identical than fraternal twins, emphasizing the role of hereditary factors.
“In addition to genetic factors, there are behavioral factors, obesity, smoking, alcohol consumption, which increase the risk of the disease. Another factor is the use of certain drugs, such as, for example, lithium and beta-blockers, a class of drugs with which cardiologist colleagues usually interact. Another factor is certain infections that can trigger or aggravate psoriasis.” said Dr. Ioniță, adding that vitamin D deficiency and stress can, in turn, trigger or worsen the disease.
Two frequent myths, debunked by Dr. Ioniță
One of the most widespread myths that patients come to the office with is related to contagiousness. “I tell them it's not contagious, it's just inherited,” said the dermatologist. Psoriasis is not transmitted from one person to another through physical contact, the use of common objects or sexual contact — it is not based on an infectious agent (bacteria, virus or fungi). Psoriasis is a chronic inflammatory disease, and physical contact with a person who has it poses no risk of contracting the disease.
Another myth is that psoriasis cannot be treated. “Here it is partially true. Psoriasis, once we have it, we can't get rid of it, but with the right treatments we can keep it under control, that is, our skin should have zero lesions, be a clean skin”admitted Dr. Doina Ioniță. Current clinical guidelines emphasize that although psoriasis is chronic and relapsing, appropriate management can significantly reduce symptoms and improve quality of life
Lifestyle and the visit to the dermatologist matter
Many patients present late to the dermatologist. “Some know they have psoriasis, some don't, because they have mild forms that they neglect”explained the doctor, who has a clear message for Romanians: “Once a year, stop by the dermatologist's office.”
Psoriasis worsens in the cold season. “It is one of those diseases that gets better in the sun and gets worse in the cold. Winter increases the addressability to the dermatologist,”
said Dr. Ionita. It advises patients to go to the dermatologist to determine the appropriate treatment because when the disease is controlled the temperature differences will no longer negatively influence the disease.
Quitting smoking and alcohol, managing stress and diet are essential. “Pro-inflammatory diet aggravates and maintains psoriasis”the doctor warned. Foods to avoid include fizzy drinks, pastries, fast food, cold meats, canned goods, white bread and ultra-processed foods.
The disease that affects the whole body
Psoriasis is not just a skin problem. “It's not just limited to the skin. The moment we understand this we realize that psoriasis is more than that“, said Dr. Ioniță. The disease is frequently associated with cardiovascular diseases, hypertension, diabetes, ophthalmological diseases, thyroid diseases or other autoimmune diseases. However, the most serious complication remains joint damage: “30–40% of patients, and undiagnosed and untreated in time, can be disabling.”
Dr. Doina Ioniță exemplified the case of a patient that illustrates the major impact that psoriasis can have on a person's life, but also how much the situation can change when the disease is treated correctly. “It's about a gentleman who knew he had psoriasis for almost 30 years and who was told, at one point, that there wasn't much more to be done”the doctor explains. Coming from an isolated rural area, the patient had lived socially withdrawn for years, until he arrived at the dermatology office. “I started investigations and treatment, and now he is very well. It was a case that made me happy, because the gentleman thought that this was how his life would be until the end.” says Dr. Ionita. The extensive lesions affected approximately 80% of his body surface area and the disease had caused him to isolate himself. Today, the patient has reintegrated socially, “began wearing short-sleeved shirts, began work,” and from “a sad, withdrawn, depressed patient”his life changed radically for the better.
Treatment, adapted to each patient
“There is no standard treatment”the doctor emphasized. Options include topical treatments, phototherapy, and injectable treatments, which “they have diversified a lot in recent years”, said Dr. Ionita.
Even in complicated cases, there are solutions. “When interdisciplinary cooperation occurs, you pick up the phone and talk to the cardiologist or any other medical colleagues who may be involved, so that the solution is adapted to the patient, that is, to improve their health, for good. You prioritize the life-threatening condition and manage the other“, concluded the dermatologist.
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Sources:
https://www.globalpsoriasisatlas.org/en/explore
https://pmc.ncbi.nlm.nih.gov/articles/PMC4285384/
https://pmc.ncbi.nlm.nih.gov/articles/PMC5389757/
