What is psoriasis?
Psoriasis is a non-contagious, inflammatory skin disease (dermatosis), also an possibly other organs concerned system disease, this concerns above all the joints and related bands and adjacent soft tissue, eyes, the vascular system and heart. She can also lead to diabetes and stroke.
It is primarily through heavily flaking, point to Palm-sized skin areas (often at the knees, elbows and scalp, also in the anus) - often with severe itching - as well as changes in the nails.
Worldwide 125 million, in Germany approximately two million people suffer the disease.
The etiology of psoriasis (hereditary disposition, autoimmune reaction) is probably multifactorial and still not finally resolved.
2004 the 29 October was proclaimed by the International Federation of psoriasis associations for the first time as world psoriasis day.
What causes psoriasis?
The etiology of psoriasis is probably multifactorial; Context, extent and effect of hereditary predisposition and autoimmune response and other potential triggers are not fully understood.
Hereditary disposition
Psoriasis is hereditary to a considerable extent, therefore familial aggregation is observed, occasionally several generations are skipped. To date, however, is not known if the psoriasis is inherited as dominant or recessive. It is believed that it is triggered by the interaction of variants of various genes and environmental influences. The risk of an identical twin of an affected person, also contracting the disease, is 65-72%. Approximately 2-3% of the population in Central Europe are affected by the disease, while the share in the USA at about 4-5% is located. For Inuit, Indians, Black Africans and Aborigines psoriasis occurs as well as not; in Japan and the People's Republic of China, the prevalence is from 0.025 to 0.3%, most commonly it is among Kazakhs (up 12%). Not all Erbmalträgern the psoriasis comes to the outbreak; to the genetic trait probably have added another, mostly still unknown factors.
Remain actually receive adverse genes that, when inherited diseases for thousands of years, is trying to explain by other selective advantages of those affected. For psoriasis, it is postulated that psoriasis prone individuals suffer less from skin infections, because they have more defensins (antibacterial proteins contained in the cells of the stratum corneum of the skin).
Malfunction of the immune system
It is assumed that it is an autoimmune T-cell-mediated immune reaction in which the immune system recognizes the body's own tissue as foreign and attacks. In the affected tissues results in a proinflammatory milieu.
Surprisingly found an Italian study, a prevalence of 18 percent with latent tuberculosis infection among over 400 psoriasis sufferers. Whether the infection is a risk factor for psoriasis, or whether both infection and psoriasis by the same defect are favored in the immune system needs to be further investigated.
Treatment for psoriasis
Based on the understanding of psoriasis as a genetic disease and the fact that a gene is not yet available, it is expected with other types of treatment do not cure, but only a reduction in symptoms. In addition, as with all diseases with phasenhaftem course and spontaneous improvements, the effectiveness of treatment methods may be difficult on the one hand differed from the placebo effect and the other part of spontaneous recovery (remission) with respect to this relief. This applies to medical treatments such as alternative medical basis. The treatment is graduated according to the severity of the disease and the possible involvement of organs:
Nutrition
In some cases there is a link between psoriasis and celiac disease. The celiac offered anyway waiver of foods with gluten gluten can also relieve psoriasis symptoms.
Psychomental approaches
Since the psoriasis worsened in many cases by negative psychological effects, treatments can prevent the stress and / or change attitudes towards illness, have positive effects of psoriasis. Self-help groups for people with psoriasis will not only help to find a suitable treatment method for psoriasis own, they give the person concerned and the certainty with which disease is not alone in the world to be. Total acceptance is an important factor in dealing with psoriasis.
Can be attributed to outsiders methods such psychological factors may also often reported successes. Patients who are susceptible to such not scientifically recognized methods, can also benefit indirectly by helping their psyche.
Exterior applications
If clinically less severe skin lesions are usually limited to topical applications (topical therapy). In most treatments the patient for a longer period of weeks or even months shall cease:
-Dithranol (also known as anthralin) - slows down the cell division and has a good efficiency. However, this method is extremely expensive to treat. Older preparations had other disadvantages such as the browning and the surrounding healthy skin, but also many items that have come into contact with the product such as clothing, bedding and sink. There are now modern preparations commercially, through which can reduce the side effects described above clearly. So by the minute therapy, applied at the dithranol only a few minutes on the affected areas and then washed off.
-Urea (Urea pura) - is used for the care and treatment in the form of grave goods in oil, cream and ointments.
-Corticosteroids - synthetic drugs that mimic the human hormone of the adrenal cortex. Strong corticosteroids such as clobetasol or betamethasone reduce the inflammatory symptoms quickly. However, because of the side effects corticosteroids should be used only briefly and only on small areas of skin. They are not suitable for treatment of large areas of skin. The most suitable corticosteroid ointments are still for the scalp. An effect caused by these drugs often, the skin atrophy (thinning of the skin). The veins shine through then through the skin. The compatibility can be favorably influenced by cortisone is applied as a fixed combination with calcipotriol. In an investigation, in patients with scalp psoriasis for 52 weeks, the fixed combination of calcipotriol and betamethasone were applied (in Lipo-gel form), there were no patients to the dreaded skin atrophy - the thinning of the skin , Due to the good compatibility and high efficiency, these fixed-dose combination is recommended in the guidelines for medical treatment of scalp psoriasis as initial therapy.
-Salicylic acid - used mainly for removing the scales. In the guideline of the German Dermatology Society for psoriasis of the scalp, is that it may lead to salicylate intoxication due to systemic absorption. This is possible especially pronounced in planar or inflammatory changes in children. However, are now usually omitted desquamation before the actual treatment in modern measures. However, since this material is also anti-inflammatory, it is used in relatively mild effect directly for treatment.
-Coal tar - Used to treat chronic skin diseases for a long time. Slows cell division and reduces itching. However, the tar substances used for this purpose are now considered carcinogenic, so they apply only to a very limited and well-known products have been withdrawn from the market.
Vitamin B12 (cyanocobalamin) in avocado oil ointment base is as non-pharmacy-Paid medical device for the treatment of psoriasis available. So far, only a small study was published. Large clinical trials for treatment with B12 ointment are not yet available.
-Vitamin D derivatives - are synthetic substances that mimic a hormone that plays an essential role in the control of immunological and regenerative processes of the skin. They reduce the mitotic activity of the skin cells. The calcipotriol used or Tacalcitol are those vitamin D derivatives, which reduce the risks of vitamin D (hypercalcemia) many times.
-These drugs can be dangerous in overdose side effects; in general, they are well tolerated. A common method of treatment consists in the combination with UV light therapy.