Psoriasis is a chronic relapsing autoimmune-related skin disease characterized by erythematous scaly plaques, commonly found on the knees, elbows, and scalp. This condition affects approximately 2-3% of the global population and may be accompanied by complications such as arthritis, significantly impacting the quality of life for patients. The course of psoriasis is cyclical, with periods of flare-ups alternating with remission, but there is currently no cure, necessitating long-term management to control symptoms.
The pathological mechanism of this disease involves the excessive proliferation of skin cells and abnormal activation of the immune system, leading to a significantly shortened skin regeneration cycle. Modern medicine has confirmed that the interaction between genetic predisposition and environmental triggers is key to the onset of the disease, although the specific pathogenic mechanisms remain a mystery. Treatment strategies for psoriasis have developed multifaceted interventions, including topical medications, phototherapy, oral medications, and biologics, but patients still require personalized treatment plans to achieve optimal control.
Genetic studies have shown that polymorphisms in specific genes such as HLA-C are highly correlated with the incidence of psoriasis, particularly the HLA-C*06:02 genotype on chromosome 6, which increases the risk of developing the condition. A family history is an important risk factor; if a first-degree relative has a history of psoriasis, the individual's likelihood of developing the disease can exceed 50%. Genetic research indicates that approximately 40% of the risk can be attributed to genetic factors, but environmental triggers still play a critical role in initiating the disease.
Improper activation of T lymphocytes is at the core of psoriasis pathogenesis, particularly the overactivation of TH17 cells that release cytokines such as IL-17, inducing keratinocyte proliferation. This autoimmune response creates a vicious cycle with impaired skin barrier function, leading to the accumulation of scales and erythema. Recent studies have further identified the abnormal activation of the IL-23/IL-17 signaling axis as a key driving factor in disease onset.
Typical skin manifestations include well-defined erythematous plaques covered with silvery scales, which may exhibit pinpoint bleeding (Auspitz sign) upon scratching. Commonly affected areas include the extensor surfaces of the elbows, knees, scalp, hips, and sacrum, with approximately 85% of patients experiencing scalp involvement. Lesions may worsen dramatically with stress, infection, or changes in climate.
About 30% of patients may develop psoriatic arthritis, characterized by symmetric arthritis, swelling of the fingers, and morning stiffness. When the spine is involved, symptoms similar to ankylosing spondylitis may occur, and X-ray examinations may reveal destructive changes in the joints. Systemic symptoms may include fatigue, low-grade fever, and weight loss.
Palmar-plantar psoriasis affects the palms and soles, often accompanied by painful nodules; inverse psoriasis typically occurs in skin folds, presenting as erythematous moist lesions. Erythrodermic psoriasis is a severe form that may lead to complications such as sepsis and requires immediate medical treatment.
Diagnosis primarily relies on clinical presentation, with doctors conducting detailed inquiries into medical and family history, as well as visual and tactile examinations of skin lesions. Skin biopsies may be performed when necessary to rule out similar conditions such as eczema or fungal infections. Joint symptoms should be evaluated alongside blood tests for rheumatoid factor, C-reactive protein, and imaging studies like X-rays or ultrasound to assess the extent of joint damage.
It is essential to differentiate psoriasis from seborrheic dermatitis, eczema, and psoriatic arthritis. Seborrheic dermatitis commonly occurs in areas with abundant oil secretion, with thinner scales and accompanying oily secretions. Psoriatic arthritis may be associated with internal tumors, necessitating blood tests to rule out malignant changes. Severe forms must be distinguished from erythrodermic drug rashes or skin manifestations of systemic lupus erythematosus.
First-line treatments include corticosteroid creams, retinoids, and coal tar preparations. Potent corticosteroids are suitable for the extensor surfaces of the limbs, while scalp lesions may require shampoos containing coal tar. Newer topical medications such as tacrolimus can inhibit T-cell activation and are suitable for sensitive areas like the face.
Narrowband UVB phototherapy is a common choice for moderate cases, with cumulative doses adjusted according to the severity of lesions. PUVA therapy combines oral psoralen with UVA exposure, effective for widespread lesions, but caution is needed regarding the risk of photoaging. 308nm pulsed dye laser has shown good results for localized lesions, especially on the scalp or nails.
Moderate to severe patients may require oral methotrexate or cyclosporine, which can suppress immune responses but necessitate monitoring of liver and kidney function. Biologics such as anti-TNF-α monoclonal antibodies (e.g., adalimumab) can precisely block inflammatory signals and are particularly effective for those unresponsive to traditional treatments, but the risk of infections must be assessed.
While it is impossible to completely prevent the onset of psoriasis, the following measures can reduce the frequency of flare-ups:
Avoiding trauma and scratching, and wearing loose clothing can reduce friction and irritation. Psychological support is crucial for patients; stress management courses or cognitive behavioral therapy can lower the frequency of flare-ups. Regular monitoring of liver and kidney function and cardiovascular indicators is essential, as psoriasis patients have a 30% higher risk of cardiovascular diseases compared to the general population.
Seek immediate medical attention if the following conditions occur:
• Lesions cover more than 3% of the body surface area.
• Joint swelling or morning stiffness lasts more than 1 hour.
• Severe itching significantly affects sleep quality.
• Signs of skin infection such as pus or ulceration.
• Treatment plans are ineffective or develop resistance.
If systemic symptoms such as fever, weight loss, or lymphadenopathy occur, it is necessary to rule out other systemic diseases. Regular follow-up every 3-6 months is recommended, especially for patients using biologics, to monitor potential infection risks.
Phototherapy suppresses inflammatory responses and excessive skin cell proliferation using specific wavelengths of ultraviolet light (such as UVB or narrowband UVB). Modern phototherapy devices can accurately control doses, which may cause short-term skin redness and swelling, but with long-term use, professional physicians will adjust based on skin conditions, significantly reducing long-term risks such as skin cancer.
Does dietary adjustment help alleviate psoriasis symptoms?While diet cannot directly cure psoriasis, reducing high-sugar and high-fat foods can lower systemic inflammatory markers, while fish rich in Omega-3 and antioxidant-rich fruits and vegetables may improve symptoms. It is recommended to work with a nutritionist to develop a personalized dietary plan, avoiding self-imposed fasting or excessive nutritional restrictions.
How does stress management specifically help control psoriasis flare-ups?Stress can trigger or exacerbate psoriasis; mindfulness meditation, regular exercise, or cognitive behavioral therapy can help regulate stress hormones. Studies show that patients who consistently engage in stress management experience an average reduction of 30% in the frequency of skin symptom exacerbations, and it is advisable to develop long-term psychological adjustment strategies in consultation with a physician.
What precautions should be taken in daily skin care?Avoid using skincare products containing alcohol or strong exfoliating ingredients to prevent irritation of the skin barrier. The water temperature during bathing should be below 40°C, and the process should be completed within 3 minutes, followed by the immediate application of fragrance-free, highly moisturizing lotion to reduce scale accumulation and itching.
How can psoriasis be distinguished from eczema in skin manifestations?Psoriasis plaques are typically covered with silvery scales, have well-defined borders, and are often found on the knees and elbows; eczema, on the other hand, tends to present as redness, oozing, and chronic itching, commonly occurring in the folds of the elbows. If symptoms are unclear, a physician may need to perform skin biopsies or blood tests for further differential diagnosis.
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