World Psoriasis Day

All About the Disease and the Treatment Regimens to Manage It

On the occasion of **World Psoriasis Day (October 29)**, every year we start our reports and updates on this relatively common and particular condition, which affects a significant portion of people who, beyond clinical management, must also cope with psychosocial impacts. It is a fairly common disease with characteristic skin lesions, although in reality it is a chronic, autoimmune, inflammatory condition that usually appears with remissions and flare-ups.

It is a disease known since ancient times. It is mentioned in Egyptian and Greek writings, even in the Old Testament, where sufferers were regarded as despised and marginalized individuals. The term psoriasis comes from the Greek word “psoros,” which means scale.

According to the **International Federation of Psoriasis Associations (IFPA)**, 2%-3% of the global population suffers from psoriasis, approximately 125 million people. In our country, it is estimated that more than 200,000 people are affected. It affects both sexes roughly equally and can appear at any age.

In a proportion of 10%-15% it appears in children before the age of 10, but more often between the ages of 15-35. However, there are also cases where it may manifest after the age of 60.

It must be clear that psoriasis is not contagious. Certainly, hereditary predisposition is one of the main causes of its appearance, but other factors also play a significant role. Any form of stress on the body can affect its manifestation: mainly psychological but also physical stress, infections, high alcohol consumption, skin injury (Koebner phenomenon), as well as poor diet or smoking can be responsible for triggering it. The season also relates to the manifestation of the disease symptoms: usually in winter, when sunlight and UV exposure are reduced, worsening may occur.

As already mentioned, psoriasis is an autoimmune disease and, as with these diseases, the body paradoxically recognizes its own normal elements as hostile, resulting in various problems. Regarding the skin manifestation of psoriasis, immune system disturbance leads to excessive production of keratinocytes (cells of the surface layer of the epidermis), which causes the formation of thick plaques of stuck skin scales that take on a characteristic silvery-gray color. These plaques may appear in different parts of the body, although there are areas where their presence is more common, such as the elbows, knees, and scalp.

There are several forms of psoriasis, with the most common (about 85% of patients) being **plaque psoriasis**, with characteristic silvery plaques. In 30% of patients, **psoriatic arthritis** may coexist.

We know that psoriasis is an inflammatory disease, so the risk of developing other inflammatory conditions is increased. We are thus talking about so-called comorbidities—the coexistence of more than one disease—such as psoriatic arthritis, cardiovascular disease, hypertension, diabetes, kidney disease, etc. Regarding disease severity, we could say that in the majority of cases (about 80%) there are mild symptoms, and 20% have moderate to severe symptoms. If lesions cover more than 5% of the body surface, it is considered severe. Regardless of severity, the significant impacts on psychology, quality of life, and social interactions of patients must be taken into account. Therefore, timely and proper disease management is very important.

The goal of the treatment regimen is to **slow the proliferation of keratinocytes** and reduce other symptoms, such as inflammation, itching, and pain. Depending on the case, specific **topical or systemic therapies** in the form of creams, foams, pills, or even injectables are chosen. In some cases, **phototherapy (PUVA)**, which uses the beneficial effects of UVB in a technical way, may help. In more severe forms or in the presence of comorbidities, newer **biologic therapies** can be included, which show truly very good results.