Psoriasis

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Psoriasis is one of the most common chronic diseases. In Western countries, an estimated 2–3% of the population is affected. The disease can occur at any age, but it often first appears between the ages of 15 and 25 or between the ages of 50 and 60.

Psoriasis can manifest in different ways depending on its form and severity. Typical signs include:

• Clearly defined, reddened skin plaques
• Silvery-white scales on the plaques
• Itching, burning, or a feeling of tightness
• Dry, cracked skin that occasionally bleeds
• Changes in the nails (pitting, discoloration, separation from the nail bed)
• Joint pain and swelling in psoriatic arthritis

Typical areas where psoriasis occurs:

• Elbows and knees (extensor surfaces)
• Scalp
• Back and buttocks
• Hands and feet
• Nails
• Less commonly: face, genital area

There are various forms that differ in appearance and location, for example:

The most common form, accounting for approximately 80–90% of cases. It presents with the typical silvery, scaly, reddish plaques, primarily on the elbows, knees, scalp, and back.

Small, teardrop-shaped lesions that often appear after a bacterial infection (e.g., scarlet fever). They often affect younger patients.

Affects body folds (armpits, groin, buttocks). No visible dandruff, but reddened, shiny skin.

A rarer form characterized by pus-filled, non-infectious pustules on the skin.

Approximately 20–30% of people with psoriasis develop inflammatory joint involvement. This can occur independently of skin findings and should be evaluated by a rheumatologist.

Psoriasis results from a combination of genetic predisposition and environmental factors:

• Genetic predisposition
  Psoriasis tends to run in families. If one or both parents have the condition, the risk of developing it is increased. The exact genetic mechanisms have not yet been fully elucidated.
• Immunological Overreaction
  The immune system plays a central role: Certain immune cells trigger an excessive inflammatory response, which causes accelerated skin renewal.

Possible triggers for flare-ups (vary by individual):

• Infections (e.g., strep throat)
• Stress and psychological strain
• Certain medications (e.g., beta-blockers, lithium, nonsteroidal anti-inflammatory drugs)
• Skin injuries (Köbner phenomenon)
• Alcohol and nicotine
• Hormonal changes
• Climatic factors (e.g., cold, dryness)

The treatment of psoriasis is tailored to each individual and is supervised by a doctor. It depends on the affected area of the body, the severity of the condition, and the patient’s overall health. Generally, a distinction is made between:

For mild to moderate psoriasis, creams, ointments, or lotions are used:

• Corticosteroids (anti-inflammatory, limited duration of use)
• Vitamin D analogs (e.g., calcipotriol, which slow down skin renewal)
• Combination preparations of corticosteroids and vitamin D analogs
• Moisturizing and nourishing basic therapy (also important between flare-ups)

UV light can reduce inflammatory reactions in the skin. The treatment is performed under medical supervision at specified intervals between sessions.

In cases of severe psoriasis that does not respond adequately to topical treatments, systemic therapies may be used:

• Conventional systemic therapies (e.g., methotrexate, cyclosporine, acitretin)
• Biologics (e.g., TNF-alpha inhibitors, IL-17 or IL-23 inhibitors): targeted therapies that intervene in the inflammatory cascade
• Small molecules (e.g., JAK inhibitors, PDE4 inhibitors)

Specialized physicians select the appropriate therapy based on the patient’s individual findings and risk profile.

Psoriasis is not just a skin condition—it can significantly impair the quality of life for those affected. Visible skin lesions, chronic itching, and the knowledge that the condition is incurable can contribute to psychological distress such as shame, social withdrawal, or depressive moods.

At the same time, stress is considered one of the most common triggers for flare-ups. This connection can create a vicious cycle. If you experience ongoing psychological distress due to the condition, it is advisable to discuss this with your healthcare provider.

Patients with psoriasis are at increased risk for certain comorbidities that should be taken into account by their doctors:

• Psoriatic arthritis (inflammatory joint disease)
• Cardiovascular diseases
• Metabolic syndrome (obesity, elevated blood lipid levels, diabetes)
• Inflammatory bowel diseases (e.g., Crohn’s disease)
• Mental health conditions (depression, anxiety disorders)

Regular medical follow-up is therefore particularly important for psoriasis.

Skin conditions such as psoriasis are among the common concerns for which a telemedical evaluation may be possible. By reviewing photographs of the affected skin areas, doctors can make an initial assessment—for example, to evaluate an acute flare-up or to monitor the progression of a known condition.

A telemedical evaluation typically takes into account photos of the affected skin areas as well as information on symptoms, duration, previous treatment, and any potential triggers.

Whether a telemedicine consultation is appropriate in a specific case depends on the severity of the condition and the patient’s individual situation and is determined by the treating physicians. A physical examination is generally indicated if psoriatic arthritis is suspected, in cases of severe disease, or upon initial diagnosis.