How does psoriasis start?

How does psoriasis start?

Psoriasis is a chronic inflammatory skin disease that affects millions of people worldwide. It manifests itself in a variety of forms and can severely impact patients' quality of life. Understanding the causes and triggers of psoriasis is crucial to its management and treatment. This article explores triggers, types of psoriasis and management strategies.

What is psoriasis?

Psoriasis is a chronic disease characterized by accelerated renewal of skin cells, leading to the appearance of red patches covered with white scales. It is a chronic inflammatory disease in which the immune system plays a central role. This imbalance in the immune system leads to excessive inflammation, which accelerates the life cycle of skin cells.

Acceleration of the cell cycle

Accelerated cell renewal in psoriasis is at the heart of the formation of the red patches characteristic of this disease. Here's why it happens:

1. Normal Cell Cycle vs. Psoriasis

  • Normal cycle: Under normal circumstances, skin cells (keratinocytes) are renewed approximately every 28 to 30 days. Old, dead cells are shed from the skin's surface and replaced by new cells formed in deeper layers.

  • Cycle in psoriasis: In psoriasis patients, this cycle is considerably accelerated. Skin cells are renewed in just 3 to 6 days. This means that new skin cells reach the surface much faster than they should.

2. Accumulation of skin cells

  • Accumulation: Because of this acceleration, skin cells don't have time to detach normally. They therefore accumulate on the skin's surface, forming thick layers of immature cells.

  • Red patches and scales: This rapid accumulation of cells leads to the appearance of thick, raised, reddish patches, often covered with silvery or white scales. These scales are actually dead cells that have not been properly eliminated.

3. Inflammation

  • Inflammatory response: The accumulation of skin cells triggers an inflammatory reaction in the skin. The immune system, which is dysregulated in psoriasis, sends out defense signals in the mistaken belief that it is fighting an infection or aggression.

  • Redness: This inflammation causes blood vessels in the skin to dilate, resulting in the characteristic redness of plaques. Immune cells also release pro-inflammatory substances, such as TNF-alpha and interleukins, which aggravate the inflammation and further accelerate the cell cycle.

4. Skin thickening

  • Hyperproliferation: In addition to the build-up of dead cells, new cells rapidly rise to the surface and don't have time to mature properly. They accumulate in thick layers, creating dense, rough patches.

  • Plaque texture: this hyperproliferation and chronic inflammation lead to thick, rough, raised plaques that are often irritating and sometimes painful.

Causes of psoriasis

The exact causes of psoriasis are not completely understood, but several factors are involved:

  • Genetic predisposition: Psoriasis patients often have a genetic predisposition. If a parent suffers from psoriasis, there is an increased risk of children developing the disease.
  • Immune system: Psoriasis is largely due to a dysfunctional immune response. T cells, a type of white blood cell, mistakenly attack healthy skin cells, causing inflammation and rapid production of new skin cells.
  • Triggering factors: Various factors can trigger or aggravate psoriasis, such as stress, infections (especially streptococcal infections, which can trigger gouty psoriasis), skin trauma (Koebner phenomenon), certain medications, alcohol and tobacco.

The different forms of psoriasis

There are several types of psoriasis, each with its own specific characteristics:

  1. Plaque psoriasis: This is the most common form, characterized by thick red patches covered with white or silvery scales. These plaques often appear on the elbows, knees, scalp and lower back.

  2. Guttate psoriasis: manifests as small, drop-shaped lesions on the skin, often triggered by a bacterial infection such as strep throat.

  3. Inverted psoriasis: This type develops in skin folds, such as under the armpits, under the breasts or in the groin area. Plaques are often smooth and shiny.

  4. Pustular psoriasis: Characterized by non-infectious pustules surrounded by red skin, often localized on the hands and feet.

  5. Erythrodermic psoriasis: This rare but serious form causes intense inflammation over a large part of the body surface, requiring urgent medical attention.

Psoriasis and psoriatic arthritis

Around 30% of psoriasis sufferers develop psoriatic arthritis, a form of inflammatory arthritis that can cause joint pain, stiffness and swelling. This complication highlights the importance of proactive disease management to prevent severe complications.

Managing psoriasis

Management of psoriasis depends on the severity of the disease and its impact on patients' quality of life. Treatments aim to reduce inflammation, slow down the excessive production of skin cells, and relieve symptoms.

  • Local treatments: These include creams and ointments based on corticosteroids, vitamin D or salicylic acid to reduce inflammation and skin thickening.

  • Phototherapy: Controlled exposure to ultraviolet B (UVB) rays can help reduce psoriasis symptoms, particularly in moderate to severe cases.

  • Systemic medications: For severe psoriasis, systemic treatments such as immunosuppressants or biotherapies may be prescribed to modulate the immune response.

  • Stress management: Stress being a major trigger, stress management techniques such as meditation or behavioral therapy can be beneficial.

What beauty routine for psoriasis?

A psoriasis-friendly beauty routine should be designed to soothe symptoms, moisturize the skin, and minimize irritation. Here's a recommended daily routine for psoriasis sufferers:

1. Gentle cleaning

  • Products to use: Opt for a gentle, soap-free cleanser specially formulated for sensitive skin. Look for hypoallergenic, fragrance-free and alcohol-free products that won't disrupt the skin barrier.
  • How to: Wash your face and body with lukewarm water, never hot, as hot water can dry out the skin and aggravate psoriasis plaques.

2. Intense Hydration

  • Products to use: Apply a thick moisturizing cream or balm containing ingredients such as ceramides, hyaluronic acid, shea butter, or natural oils like argan oil or avocado oil.
  • How: Moisturize your skin immediately after a shower, when the skin is still slightly damp. This helps seal in moisture and protect the skin barrier.

3. Localized treatments

  • Products to use: If your dermatologist has prescribed topical creams (such as corticosteroids, retinoids or vitamin D analogues), apply them to psoriasis plaques after moisturizing. For over-the-counter treatments, products containing salicylic acid or coal tar can be effective in softening plaques and reducing inflammation.
  • How to use: Apply treatment to affected areas, massaging gently until completely absorbed. Be sure to follow your dermatologist's instructions on how often and how much to use.

4. Sun Protection

  • Products to use: Use a fragrance-free, non-comedogenic broad-spectrum sunscreen SPF 30 or higher to protect your skin from UV rays, which can worsen psoriasis symptoms in some people.
  • How to: Apply sunscreen generously to all exposed areas 15 minutes before going out, and reapply every two hours if you're outside.

5. Scrubbing (do with care)

  • Products to use: Use a gentle scrub or chemical exfoliant based on lactic acid orsalicylic acid to gently remove dead skin cells, but avoid mechanical scrubs which can irritate the skin.
  • How: Limit exfoliation to once or twice a week, and be gentle. If your skin is very sensitive or in a flare-up period, it's best to skip this step.

6. Soothing Bath or Shower

  • Products to use: Add natural oils like colloidal oatmeal oil or Epsom salts to your bath to soothe the skin.
  • How: Don't stay in the water for too long (no more than 10-15 minutes) to avoid drying out the skin. After bathing, pat dry gently with a towel rather than rubbing.

7. Avoid Irritants

  • Avoid: Avoid products containing perfumes, dyes, parabens or alcohol, as they can irritate the skin. Opt for soft cotton clothing and avoid rough or synthetic fabrics that can cause chafing.

8. Scalp care

  • Products to use: Use a medical shampoo containing salicylic acid, coal tar, or zinc sulfate to treat scalp psoriasis.
  • How: Gently massage the shampoo into the scalp and leave for a few minutes before rinsing. Avoid scratching the patches, even if they are irritating.

9. Stress Management

  • Why: Stress is a major trigger for psoriasis. Incorporate stress management techniques into your daily routine, such as meditation, yoga, or deep breathing exercises.

10. Regular consultation with a dermatologist

  • Why: A dermatologist can adjust your care routine as your psoriasis progresses, prescribe specific treatments and monitor potential side effects.

Conclusion

Psoriasis is a complex disease resulting from the interaction between genetic predisposition, the immune system and various triggering factors. Although suffering from psoriasis can be difficult, proper management, including appropriate psoriasis treatments and proactive symptom management, can significantly improve patients' quality of life. If you are experiencing psoriasis symptoms, it's important to consult a healthcare professional for a diagnosis and personalized treatment plan.

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