Psoriasis (Clinic)
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The therapeutic approach of psoriasis should in any case be individualised. For this reason, there must be knowledge and expertise from the attending Dermatologist and sufficient time should be available for the patient's study, so that all the data and the course of the disease are recorded. The acquisition of a relationship of trust between the patient and the doctor is necessary for the best result. At the Psoriasis Clinic of St. Luke's Hospital, the first basic issue that we clarify to the patient is that his condition is not contagious, it is not due to something that he himself did or did not do and that with the appropriate treatment and support he will have very good results, since today we have important drugs that ensure almost complete control of the disease.
At St. Luke's Hospital, there is a regular and specialised Psoriasis Clinic, addressed both to patients with psoriasis and to people with a family history of psoriasis.
Psoriasis, a disease known since antiquity - and with a Greek name throughout the international literature (psoriasis) - belongs to autoimmune or, to be more specific, to self-inflammatory diseases. Psoriasis is particularly common, since statistics show that it concerns 2-3% of the human population! It has a genetic predisposition and can occur at any age.
The reason for its manifestation - trigger - as recorded in medical terminology - are:
• Stress
• Infections
• Some medications
• Injuries
• Hormonal disorders, etc.
Thus, the predisposition and environmental factors lead to a particular immune response of the organism, quite complex and not entirely specified even today.
Psoriasis can occur in various forms. The most famous are:
Depending on the part of the body the rash is found, it is also divided into:
The latter form coexists in a percentage of about 30% with a form of arthritis, psoriatic arthritis. It is particularly interesting that psoriatic arthritis can also exist without any obvious manifestation on the skin, which is why its diagnosis is often delayed.
The diagnosis is made by the rheumatologist and is based on the history, clinical examination and laboratory testing. The clinical picture of psoriasis is most often characteristic:
Red plaques, small or large, covered by silver-white scales which either easily fall off like dandruff from the head, or are quite thick and well attached.
Classic parts of the body where lesions appear are generally extensive surfaces:
Fortunately, the face is rarely affected. Persistence and the constant appearance of new lesions, but also the itching that is very common, are the main reasons that lead patients to the doctor. The diagnosis is most often easy with the standard clinical picture. Rarely, a biopsy will be needed to confirm.
The course of psoriasis is unpredictable. It can improve and worsen, without identifying the cause. However, since, as mentioned, infection of the joints is frequent, as well as the relationship of psoriasis with other diseases, it is of great importance the early diagnosis and systematic monitoring of patients.
In most cases, local treatment is effective. Cortisone preparations, vitamin D3, local immunomodulatory drugs, emollients, exfoliants and phototherapy with appropriate devices give a satisfactory improvement.
In the most serious forms of the disease or where local treatment does not work, and especially when arthritis coexists, systemic treatment is necessary.
Basic medicines in the treatment of severe psoriasis are:
The effectiveness of these classic therapies is significant, but unfortunately the disadvantage is the appearance of side effects from their chronic use and the gradual reduction of their positive action.
In the last fifteen years, a new category of medications has been used in the treatment of psoriasis. They are the so-called "biologic medications", products of high biotechnology, which have literally revolutionized the treatment of autoimmune and neoplastic diseases. These medications selectively target the subtle pathogenetic mechanisms of psoriasis, with the highest efficacy and clearly fewer side effects. Today, there are two major categories of these medications that act either on the TNFα agent or on the Interleukines (IL 12/23 and IL17A), while new ones are constantly being tested. Of course, in the case of these medications, full clinical and laboratory checkup of the patient and regular monitoring are required, so that the advantages of high effectiveness and the reduced likelihood of problems from the treatment give patients the quality of life they want and deserve.
The therapeutic approach of psoriasis should in any case be individualised. For this reason, there must be knowledge and expertise from the attending Dermatologist and sufficient time should be available for the patient's study, so that all the data and the course of the disease are recorded. The acquisition of a relationship of trust between the patient and the doctor is necessary for the best result. At the Psoriasis Clinic of St. Luke's Hospital, the first basic issue that we clarify to the patient is that his condition is not contagious, it is not due to something that he himself did or did not do and that with the appropriate treatment and support he will have very good results, since today we have important drugs that ensure almost complete control of the disease.
Dimitrios Sotiriadis, Professor of Dermatology, AUTh
At St. Luke's Hospital, operates a Special Psoriasis Clinic, every Wednesday 14:00-16:00 by appointment.
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