This is what living with psoriasis is like: ‘People are walking around me in a wide arc’

Three questions about psoriasis

Dermatologist Ewout Baerveldt answers three questions about the complex skin condition psoriasis.

1. What types of psoriasis are there?

“There are a number of forms of psoriasis, where psoriasis vulgaris the most common variant. In addition, you have psoriasis guttata, as Ellis has, and psoriatic arthritis, the form Gonny was diagnosed with. If you look at the life course of a person, psoriasis guttata in many cases the form you first encounter as a young adult. This shape means that you get all kinds of small drop-shaped blisters on your skin, which can often cause pain, itching and flakes.

About half of the people who psoriasis guttata has had, will receive at a later stage psoriasis vulgaris. This is the regular form of psoriasis and is also called the ‘plaque form’, because the many vesicles can ‘fuse’ to form a large plaque.

Next psoriasis vulgaris can you too psoriatic arthritis develop. This affects your joints. Complaints from psoriatic arthritis are frequently expressed in the fingers – but can also reach other joints such as the lower back or hip.

Some people have both forms of psoriasis at the same time, but it also happens that patients only psoriatic arthritis and therefore only suffer from their joints, without spots on their skin.”

2. How does psoriasis develop?

“Research shows that you can have a genetic predisposition to get psoriasis. In 30 percent of psoriasis patients, an immediate family member also has psoriasis. In addition to genetic predisposition, infections and stress are also triggering factors.

If you have psoriasis, the interplay between your immune system and your skin does not work well. External triggers, such as bumping into something or otherwise damaging your skin, cause your skin cells to divide more quickly than normal. This rapid exchange leads to hard, thick layers of flakes on your skin, but also stimulates the immune system and attracts extra immune cells to the skin. In some cases, these immune cells even migrate to the outer layer of your skin, creating micro-abscesses. This process causes pain and itching.”

3. What treatment methods are there for psoriasis?

“To treat psoriasis, you need to balance the interplay between immune system and skin. There are several drugs that can help with this, such as light therapy, creams, drugs in pill form, or the biologics which Ellis mentioned earlier. That way you force your skin cells to relax and make sure they start dividing more normally. Ultimately, these cells will therefore produce fewer substances that increase your inflammation levels.

Psoriasis is a chronic disease and unfortunately can never be completely cured. It is therefore important that we continue to look for new options for treating psoriasis. We’ve come a long way, but we’re not there yet. Some of the drugs are so effective that they control 75 to 90 percent of skin abnormalities.”