Psoriasis treatment in Wrocław and Nysa

Psoriasis is a chronic inflammatory disease of immune origin affecting about 2–3% of the population. Its essence is the accelerated maturation and excessive keratinisation of the epidermis, accompanied by an inflammatory infiltrate in the dermis. The disease is not contagious and is not transmitted by contact with a patient.

Two peaks of onset are distinguished. The early-onset form appears between the ages of 15 and 30 and is more often associated with a family history and a more severe course. The late-onset form occurs after the age of 50 and usually runs a milder course. Psoriasis belongs to the systemic diseases, so the assessment of a patient covers not only the skin, but also the joints and the cardiovascular risk factors.

We hold consultations in Wrocław at ul. Barlickiego 31/1U and in Nysa. We see patients privately, without a referral. Reception: 573 290 488. 573 290 488.

The clinical picture

The basic lesion takes the form of a papule or a plaque of a red-brown colour, clearly demarcated from the surrounding skin and covered with a silvery, layered scale. The typical location covers the extensor surfaces of the elbows and the knees, the sacral area, the scalp and the nails.

The candle-wax sign – scraping the scale causes it to split and the surface of the lesion to whiten.
The Auspitz sign – after the scale is removed, pinpoint bleeding appears.
The Koebner phenomenon – new lesions arise at the site of an injury, a scratch or a scar, usually after 7–14 days.
Itching – contrary to the widespread opinion, most patients report it, although usually less intensely than in atopic diseases.

Clinical forms

Plaque psoriasis

The most common variant, covering about 80–90% of patients. It is characterised by well-demarcated plaques more than 1 cm in diameter, located symmetrically on the extensor surfaces.

Guttate psoriasis

It occurs mainly in children and young people, usually 2–3 weeks after a streptococcal throat infection. The lesions take the form of numerous small papules on the trunk and the proximal parts of the limbs. The prognosis is favourable; in some patients the lesions resolve spontaneously.

Inverse psoriasis

The lesions cover the skin folds: the armpits, the groin, the inframammary and the intergluteal areas. Because of the moisture of these areas the scale is poorly expressed and the lesion has the character of a smooth, glossy erythema. This variant is sometimes confused with a candidal infection.

Pustular psoriasis

It occurs in a localised form, covering the palms and the soles, and in a rare generalised form. Generalised pustular psoriasis with fever and a poor general condition requires urgent hospitalisation.

Psoriatic erythroderma

Involvement of more than 90% of the body surface with generalised erythema and scaling. This condition is associated with disturbances of the water and electrolyte balance and of thermoregulation and requires hospital treatment.

Psoriasis of the scalp and the nails

Involvement of the scalp occurs in more than half of patients and is sometimes the first location of the disease. The lesions usually extend beyond the hairline, onto the forehead and the retroauricular area, which distinguishes them from seborrhoeic dermatitis. The scale is thick and silvery, and removing it mechanically aggravates the lesions in accordance with the Koebner phenomenon.

Nail changes are found in 40–50% of patients. They include pitting of the plate, oil spots, separation of the plate from the bed and subungual hyperkeratosis. Their presence is associated with an increased risk of joint involvement, which is why we always assess the nails during the examination.

Psoriatic arthritis

Joint involvement affects 20–30% of patients with skin psoriasis and in most cases develops several years after the skin lesions appear. Early diagnosis matters, because untreated inflammation leads to irreversible damage to the structure of the joints.

Symptoms that require referral to a rheumatologist:

morning stiffness of the joints lasting longer than 30 minutes,
swelling and tenderness of the joints, particularly the distal interphalangeal joints,
swelling of a whole finger giving it a sausage shape,
pain in the heel at the attachment of the Achilles tendon,
pain in the sacral area of an inflammatory character, waking the patient in the second half of the night and resolving after moving about.

Coexisting diseases

The chronic inflammatory process involves the whole body, so obesity, type 2 diabetes, arterial hypertension, lipid disorders and fatty liver disease occur more often in patients with psoriasis. The risk of cardiovascular events and of depressive disorders is also increased. For that reason, during the consultation we pay attention to body weight, blood pressure and the results of basic laboratory tests.

Differential diagnosis

Disease	Distinguishing features
Seborrhoeic dermatitis	Greasy, yellowish scale, lesions not sharply demarcated, located in the seborrhoeic areas, no nail changes.
Chronic eczema	Lesions with indistinct borders, intense itching, frequent oozing, located in the flexures.
Tinea of the glabrous skin	A ring-shaped lesion clearing in the centre; the mycological examination is decisive.
Pityriasis rosea	Onset from a single herald patch, arrangement of the lesions along the lines of the ribs, spontaneous resolution within 6–8 weeks.
Lichen planus	Papules of a violaceous colour with Wickham striae, frequent involvement of the oral mucosa.
Cutaneous T-cell lymphoma	Lesions with an atypical distribution, resistant to treatment; histopathological assessment is required.

Diagnostic procedure

We make the diagnosis on the basis of the clinical picture. The examination covers the whole surface of the skin, the scalp and the nails, because lesions in covered places are often overlooked by patients. In doubtful cases dermoscopy is helpful, showing evenly distributed dotted vessels on a uniform red background.

Assessment of severity – we determine the area of skin involved and the effect of the disease on daily functioning. This documentation is required for qualification for systemic treatment.
Laboratory tests – a blood count, liver and kidney parameters and a lipid profile are performed before systemic treatment is started and periodically during it.
Skin biopsy – reserved for cases with an atypical clinical picture.

Psoriasis treatment

The choice of psoriasis treatment depends on the extent of the lesions, their location, the presence of joint involvement and the coexisting diseases. In mild forms topical treatment is sufficient; in moderate and severe forms systemic treatment or phototherapy is necessary.

Topical psoriasis treatment

Vitamin D3 analogues – calcipotriol, used alone or in a preparation combined with a glucocorticosteroid. It is the basis of long-term treatment.
Topical glucocorticosteroids – selected by potency according to the location of the lesions; on the face and in the folds we use only weak preparations and for a short time.
Keratolytic preparations – salicylic acid and urea, used to remove the layers of scale before the treatment proper.
Calcineurin inhibitors – used in sensitive areas, including inverse psoriasis and lesions on the face.
Tars – still used, mainly in preparations for the scalp.

Phototherapy in psoriasis treatment

Irradiation with narrow-band UVB at a wavelength of 311 nm is used in disseminated lesions, in cycles usually covering 20–30 sessions carried out three times a week. The treatments are performed in centres equipped with an irradiation cabin.

Classic systemic treatment

Methotrexate, acitretin and ciclosporin A are used in moderate and severe forms. Each of these medicines requires assessment of the contraindications and regular monitoring of laboratory tests. Acitretin is absolutely contraindicated in women planning a pregnancy, and the interval required after stopping it is long and must be discussed before therapy begins.

Biologic psoriasis treatment

Biologic medicines and Janus kinase inhibitors are used in severe forms of the disease resistant to classic treatment. In Poland these therapies are conducted within the drug programme of the National Health Fund, in designated centres. The task of the clinic is to assess the severity of the disease, to document the course of the treatment so far and to prepare the patient for qualification at such a centre.

Aggravating factors

infections, above all streptococcal pharyngitis,
mechanical injuries of the skin, tattoos and cosmetic procedures that break the continuity of the epidermis,
chronic stress,
smoking and the consumption of alcohol,
certain medicines, including beta-blockers, lithium preparations, antimalarials and non-steroidal anti-inflammatory drugs,
abrupt withdrawal of systemically administered glucocorticosteroids, which may provoke the generalised pustular form.

Contraindications and limitations in psoriasis treatment

We do not recommend systemically administered glucocorticosteroids in the treatment of psoriasis. Mechanical removal of the scales and intensive peels aggravate the lesions in accordance with the Koebner phenomenon. Controlled exposure to sunlight brings improvement in some patients, but sunburn acts in the opposite way and provokes a flare.

Skin care

daily use of emollients, with particular attention to preparations with urea at a concentration of 5–10%,
short baths, in water of moderate temperature, using cleansers without ionic detergents,
maintaining a correct body weight, which has been shown to improve the response to treatment,
giving up smoking.

Prices

Medical visit – dermatological examination: 280–350 PLN
Consultation with a specialist online, with the possibility of issuing a prescription: 220 PLN
Examination of the nails for a fungal infection – collection of material and mycological examination: from 100 PLN

The full list is available on the page HappyDERM price list.

Frequently asked questions

Is psoriasis contagious?

No. Psoriasis is an inflammatory disease of immune origin and is not transmitted by contact with a patient, by using a shared swimming pool or by using the same objects.

Can psoriasis be cured?

The disease runs a chronic and relapsing course, so we do not promise a permanent cure. Modern treatment does, however, make it possible to clear the skin lesions in a substantial proportion of patients and to maintain that state for a long time.

Is psoriasis hereditary?

What is inherited is the predisposition to develop the disease, not the disease itself. If one parent is affected, the risk for the child is in the region of a dozen or more per cent; when both parents are affected it is considerably higher. For the disease to appear, environmental factors must also act.

Does diet affect the course of psoriasis?

There is no diet that cures psoriasis. It has been shown, however, that a reduction of body weight in patients with obesity improves the response to psoriasis treatment, and that limiting alcohol reduces the frequency of flares.

Can a tattoo be done in psoriasis?

We advise against it. Breaking the continuity of the epidermis may provoke new lesions at the site of the procedure, which is known as the Koebner phenomenon.

Does the sun help in psoriasis?

In many patients moderate exposure to sunlight brings improvement. Sunburn, however, acts in the opposite way and leads to a flare, so exposure should be gradual and controlled.

When should a rheumatologist be consulted?

With morning stiffness of the joints lasting more than 30 minutes, swelling of the fingers, pain in the heels or pain in the sacral area that wakes the patient at night. Early diagnosis of arthritis makes it possible to prevent permanent damage to the joints.

Do you provide biologic treatment?

Drug programmes are carried out in centres designated by the National Health Fund. At the clinic we provide diagnosis, topical treatment and classic systemic psoriasis treatment, and we prepare the documentation needed for qualification for the programme.

The doctors who see patients

Consultations are provided by dr n. med. Małgorzata Micał-Strąk, lek. Ireneusz Pijanowski and lek. Dagmara Pawełczyk-Sicińska. The appointment with the chosen doctor is arranged during booking.

Booking a visit

An appointment for a dermatological consultation can be booked by telephone on 573 290 488. The Wrocław clinic is located at ul. Barlickiego 31/1U.

Telephone booking: 573 290 488. The contact details of all the clinics are available on the page contact.