Psoriasis (psoriasis)

In Guide by Patrick Michel Views: 4

The Psoriasis (psoriasis) is a common benign skin condition. It runs almost always chronic. Typical characteristics are sharply limited, red, raised, covered with silver-white scales skin that itch sometimes. The disease can occur at any age. Men and women are about equally often affected.

Typical skin changes of psoriasis on the knee

Often, just individual lesions (so-called herd) on the course pages of elbows and knees occur with psoriasis. Partly, the Psoriasis but also to the whole body spread out. Except for the skin, mucous membranes, joints and nails can fall ill in addition. How strong are these complaints, is different.

Psoriasis is not contagious. The skin characters themselves are probably thrown error-driven attack of the immune system (auto-immune reaction) cells of the skin (keratinocytes) that proliferate in response particularly hard. As a result, thickened part of psoriasis the skin on the affected area and scales.

The diagnosis of psoriasis is usually easy because the disease on the basis of the typical lesions is visible. Other known cases of psoriasis in the family are a clear indication. A special form of psoriasis known as psoriatic arthritis, affects also the joints. They can be distinguished by blood tests and imaging techniques such as computed tomography (CT) or a magnetic resonance imaging (MRI) of other inflammatory joint diseases.

What treatment is appropriate depends on the specific situation. It is often necessary to combine different medications and therapeutic approaches. There is a wide range of products and therapies that improve the Psoriasis symptoms. Often, those affected with the right treatment for a longer period are free of pain. The Psoriasis cannot be cured but so far. Supporting any therapy is a regular, careful, and individually tailored skin care.

Psoriasis: Definition

The Psoriasis (psoriasis) is a common in fair-skinned individuals, immunologically inflammatory skin disease. The Psoriasis is based on an auto-immune reaction which means that the immune system is its immune reaction against the cells of the body.

Many factors contribute to creating a psoriasis. These include other triggers and risk factors in addition to the genetic condition. The latter include infections, medicines (beta-blockers, lithium, interferon, chloroquine) and external agents (mechanical stress) such as for example a cutting injury. The climate plays a role: in the summer, the symptoms of psoriasis improve frequently through the increased exposure to the Sun. It has an anti-inflammatory effect and suppressed the body’s immune reactions shooting over.

In addition, psychological factors influencing the clinical picture: the complaints with psoriasis generally deteriorate under stress.

Sharply, covered with silver-white scales, red, raised lesions, especially on the elbows and knees, the sacrum and the hairy areas of the head are typical of the psoriasis. Sometimes itch the appropriate locations. Also joints and nails can be affected by psoriasis.

Historic

The Psoriasis is no disease of modern times: already more than 2,000 years ago, the Greek doctor described Hippocrates (c. 460 – 370 BC) scaly skin diseases, where it probably was psoriasis.

The medical term psoriasis derives psora of the Greek word, which stands for “Itching” or “Scratching”. Due to this misleading name psoriasis for a long time was distinguished from the itch caused by mites (Skabies).

Even today, the Psoriasis as a chronic disease has often serious consequences for health, quality of life and work. Although it is not contagious, psoriasis for the parties concerned due to the often easily visible lesions is mentally very stressful.

Frequency

The Psoriasis is one of the most common chronic skin diseases. In Germany, approximately 1.5 million people are affected. Men and women will develop about equally often it.

Most of the persons concerned (about 70 percent) is suffering from type-I or early type of psoriasis vulgaris, which occurs before the 40 years old. The early type between 10 and 25 most commonly occurs at the age. The rarer type II known as psoriasis, type of late, however, usually between the age of 35 and 60. occurs.

Psoriasis: Causes

Several reasons underlie the Psoriasis (psoriasis). It is a so-called multifaktoriell conditional disease. On the one hand, there is a genetic disposition, on the other hand, the disease breaks out only through the interplay of a number of causative factors (risk factors) such as infections, medications or external agents (mechanical stress) with skin lesions. About 40 percent of those affected have relatives suffering also from psoriasis. Mechanical injuries of the skin throw the psoriasis, it is called the Koebner phenomenon. This show, for example, lesions along of scratches on the skin. The climate or psychological factors can promote the Psoriasis to occur.

In addition to the genetic condition, there are a number of factors considered triggers and risk factors and contribute to an outbreak or a worsening of psoriasis. These include:

• Smoking
• Overweight
• Alcohol consumption
• emotional stress
• certain medications (e.g., beta blockers, ACE inhibitors, lithium, antimalarials, or kortison free drugs)
• external mechanical stress (pressure, injuries)
• or climatic circumstances.

Auto-immune reaction

An auto-immune reaction is based on the Psoriasis (psoriasis) in which the immune system is directed against cells of the body. This inflammation-promoting proteins, as well as the overactivity of a given variety of white blood cells, the so-called TH1 lymphocytes play a central role. These cells mediate the immune response through their messengers and assume a key role in the inflammatory response.

Body’s cells of the epidermis, the so-called keratinocytes, which play a central role in the renewal of the skin are auto-immune reaction. The skin reacts to the attack of the immune system with a general inflammatory response. The keratinocytes divide faster so that excessive amounts of new tissue is formed. It follows the well-known symptoms: the skin is thick and flakes.

Also infection may affect the Psoriasis will break out. There are indications that streptococci at an appropriate investment favour that the Psoriasis occurs and negatively affect its course… After Streptokokkus infections, that for example a purulent tonsillitis (angina tonsillaris) or cause an otitis media, there is often a psoriasis thrust.

Psoriasis: Symptoms

The Psoriasis (psoriasis) can be easily recognized on the basis of the typical symptoms. By the reaction of the immune system skin in people with psoriasis (psoriasis) renews itself faster than at a healthy. Usually this takes about 28 days, in people with psoriasis, however, only 4 days.

The affected skin areas are typically hot limited, greatly durchblutet through and flushed. The cells of the top layer of skin (epidermis) takes about seven times faster on the surface of the skin as in normal skin, where they form a layer of shiny, silvery-white scales. A last layer of the skin, which pull off (“phenomenon of last cuticle”) is located under the shed. Overall, the skin is dry, often painful cracks or blisters are formed. In about half of those affected with psoriasis, nails also show symptoms of psoriasis.

The sublime, reddened and inhibitors herd of psoriasis are typical symptoms and also plaques are called. They can be very small, usually they are but coin to Palm-sized and occur often symmetrically on both sides of the body. Often, sufferers suffer from itching. Typically develop the plaques on the line side of elbows and patellae and on the hairy part of the head.

The herd of psoriasis can occur as isolated, limited hot spots, but also flow together (konfluieren) and cover wide areas all parts of the body. Usually the lesions limited however to the place where they first occurred. Occasionally they disappear also spontaneously by itself.

Three main forms of psoriasis can be distinguished on the basis of the typical symptoms:

• Common psoriasis (psoriasis vulgaris)
• Psoriasis with warty formation, so Eiterbläschen (Pustular Psoriasis)
• Psoriasis with joint participation (psoriasis arthropathica, psoriatic arthritis)

A person with psoriasis can educate at the same time, several forms of psoriasis.

Common psoriasis (psoriasis vulgaris)

Nail infection

The usual psoriasis (psoriasis vulgaris) accounts for about 80 percent of all cases of psoriasis. It differs in type I and type II: the Psoriasis of the type-I starts usually in the age between 10 and 25 years and characterized by a history of serious and frequent relapses. Also the genetic susceptibility plays an important role, so the Psoriasis within the family occurs very often. The Psoriasis vulgaris of the type 2 starts at the age of 35 to 60 years and is usually mild. Less genetic predisposition is also crucial, more cases of psoriasis in the family are rare.

The first smaller later to Palm-sized flammable reddened herd primarily at head, elbows, and patellae occur. Also the Gesäßfalte is often affected. At this point, most of the time no scales, but small fissured of skin (so called “creams”) arise. The plaques shed it continuously, with little more than itch for half of those affected also.

The disease runs very individually and is pronounced differently. While mild cases are hard to see, other sufferers suffer frequent batch mode with conspicuous plaques. In severe cases, large areas of the body of plaques can be covered. The entire body is covered, almost speak of a psoriatischen erythroderma physician.

In about half of cases, the Psoriasis (psoriasis) also on the nails spreading. The changes range from light Eindellungen (so-called spotted nails) and discoloration (so-called stains) to the complete destruction of nail.

There are three types of psoriasis vulgaris, each delivering a speech by different symptoms:

• Plaque Type: Most common form with at least coins large plaques (herds). The severe progressive form, where, also, chest, back, arms and legs extensively of plaques are covered, heals mostly incomplete. The plaques are not treated, they remain in place over months or years and spread partially even further.
• Exanthematische psoriasis (psoriasis guttata): sudden appearance very small stecknadelkopf-up penny-sized herd, especially on the chest and on the back. Often in children and young adults, often by an infection with bacteria (infection of Streptokokkus).
• Psoriasis inversa/psoriasis intertriginosa: with this form are clutching, soles of the feet and other skin areas infested are otherwise rather not affected to such areas where skin folds densely to each other are like armpits, in the bar area or under the female breast (so called other)

Psoriasis with warty education (Pustular Psoriasis)

The Psoriasis Pustular accounts maximum 2.5% of cases of psoriasis for. On the reddened skin areas develop aseptic (sterile) Eiterbläschen. Typically, soles of the feet and palms are affected, derived from the Latin the term psoriasis is keratoderma. This form of psoriasis is called type Barber. More commonly, it affects women, especially smokers. Often, the Psoriasis occurs Pustular after bacterial infections. The Eiterbläschen arise because accumulate white blood cells (leukocytes) in the top layer of skin (epidermis).

In severe cases, psoriasis can present Pustular on the entire body. In this very rare so-called psoriasis pustulosa generalisata is extensively lit and full of blisters the skin. This form of psoriasis is type Zambusch. Mostly occur also fever, malaise, and a heavy feeling of illness. This form of psoriasis can be life-threatening and severely damage the skin function.

More is a form of psoriasis Pustular annuläre psoriasis pustulosa: you by 5 to 30 cm large dark red inflammation characterised, which are lined by pustules and himself to the Center back neck-shaped scale off.

A psoriasis, Pustular can happen even in the pregnancy. Usually, the disease in the last third of pregnancy occurs and is accompanied with fever.

Psoriasis with joint participation (psoriatic arthritis)

The psoriatic arthritis (psoriasis arthropathica) is a rheumatic form of psoriasis, in which the joints are attacked. The Psoriasis-arthritis mainly occurs in connection with the usual psoriasis type I. Between 10 and 20 per cent of the Psoriasis suffer from psoriasis arthropatica. The joints swell and movements are possible only to a limited extent. Despite this rheumatic complaints, known as rheumatoid factor (specific antibodies) in a psoriatic arthritis is not increased. Very often, the nails are infected at the same time with the joints.

The psoriatic arthritis exhibit various clinical syndromes:

The peripheral type of psoriasis-arthritis, at least a small joint is painful, red, and swollen. Often the finger and toe joints are with this type, or all joints of a finger attack (so-called beam attack, “Wurstfinger”). The complaints occur over several months and years in batch mode. This often different joints are affected. The tissue around the joint capsule swells and in the vicinity of the joint of the bone loses substance (bone loss, osteoporosis).

A severe form of peripheral type is the destructive (mutilierende) form of psoriatic arthritis. You damages subject to especially the small joints of the fingers, hands, toes and feet but also the vertebral joints.

The rare axial type has a stiffening of the iliac joints (Ileosakralgelenke) and the spine result. In addition, the surrounding joints may be affected.

Psoriasis: Diagnosis

In most cases the diagnosis on the basis of the typical lesions can in a psoriasis (psoriasis) be.

One scratching the affected areas, they show the following characteristic signs of psoriasis:

• Candle spot phenomenon: By scratching on a plaque the cuticle layer on the Kratzspur brightens like when a candle wax stain.
• Phenomenon of last cuticle: the scales are further away, is becoming a shiny “last hymen”.
• Bloody Tau: will further be scratched, it comes to punctate bleeding.

In addition, more cases of psoriasis in the family indicate psoriasis. Still doubt in the diagnosis, the doctor removes a skin sample (biopsy) and examines whether the Supreme Hautschichtübermäßig is verhornt, thickened, or inflamed. These findings are called Keratoderma, follicular Hyperkeratosis and epidermal hyperplasia in technical jargon. In addition, more immune cells, more specifically white blood cells (called lymphocytes and granulocytes) and phagocytes (macrophages) are visible under a microscope in the upper layers of the skin (the epidermis and the DermIS).

If the signs are only very slightly pronounced, it can be difficult to recognize a psoriasis. Diseases that can be mistaken for a psoriasis and therefore the diagnosis be excluded must include:

• Eczema
• Skin fungal disease (Mycosis)
• flat Knötchenflechte (Lichen planus)
• Spike Lichen (Pityriasis rubra pilaris)
• Infections of the skin
• Syphilis

The Psoriasis with joint participation (psoriatic arthritis) is sometimes hard to distinguish from other acute or chronic joint diseases such as rheumatoid arthritis or the Bechterew’s disease. This is especially the case if there are no typical skin problems.

Also blood tests help in the diagnosis of psoriatic arthritis. Thus this form of psoriasis, where also the joints are affected, can be distinguished from other inflammatory joint diseases. Imaging techniques such as a computed tomography (CT) or a magnetic resonance imaging (MRI) in the rheumatic form of psoriasis diagnosis are sometimes useful.

Evaluation index for the Psoriasis (PASI)

The Psoriasis runs and expressed very differently – not only from Betroffenem to Betroffenem, but also from batch to batch.

To represent the severity of psoriasis vulgaris objectively, doctors use a rating index for the psoriasis, the PASI (psoriasis area and severity index). He assessed how much various symptoms are more pronounced, namely:

• how much the affected areas of the skin are red
• how strong the skin flakes
• how much the skin layers is traversed by the immune cells
• extent to which the parts of the body of head, arms, torso, and legs are affected

So, the individual course of psoriasis over time can be documented and compared with other cases. The PASI also shows whether a treatment is effective.

Psoriasis: Therapy

Garland-like psoriasis (psoriasis gyrata)

The discomfort of psoriasis leave to relieve through a variety of treatment options, include products and forms of physical therapy. You can also cause that those affected have no complaints on a temporary basis. A cure of psoriasis in the long term completely disappears, however is not possible.

The treatment of psoriasis range from skin care ointments of treatment with strong drugs inhibiting the immune system. A distinction the internal (systemic) and local (topical) therapy in psoriasis in General. The basis of every psoriasis treatment is regular, careful, and individually tailored skin care.

Basically, the treatment for psoriasis is based on three pillars:

• local (external) therapy
• internal treatment
• Light therapy (phototherapy)

The Psoriasis treatment aims to prevent the skin is further thickened and inflamed.

Local therapy

The active ingredients used in the local (topical) treatment of psoriasis externally apply those concerned in the form of creams, ointments and lotions. Bath products are also available.

When an acute psoriasis thrust initially removing the thick layer by ointment associations with active ingredients like salicylic acid or urea. Until then, special medication for inflammation of psoriasis to their location, the living skin cells can penetrate.

Vitamin D supplements and corticosteroid preparations and ointments containing Dithranol or retinoid for the treatment of disease attacks are suitable in psoriasis. Dithranol inhibits excessive growth of cells and inflammatory processes. Retinoids are derivatives of vitamin A and be administered in other keratinization disorders such as acne. For example, Tretinoin (vitamin A acid) is used for external application.

But even in largely adenoma times, the skin needs careful maintenance. For example, ointments that contain moisture-binding urea is suitable for daily external use.

Internal treatment

For more severe forms of psoriasis medications used to treat in tablet form. Thus, an internal (systemic) treatment with retinoids (Acitretin, for example) is possible. These active substances intervene in the keratinization process by ensuring that the skin and mucous membrane cells back to normal grow and mature (epidermal differentiation).

Women who cannot have children, should not take these active substances. In pregnant women it may be used by no means. If treatment with retinoids is necessary, a careful contraception is important.

Drugs that suppress the immune system (immunosuppressive drugs), are an effective therapy option, especially in severe cases. The immunosuppressive drugs include methotrexate, Cyclosporine, or Fumarsäureester. The latter are already approved for moderate psoriasis.

Methotrexate is the basic therapy for psoriasis with joint participation, to stop the destruction of the joints and to avoid future disabilities. But, the drugs carry the risk some serious side effects. Their intake has to be discussed with the doctor.

Light therapy (phototherapy)

For the treatment of psoriasis, a photo-sole treatment offers of which significantly improves the symptoms almost always. This light therapy takes a dip in brine water affected parties and is at the same time continuously irradiated with UV light.

When Photochemo-or PUV A therapy – Psoralen and UV-A therapy – radiation and combined a so-called Photosensitizer: before irradiation, the individual occupies the active ingredient of Psoralen, a sensitizer of light or the Psoralen is admitted in the pool water. Thus, the UV rays in the skin have much more so much lower UV-A radiation doses are necessary. This is beneficial, because the lower the UV radiation doses, the less damage to the skin and reduces the risk of skin cancer. The active ingredient of Psoralen binds in the cells at the genetic information (DNA). UV light can work better and blocks cell division.

Laser therapy

The mode of action of laser therapy is the same as when the light therapy (phototherapy). The laser creates a light, whose Wellenlänge is optimal for the treatment. However, a laser on smallest land produces very high energy. This treatment is so although precise, but also much more difficult and more expensive than the conventional phototherapy. It is suitable especially for smaller herd, for example at the knees or elbows.

Biologics

Biologics include a class of compounds that interfere with the communication of cells of the immune system naturally. They are usually genetically manufactured and are largely identical with the body’s bio-molecules.

An active ingredient in the Group of Biologics is etanercept. It inhibits the cell neurotransmitter TNF-alpha, which plays an important role in inflammation of the joints. Etanercept is for the treatment of common psoriasis (psoriasis vulgaris) and approved the Psoriasis with joint participation (psoriatic arthritis). Etanercept can be applied in psoriatic arthritis as the only treatment or in combination if the previous basic therapy was inadequate. About the active ingredient methotrexate is used as basic therapy.

Two other Biologics approved in Germany are infliximab for the treatment of chronic plaque psoriasis and psoriatic arthritis, and adalimumab for the treatment of psoriatic arthritis.

By the beginning of 2009, doctors prescribed the active ingredient of Efalizumab. It was used in adults with moderate to severe common psoriasis plaque-type when other internal (systemic) treatments failed or could not be applied.

However, if the active substance was included in the long term, researchers observed several cases of brain diseases. For this reason the European Medicines Agency EMEA recommends since February 2009 no longer, to prescribe the drug. Meanwhile, the drug in Europe is no longer on the market.

Skin care

A careful skin care in a psoriasis (psoriasis) always belongs to the therapy. It not only helps restore the disturbed barrier function of the skin, but also prevents that the skin dries out – because that irritates the skin and can cause new herd of psoriasis.

In psoriasis, the skin suffers more or less strongly pronounced lack of moisture. With more oily skin, you should use creams and lotions that have a low fat and high water content. Ointments with high fat content and little water are better suited for the low-fat, dry skin. It is the Merkspruch: wet on wet, dry to dry.

Neutral Waschemulsionen with reverse moisturising substances offer to wash. Ingredients are here such as urea, which binds the moisture, glycerin, hyaluronic acid, vitamin E, or collagen. Avoid long baths or hot water. In addition, both can dehydrate your skin. Oil baths and return product washing additives make the skin supple again. Rub dry this up after the bath with the towel, but DAB off only. This will also prevent new herd of psoriasis caused by the scratch.

Psoriasis: Course

How the Psoriasis (psoriasis) in the course of developing is individually different. The Psoriasis is usually a chronic course, and occurs in bouts. Completely symptom times intervals can follow where the skin strongly scales. In the summer months, the Psoriasis often improved by the solar radiation.

For many of those affected with psoriasis, the uncertain course is mentally stressful. The disease can be but mostly well control with consistent skin care and the today available therapies. So far the Psoriasis cannot be cured however.

Psoriasis: Prevent

There are no special measures, which you can use to prevent a psoriasis (psoriasis). You can reduce the chance to get psoriasis but if you avoid risk factors such as obesity, smoking and excessive alcohol consumption. This is especially true if you have a hereditary predisposition for psoriasis. Nevertheless, the Psoriasis can break out even with sporty active, lean people who pay attention to a balanced diet.

Batch mode to prevent

If you already have psoriasis disease episodes can be often through a healthy lifestyle (nicotine waiver, normal weight, only moderate alcohol consumption) prevent or delay. Any interested parties must find out but ultimately even what is good or bad for individuals.

Consistent skin care at adenoma times is important to postpone new episodes of disease or to alleviate. Avoid – as far as possible – mechanically and chemically to irritate the skin.

Many sufferers also benefit from relaxation exercises and self safety training. The individual handling of the Psoriasis can significantly affect its course.

Diet for psoriasis

There is no question that diet affects the skin and its appearance. General statements and recommendations to avoid certain foods, for psoriasis are disputed. Also, the diet can replace not the treatment of psoriasis.

Consensus studies that alcohol, nicotine and overweight have a negative affect on the psoriasis, Omega-3 fatty acids and a low-meat or vegetarian diet, however, are positive researchers due to different.

Although it is generally safe to consume small amounts of alcohol, rule or excessive consumption of alcohol worsens usually the clinical picture. In addition subjected alcohol liver: this, the skin condition is worse and the alcohol can lead to interaction with the medications applied when severe psoriasis.

The scientists are largely agreed that Omega-3 fatty acids beneficial affect on the psoriasis. Omega-3 fatty acids are long-chain, polyunsaturated fatty acids, which are contained mainly in oily saltwater fish. Their protection effect on arteriosclerosis has long been known. In addition you shall enter since some time also reinforces them rheumatic diseases, and the psoriasis, because they have an anti-inflammatory effect.

Their effect is based on their opponent function of arachidonic acid, which plays an important role in formation and progression of inflammation. Therefore, you should take care to record sufficient Omega-3 fatty acids and to restrict the arachidonic acid in food at the same time. A low-meat or vegetarian diet can help you because much arachidonic acid contain for example sausages and high-fat meats, but also cream, butter, and eggs.

Fruit and vegetables provide the body with vitamins. About the vitamins C and E have an anti-inflammatory effect. Fresh fruits and vegetables contain plenty of vitamin C and of different vegetable oils such as Weizenkeim-or sunflower oil, fatty fish (e.g. salmon) and nuts provide with vitamin E.

Who would not entirely without animal foods, can treat lean meat two small servings per week. Also low-fat dairy products are fine. Fish should be, however, regularly on your diet: to accommodate sufficient Omega-3 fatty acids, you should eat often high fat sea fish, preferably twice a week. If you like no fish, you can access also fish oil capsules.

In addition to these general rules, it is important that you find out for yourself what foods you deteriorate the psoriasis or provoke new flare-ups. You should then specifically avoid this in your personal menu.

Overweight (obesity)

Obesity seems to worsen a psoriasis. Obese are significantly more common psoriasis affected than Normalgewichtige.

Psoriasis occurs frequently with the so-called metabolic syndrome. This syndrome combines that certain diseases often occur, namely high blood pressure, elevated blood lipid levels and diabetes mellitus (type II) – or a reduced insulin sensitivity as a precursor thereof. People who diet is wrong and move little risk to develop a metabolic syndrome. It occurs quite often in Western industrialised countries.

More information

WrongDiagnosis.com suggested reading:

Psoriasis drug information

Discussion forum psoriasis
Can those affected and other interested questions and experiences around this chronic, but exchanging rheum skin disease and discuss new treatment approaches, therapeutic experiences or tips for everyday life.

Support groups / clinics:

PANAP Selbsthilfe e.V.
Daffodil trail 18
26209 Had Sandkrug
Phone: +49-(0)-44 81-212
panap@t-online.de
www.panap.de

Link tips:

www.psoriasis-Bund.de
www.psoriasis-Bund.de the German psoriasis Bund e.V. is the only nationwide active non-profit self-help Association of people suffering from the Psoriasis (psoriasis). The Federal Government held meetings and lectures, promotes the exchange of experience and represents the interests of the persons concerned.

Book tips:

Check-list Dermatology

Sterry, Wolfram et al.

744 Pages, Thieme, in 2004 the grey part offers with working and investigation techniques, green part of leading basis for a good Diagnostik.Der you on the often difficult path of the symptom to diagnose. In all matters of Dermatology, Venerology, Andrology and Phlebology the blue part offers concrete answers, information and instructions for your daily work. See special conservative and operative therapies, as well as all the necessary information for dermatological emergencies in the red part. Completely revised and updated! Many chapters completely new, such as Andrology, psoriasis, dermatological surgery. Even better part of guiding symptom.

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Dermatology textbook and Atlas

Rassner, Gernot

2006 In an increasingly polluted environment differentiated knowledge of skin diseases is extremely important 519 pages. Dermatological knowledge is one of the tools of each doctor. The numerous large-format color illustrations in this volume represent the diverse variants of skin diseases. Right next to the pictures find clear and focused: basics, results, conditions, diagnosis, differential diagnosis, current therapy and the entire knowledge of testing for the basic course.

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Sources:

Guidelines of the German Dermatological Society: therapy of psoriasis vulgaris. AWMF guidelines register no. 013 / 001 (State: 23.2.2011)

Moll, I.: Dermatology. Thieme, Stuttgart 2010

Psychrembel: Clinical dictionary. 262. Auflage, de Gruyter, Berlin 2010

Sterry, W., Paus, R.: check-list Dermatology. Thieme, Stuttgart 2010

German rheumatism League: psoriatic arthritis – psoriasis with arthritis, advice for those affected. German rheumatism League Bundesverband, Bonn 2009

Public statement on RAPTIVA (efalizumab): withdrawal of the marketing authorization in the European Union. Online information of the European Medicines Agency: www.ema.europa.eu (3.8.2009)