Psoriasis: Symptoms, Treatment, and Living With a Chronic Condition

Psoriasis – A Chronic Inflammatory Skin Disease

Psoriasis is a chronic inflammatory skin disease driven by immune mechanisms and requiring long-term, continuous management. Its characteristic rash consists of well-defined erythematous papules and plaques covered with thick, silvery scales, which may appear on various parts of the body.

It is a serious condition that significantly affects patients’ quality of life. Because psoriasis is a visible disease, persistent rashes and scaling can influence clothing choices, lifestyle, work, physical activity, and hobbies. Patients are often concerned not only about the disease itself but also about social stigma, as psoriasis is still mistakenly believed to be contagious.

To better understand the most important aspects of psoriasis diagnosis, management, and treatment, we spoke with dermatologist Dr. Vesta Kučinskienė from the Clinic of Dermatology and Venereology at the Lithuanian University of Health Sciences.

Has Psoriasis Changed in Recent Years?

Psoriasis is now recognized as a chronic systemic disease that may also affect the joints. According to recent research, its prevalence varies across ethnic groups. It is most common in Northern Europe and less frequent in Africa and Asia.

Symptoms typically appear between the ages of 15 and 35, with about 75% of patients developing the disease before the age of 40. However, psoriasis can occur at any age, and approximately one in ten patients develops symptoms during childhood. Early onset is often associated with a more severe and recurrent course of the disease.

Although the clinical presentation remains characteristic—reddish, well-defined scaly plaques—psoriasis is increasingly viewed not only as a skin and joint condition but as a systemic inflammatory disease that can affect internal organs and significantly impair quality of life.

Living With Psoriasis

Although psoriasis is a chronic condition, it can now be effectively managed. Patients are encouraged not to lose motivation, to communicate openly with family members and other patients, and to remain socially active. Consulting a dermatologist is important not only for medication management but also for advice on lifestyle and nutrition.

If necessary, patients should seek support from other specialists, such as rheumatologists or psychologists, to address the broader impact of the disease.

Modern Treatment Approaches

Today, patients with moderate to severe psoriasis may benefit from biological therapies. These treatments offer more individualized disease control and can help reduce flare-ups over longer periods.

Treatment is selected based on disease severity and extent. In many cases, psoriasis affects only a limited area of the skin—approximately 75–85% of patients have mild, localized disease. Therefore, topical treatments remain the cornerstone of therapy. Even patients receiving phototherapy or systemic treatments often continue using topical medications.

Challenges With Topical Treatment

Because psoriasis requires long-term treatment, adherence to topical therapy can be challenging. Many patients find it difficult to apply medications multiple times per day due to time constraints or inconvenience.

Studies show that:

• 44% of patients are dissatisfied with slow absorption,
• 41% are bothered by frequent application,
• 34% report that greasy formulations stain clothes and bedding,
• 20% lack sufficient knowledge about the disease and its treatment,
• only 5% cite financial reasons for non-adherence.

Combination Therapy: Calcipotriol and Betamethasone

One of the first-line topical treatments is a combination of calcipotriol and betamethasone dipropionate. This combination is more effective than either component alone due to its enhanced anti-inflammatory and antiproliferative effects.

The corticosteroid reduces inflammation and irritation, while calcipotriol helps minimize steroid-related side effects. As a result, this combination can be used safely for longer periods compared to topical corticosteroids alone.

A gel formulation of this combination has recently been introduced. It is less greasy, absorbs more quickly, does not stain clothing, and is more convenient for patients. It is applied once daily and is suitable for both scalp psoriasis and lesions on the body.

Safety of Topical Corticosteroids

Concerns about long-term corticosteroid use, particularly skin atrophy, are common. However, evidence suggests that calcipotriol may reduce the risk of steroid-induced skin atrophy.

Corticosteroids can promote skin thinning by affecting fibroblast activity and collagen production. In contrast, calcipotriol activates vitamin D receptors and supports protective mechanisms in the skin. Clinical studies show that the combination therapy can be used safely for up to one year without causing skin atrophy.

When to Refer to a Dermatologist

While mild cases are often managed by primary care physicians, referral to a dermatologist is recommended when:

• the disease is widespread,
• lesions persist despite long-term treatment,
• symptoms do not improve or remain unchanged.

Patients should also be referred if they require a more detailed evaluation or advanced treatment options.