Psoriasis--a dermatological enigma.

Abstract

At the beginning, the interdisciplinary character of psoriasis encroaching into numerous fields of medicine as well as non-medical sciences is emphasized. The disease has been found an interesting field for genetic studies, also entering the fields of endocrinology and pathophysiology, and as a psychosomatic phenomenon arising many questions in the domain of psychiatry and psychology. With the associated joint and bone alterations, psoriasis is an intriguing problem for an array of medical disciplines, e.g., rheumatology, orthopedics, physical medicine and balneology. Pediatrics is involved through psoriasis in children, and ophthalmology through ocular symptoms of the disease. The therapeutic use of ultraviolet rays introduces psoriasis in the field of photobiology, and the impact of diet into the domain of dietetics. Also, alternative medicine is involved to a greater extent in psoriasis than in any other disease. This survey is followed by a historical account of psoriasis, revealing that the disease was known in all periods of the development of mankind that have left written documents behind. However, it was only toward the end of the 18th century and at the beginning of the 19th century that psoriasis was recognized and described as a unique and independent disease. The prevalence of psoriasis in Europe und USA ranges between 1.5%-2% and 0.5%-1.5%, respectively. The disease is rare in blacks, Indians and yellow race, whereas in Eskimos it is not found at all. Then, psoriasis is presented as a hereditary disease, the onset of which requires the action of so-called provocative factors triggering the hereditary elements. Psoriasis most commonly develops at the age of 20-50 years, i.e. during the most active period of man's life. Then, the morphological classification of psoriasis according to clinical picture is presented, with a historical account of pathophysiologic and etiologic concepts over the past hundred years. And finally, the basic trends and concepts of the treatment of psoriasis are described, with special reference to the fact that it should be considered a skill rather than a schematic procedure. The possibilities and value of preventive measures, emphasizing the role of patient health education in the complex treatment of the disease, are presented.