Autoimmune diseases: when the immune system goes on strike

In autoimmune diseases, the immune system is directed against the body's own cells and tissues due to misdirected processes. We present three autoimmune diseases here.

1. Psoriasis vulgaris

Triggers and Symptoms Psoriasis is a chronic, inflammatory, non-contagious systemic disease which, in addition to the skin, can also affect other areas of the body (e.g. nails, joints, intestines) and occurs in phases . Psoriasis can occur at any age, but there are two age peaks: second to third and less often from the fifth decade of life. The cause is a malfunction of the immune system, through which an inflammatory reaction and thickening as well as excessive cell division of the uppermost skin layer occur. Sharply defined, inflamed, reddened, raised areas (plaques) with firmly adhering white-silvery scales appear on the skin. In those affected, the skin renews itself much faster than normal (three to five days instead of 28), which leads to severe cornification in the form of the typical silver-white flaking. The preferred locations for plaques are the extensor sides of the arms and legs, especially the elbows and knees, and the lower back (psoriasis vulgaris). There are also different types of psoriasis, and the scalp (psoriasis capitis), the genital area (psoriasis inversa) or the nails can also be affected. It is characterized by a severe itching (pruritus) of the affected skin. The underlying disease is a genetic predisposition. There are also external triggers that can cause the disease to break out or worsen it: external mechanical stimuli of the skin, sunburn, medication (e.g. antihypertensive agents, painkillers), nicotine, alcohol, obesity, stress and bacterial infections. Sunlight and warmth have a positive effect, so symptoms often improve visibly in the summer months. Research has shown that the inflammatory processes in psoriasis also take place internally. Patients can develop inflammation of the joints (psoriatic arthritis), among other things, and psoriatic patients are more likely to suffer from inflammatory bowel disease, high blood pressure, cardiovascular diseases, high blood lipid levels and diabetes mellitus. Since the skin changes are visible, they often create a high level of suffering in those affected. The disease can be very stressful and lead to a reduced quality of life and depression.

Medical measures Psoriasis is a serious disease and should definitely be treated dermatologically due to the many co-factors. The good news: there are very modern and effective therapies available today. Generally speaking, the treatment principle consists in suppressing the immune system or in an anti-inflammatory mode of action. Psoriasis is treated , among other things, with locally applied cortisone preparations (ointments, creams). Variants of vitamin D3 are also used for local anti-inflammatory therapy . In addition, light therapy ( e.g. UV-B or UV-A) can be carried out for a limited period of time , as it also has an anti-inflammatory and inhibitory effect on the rate of cell division in the epidermis. Severe forms that affect a large part of the body surface or that occur in special locations are treated internally with tablets or injections.

Accompanying care In addition to medical therapies, cosmetics can be of great importance for diseased skin. The following applies here: as low-irritation as possible. We therefore recommend products that are particularly suitable for sensitive skin . The skin should be cleaned with moisturizing, soap-free washing additives or oil baths without fragrances. Dermatological, low-irritation bases, for example with urea (urea), can optimize the effect of external drugs. The richness of the products depends on how dry the skin is overall and can differ in summer (more moisture-rich) and winter (more oily). The desquamation (keratolysis) of the skin can be cosmetically supported very effectively with salicylic acid-containing creams in different concentrations, which in addition to the keratolytic effect also have mild anti-inflammatory effects.

2. Vitiligo

Triggers and Symptoms The immune system attacks the pigment cells (melanocytes) of the skin, and as a result the pigment cells are destroyed. There is a depigmentation of the skin, as s charf distinguishable white spots shows (vitiligo). It usually occurs between the ages of 10 and 30. Interestingly, darker skin types are more often affected than light ones. One differentiates between different forms. Most often Vitiligo occurs symmetrically and begins around the body orifices, especially around the eyes and mouth. But it can also occur on the phalanges of the fingers or the hands, on the trunk, the genital area and even on the mucous membrane, on individual strands of hair or the eyelashes. The course is very individual , from individual bursts to a continuous enlargement of the spots to standstill. Similar to psoriasis, high visibility of the Vitiligo spots is responsible for a high level of psychological stress on those affected. The causes of Vitiligo are not fully understood, but there is a certain hereditary predisposition. Other triggers are stress and various medications (blood pressure medication, blood lipid lowering drugs and antibiotics). There are also triggering stimulus effects. Vitiligo often occurs with other autoimmune diseases , for example with autoimmune thyroid disease (Hashimoto's thyroiditis) or circular hair loss (alopecia areata). It is noticeable that patients with vitiligo are more likely to develop black skin cancer.

Medical measures The therapy does not is simple and is often tedious . The primary goal is to achieve permanent repigmentation of the skin, but this expectation is rarely met. Therefore, it can often be seen as a therapeutic success if existing spots do not enlarge any further. The choice of therapy always takes into account the degree of severity, the activity of the disease and the level of suffering. Initial, locally limited stains can be treated with externally applied cortisone preparations over a longer period of time, then local cortisone replacement preparations (calcineurin inhibitors) are used. In the case of moderate forms of the disease, UV-B therapy or laser therapy (excimer laser) can also be carried out. In severe cases, cortisone or other immune system suppressing drugs are also used internally.

Accompanying care Vitiligo is primarily an optical, cosmetic problem for those affected. With heavily opaque make-up (camouflage), an adjustment to the rest of the skin tone can be made, and the vitiligo is less visible. Even self can help. Consistent and high light protection is very important for care , as the lack of pigments means that the skin areas are very UV-sensitive.

In the initial stage of scleroderma, one or more, relatively sharply delimited, round-oval, sometimes increasing reddening of the skin can be seen.

3. Scleroderma

Triggers and Symptoms The disease (Greek scleros = hard, derma = skin) is primarily characterized by an increasing hardening of the connective tissue . A distinction is made between a localized (circumscribed) and systemic form with organ involvement. Overall, it is a rare disease with a variety of forms. In circumscribed scleroderma , individual skin areas typically harden, which is very annoying and also restrictive for the patient (especially in joint areas), but not life-threatening. Women get sick significantly more often than men. Initially, one or more, relatively sharply delineated, rounded-oval, sometimes increasing reddening of the skin as an expression of the inflammation of the skin and the subcutaneous fatty tissue. The areas increasingly become white or reddish-brownish and harden due to an increase in the connective tissue at the expense of the subcutaneous fatty tissue. Then one often sees in the center of the affected skin region a white or yellowish hairless plate with a surrounding ring-shaped blue-violet ring (lilac ring) that has grown together with the lower tissue layers. These plaques tend to appear on areas of the skin where pressure is exerted (belts, rucksack straps, bra straps, etc.). Therefore, in order to avoid or reduce the progression, the cause of the pressure should be eliminated (loose clothing, etc.). The course of the disease extends over several years, The exact triggers for the disease are not known, but it is increasingly viewed as an autoimmunological disease. Genetic, hormonal, medicinal, infectious (especially with Borrelia) factors are discussed as triggers, but a causal connection has not yet been proven.

Medical measures A fundamental cure does not exist, but the disease can be improved by some measures. Cortisone preparations, cortisone replacement preparations or variants of vitamin D3 can be applied locally. Phototherapy with UV-A radiation can have a good influence on the underlying inflammatory processes in the skin. If the course is severe , internal anti-inflammatory or immune system-suppressing drugs are given. Massages and physiotherapy have a supportive effect.

Accompanying care The hardened skin should be regularly supplied with fatty moisturizers . This protects the skin barrier, maintains the elasticity of the skin and relieves the increasing tension in the skin. Oil-based baths also help relieve skin tension. The use of sun protection is compulsory because the tanning of the surrounding skin makes the abnormal skin changes particularly visible. Regular manual lymphatic drainage by the beautician is helpful .

Dr. med. Christine Schrammek-Drusio, dermatologist and allergologist, managing director of Dr. med. Christine Schrammek Kosmetik GmbH Essen, Christina Drusio , specialist in dermatology and venereology, member of the management board of Dr. med. Schrammek Kosmetik GmbH, Essen