What is Psoriasis?
Psoriasis is a common and chronic skin disorder. It is a chronic, multisystem, inflammatory disease that affects mainly the skin, nails and joints. Psoriasis is prevalent in around 2% of the population. The prevalence of psoriasis in India varies from 0.44 -2.8%. Psoriasis is two times more common in males in comparison to females.
Psoriasis leads to a rapid build-up of cells on the skin surface. These cause scaly, red patches that can be itchy and painful sometimes. Often the symptoms of psoriasis may improve followed by worsening.
Causes and risk factors
Causes of psoriasis haven’t been fully researched, but it has been linked to the cells of the immune system. A specific kind of white blood cell known as T cells present in the body fights with bacteria, viruses and other foreign bodies. In the case of psoriasis, the T cells attack the normal healthy skin cells. The T cells also lead to other immune reactions in the body.
The new skin is formed too quickly before the old skin can slough off, ending up as patches of scaly skin on the surface. The exact cause for T cells behaving in such a way is unknown.
Psoriasis can be triggered by:
- Skin, throat and other infections
- Injuries of the skin
- Certain medicines like antimalarial medication, beta blockers, etc.
Symptoms and signs
The symptoms and signs of psoriasis vary in each individual and can be one or more of:
- Red skin patches that are scaly in nature
- Cracked and dry skin that can bleed
- Itching, soreness or burning
- Itching, burning or soreness
- Thick or ridged nails
- Stiff and swollen joints
The patches of psoriasis may be limited to few spots or larger areas may be involved in the case of a major flare-up.
The different types of psoriasis are:
- Plaque psoriasis: It is the most widely seen form of psoriasis. It causes dry red plaques with scaling. These may be painful and itchy. They occur on any part of the body.
- Scalp psoriasis: Scaly, red and itchy spots on the scalp.
- Nail psoriasis: Both the finger and toenails may be affected by psoriasis which may cause discolouration, abnormalities in growth and pitting.
- Guttate psoriasis: Especially seen in children and young adults. It is caused by throat infections or bacterial infections. This is evident by small, droplet-like sores on the arms, legs, trunk and scalp.
- Psoriatic arthritis: Apart from the inflammation with scaly patches, psoriatic arthritis can lead to swollen and painful joints.
- Inverse psoriasis: It occurs in the groin, armpits and genital regions in the form of red patches of skin which are inflamed and smooth in nature. It is caused by infection by fungi.
- Pustular psoriasis: It is a rare form and usually develops rapidly and marked with pus-laden blisters.
Psoriasis is commonly diagnosed by physical examination of the skin, nails and scalp. Your medical history is also taken in detail.
In rare cases, a sample of skin may be taken (skin biopsy) to determine the exact cause of psoriasis. If symptoms of psoriatic arthritis are present, x-rays and blood tests may be done.
Treatment and prevention
Treatment for psoriasis can include:
Skin ointments and creams are used for treating mild to moderate forms of psoriasis. In severe forms, medications or light therapy with topical creams may be used.
The usual topical psoriasis treatment includes:
- Corticosteroids: Topical corticosteroids are widely prescribed for the treatment of mild to moderate forms of psoriasis. They aim to suppress the high skin turnover and bring down the inflammation and itching.
- Analogues of vitamin D: These artificial forms of vitamin D reduce the skin cell growths.
- Salicylic acid: It encourages dead skin sloughing and reduces the scaling.
- Coal tar: For psoriasis, coal tar is possibly the oldest treatment. Coal tar helps in reduction of itching, inflammation and scaling.
- Moisturizers: Psoriasis can’t be healed by moisturizing creams but they are helpful in bringing down the scaling and itching.
Here predominately ultraviolet light is used for treating psoriasis. The simplest form of phototherapy can include skin exposure to sunlight in a controlled manner. Artificial ultraviolet A or B with medication may be prescribed. Sometimes, coal tar and UVB treatment could be combined and it is known as the Goeckerman treatment.
Psoralen plus ultraviolet A (PUVA): It is also known as photochemotherapy. It includes the use of light sensitising medicines like psoralen before UVA exposure. Side-effects in the long-term include wrinkles, freckles, and heightened risk of skin cancer.
Certain medication may be given orally or injected based on the signs and symptoms of psoriasis. Oral methotrexate decreases the skin cell production and suppresses inflammation. Prolonged usage of methotrexate can lead to liver damage and decrease the production of WBCs, RBCs and platelets.
Drugs that modify the immune system are sometimes used for treating psoriasis. However, these must be used with caution and can lead to potentially fatal infections.
Despite a wide range of treatment, psoriasis treatment can be challenging. Psoriasis randomly alternates unpredictably through cycles of improvement and deterioration.
If one has psoriasis, take the following steps to avoid flare-ups:
- Moisturisers: Keeping the skin moist with lotions or creams will prevent the symptoms from getting worse.
- Care for scalp and skin: Do not pull out or scratch the patches. Use recommended shampoos for your scalp. Bathing and use of tar-based shampoos can bring respite.
- Humidifiers: Use a humidifier to keep the skin moist.
Psoriasis can also upset one’s quality of life by raising the risk of depression, low self-regard and social isolation.
If one has psoriasis, one is at greater risk of:
- Psoriatic arthritis: Psoriasis may lead to debilitating joint damage and loss of function.
- Eye conditions: Conjunctivitis, uveitis and blepharitis are commonly reported in individuals with psoriasis.
- Type 2 diabetes: The probability of type 2 diabetes increases with severe psoriasis.
- Obesity: Again people with severe psoriasis are more likely to be obese.
Psoriasis also increases the likelihood of metabolic syndrome, cardiovascular disease, kidney disease, etc.
Visit your physician in case you suspect psoriasis. Discuss psoriasis with your doctor if it is of severe nature and causes problems in joints.
Seek immediate medical attention if the psoriasis symptoms worsen. Also, discuss with your doctor in case the symptoms worsen or no improvement is noticed with treatment.
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- Guidelines of care for the management of psoriasis and psoriatic arthritis, American Academy of Dermatology, Inc. https://www.aad.org/file%20library/…/guidelines-psoriarsis-sec-1.pdf
- National Psoriasis Foundation. Comorbidities associated with psoriatic disease. https://www.psoriasis.org/about-psoriasis/related-conditions
- Psoriasis in India: Prevalence and pattern. Indian J Dermatol Venereol Leprol 2010. 76:595-601
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Accessed 22 Dec. 15. http://www.niams.nih.gov/Health_Info/Psoriasis/
- Image Source: Kim Kardashian Facebook Official Page.