Psoriasis: Overview
Psoriasis is a chronic inflammatory, long-lasting, noncontagious skin disease. It is an immune system disorder. It consists of body inflammation involving raised areas of abnormal skin and red itchy scaly plaques mainly over the hands, knees, elbows, legs, back, and scalp. In psoriasis, the skin cells multiply at a faster rate than the normal cells. Psoriasis skin disease can be localized or spread all over the body. It is a common, chronic skin disorder with no treatment. Psoriasis disease appears in cycles, it shows up for a few weeks or months, then slows down for a while or enters into remission.
Psoriasis symptoms
Psoriasis symptoms are not the same for everyone. Common signs and symptoms include:
- Red scaly, white patches
- Small scaling spots mostly in children
- Dry, cracked skin
- Burning, itching or soreness
- Pitted or cracked nails
- Joint pain
- Stiff joints
- Itching sensation
Types of Psoriasis based on location
There are five types of psoriasis based on the locations -
They are as follows -
- Genital psoriasis It is a common type of psoriasis skin disorder. Many people experience this type of psoriasis. It is observed on the skin in the genital area or on the inner and upper thighs
- Scalp psoriasis It also indicates Psoriatic arthritis (PsA), as many people exhibit both symptoms together. Scalp psoriasis symptoms appear like fine scaling which may appear like dandruff, thick pink plaques that cover the entire scalp.
- Facial psoriasis It mainly occurs on the eyebrows, the skin between the nose and the upper lip, and on the forehead and hairline. Psoriasis on the face is usually mild in nature.
- Inverse psoriasis It affects the skin folds of the body. It is observed in the buttocks, groin, and under the breasts. Fungal infections may induce this type of psoriasis. Inverse psoriasis results in smooth patches of red skin that intensifies with friction and sweating.
- Hands, Feet and Nails It is observed on the palms of the hands and/or the soles of feet. The nails appear pitted and cracked. Psoriasis on the hands can be troublesome as it is tough to do the normal daily activities of life.
Types of Psoriasis based on aetiology
- Guttate psoriasis It is caused by streptococcal infection (pharyngitis or perianal). It appears as small, scaly red, tear-drop shaped called papules. It is mainly seen in children and young adults.
- Pustular psoriasis Its symptoms include pustules which are yellow, pus-filled lesions. They can be Generalized pustular psoriasis (GPP) which covers many parts of the body, or Localized pustular psoriasis covering smaller areas on the palms of the hands or the soles of the feet.
Psoriasis Causes
Psoriasis causes are still unclear, but it is sure that our immune system and genetic factors play a significant role.
Trigger factors-
The trigger factors differ from person to person. They are - Many people who are exposed to psoriasis skin disorder may be symptom-free for years. The disease usually appears when it's triggered by some environmental factors. Common psoriasis triggers factors are as follows -
- Skin injury - It refers to the Koebner [KEB-ner] phenomenon, which states that cuts, scratches, vaccinations, sunburns, and bug bites can bring about psoriasis.
- Streptococcal infections
- Cold weather and dry conditions
- Stress factors
- Lot of alcohol consumption
- Medications including high blood pressure medications and antimalarial drugs and lithium.
- Withdrawal systems of oral or systemic corticosteroids
Psoriasis Risk factors
The risk factors for psoriasis disease are -
- Family history Psoriasis disease can pass on from one generation to another. If your parents have this disease then the chances of you getting it increases
- Stress As stress greatly impacts your immunity, high-stress levels may increase your risk of psoriasis.
- Smoking Tobacco smoking increases the risk of psoriasis but it also escalates the intensity of the disease. Smoking can also play a trigger factor in the initial development of the disease.
Complications -
Psoriasis skin disease can induce other complications, such as -
- Psoriatic arthritis
- Eye problems like conjunctivitis, uveitis and blepharitis
- Obesity
- High blood pressure
- Type 2 diabetes
- Cardiovascular disease
- Certain autoimmune illnesses, such as sclerosis, celiac disease, and the inflammatory bowel disease called Crohn's disease
- Mental health problems, such as depression and low self-esteem
Diagnosis
Your dermatologists will note your medical history and examine the affected part of the skin, including skin, scalp and nails. The dermatologists might collect a small skin sample (biopsy) for microscopic examination to determine the type of psoriasis and rule out other disorders. Your doctor may recommend a blood test to rule out any other health conditions relating to the development of psoriasis.
Psoriasis treatment
Psoriasis cure focuses on stopping the skin cells from growing and get rid of scales from the skin. The treatment option depends on the severity of the psoriasis disease.
The Psoriasis treatment options are -
Topical therapy -
- Corticosteroids These medicines are commonly used to treat mild to moderate psoriasis disease. Corticosteroids are available in many forms such as ointments, lotions, creams, sprays, gels, foams, and shampoos. Mild psoriasis ointments are used for for sensitive areas, like skin folds, face and large patches. Topical corticosteroids can be applied during flares, and on alternate days to manage remission.
- Vitamin D analogues The synthetic form of vitamin D, such as calcipotriene and calcitriol decreases skin cell growth, thus minimizing the intensity of psoriasis symptoms.
- Retinoids The synthetic form of vitamin A is known as Retinoid. The retinoid used to cure psoriasis is called tazarotene. Tazarotene is unsafe during pregnancy or breastfeeding or if you intend to become pregnant.
- Calcineurin inhibitors These include such as tacrolimus ointment and pimecrolimus cream. These medicines can treat Plaque psoriasis and Inverse psoriasis. They reduce plaque buildup and inflammation. These medicines are not recommended for prolonged use due to the risk of skin cancer or lymphoma. They are also not safe during pregnancy or breastfeeding.
- Salicylic acid The synthetic form of vitamin A is known as Retinoid. The retinoid used to cure psoriasis is called tazarotene. Tazarotene is unsafe during pregnancy or breastfeeding or if you intend to become pregnant.
- Coal tar It effectively cures plaque-type psoriasis and scalp psoriasis. It reduces itching and swelling. Coal tar can be prescribed alone or in combination with other medicines. It is considered safe for long-term use.
- Goeckerman therapy It is a therapy to manage moderate to severe forms of plaque psoriasis. It works by using a combination of crude coal tar and artificial ultraviolet radiation. Goeckerman therapy is a unique form of light therapy.
- Anthralin Anthralin is a psoriasis cream to decelerate skin cell growth. Anthralin takes off scales and makes skin smoother. It is not recommended on the face or genitals. Anthralin causes skin irritation, and it stains easily. It's applied for a short period of time and then cleaned off.
Light therapy
Phototherapy or light therapy is a first-line treatment to cure moderate to severe psoriasis. In this, the skin is exposed to ultraviolet light. It is done under medical supervision.
- Sunlight Short duration of sunlight exposure (heliotherapy) might improve psoriasis, at least temporarily. Sunlight consists of ultraviolet light, consisting of UVA and UVB rays. The UVB rays slow psoriasis growth rate.
- UVB broadband Specific doses of UVB broadband light from an artificial light source can cure psoriasis that doesn't improve with topical treatments. Few side effects observed are itching, redness, and dry skin. Use moisturizers regularly to ease your discomfort.
- UVB narrowband UVB narrowband phototherapy is more effective in managing psoriasis than UVB broadband treatment. It's recommended two or three times a week to improve the skin. Prolonged usage of Narrowband UVB phototherapy may lead to severe and long-lasting burns.
- Psoralen plus ultraviolet A (PUVA) PUVA therapy comprises psoralen and UVA. PUVA is an ultraviolet light therapy treatment for psoriasis. The psoralen is taken before the skin is exposed to UVA. It is an aggressive treatment to manage severe cases of psoriasis.
- Excimer laser It is a form of phototherapy, a strong UVB light that targets only the diseased skin. This laser therapy needs fewer sessions than traditional phototherapy as it contains more powerful UVB light. Excimer laser side effects include redness and blistering.
Oral or injected medicines -
The risk factors for psoriasis disease are -
- Steroids Triamcinolone topical steroid can relieve psoriasis symptoms such as itching, crusting, scaling, redness, inflammation, dryness, and discomfort. It also serves as a dental medicine (paste) to relieve the discomfort of mouth sores. Triamcinolone is a corticosteroids medicine. It activates natural substances present in the skin to decrease redness, swelling, and itching sensation.
- Retinoids Oral retinoids known as Acitretin are pills to slow down the production of skin cells. Doctors prescribe Acitretin to manage severe cases of psoriasis. Its side effects are dry skin and muscle soreness. They are not allowed during pregnancy or breastfeeding.
- Methotrexate It is a powerful drug. Doctors prescribe it to treat adults with severe, disabling psoriasis that cannot be cured with skin medicines applied or phototherapy. Methotrexate suppresses the overactive immune system that leads to psoriasis.
- Cyclosporine This medicine is an effective remedy for extensive and disabling psoriasis. It can cure many types of psoriasis quickly. Cyclosporine suppresses the immune system, therefore doctors have to examine the patient's health before prescribing this medicine.
- Biologics These are new and strong drugs. They target only that area of the immune system that is hyperactive due to psoriasis. Therefore they cause no damage to other body organs, as compared to other strong medicines.
Change in lifestyle habits -
- Bath every day Bathing daily helps to take off scales and soothes the inflamed skin.
- Use moisturiser Moisturizing the skin smooths the roughness and reduces itching and swelling.
- Cover the diseased areas overnight Before bedtime, apply an ointment-based moisturizer to psoriasis affected skin and wrap it with plastic. In the morning, remove the plastic and clean away the scaly skin.
- Use limited sunlight Limited amount of sunlight can improve psoriasis, but more sunlight can increase the risk of skin cancer.
- Stay away from psoriasis triggers Find out what triggers your psoriasis, and take precautions to avoid them.
- Avoid alcohol consumption Drinking alcohol may make some psoriasis treatments ineffective. So avoid drinking alcohol during psoriasis treatment.
- Maintain a healthy lifestyle Follow a healthy lifestyle by eating nutritious food and avoiding smoking. Stay away from pollution and dirt because pollution leads to flaring up of psoriasis symptoms.Consult your dermatologists to choose the right type of shampoo or soap, that does not cause any harm to your skin.
Dos and Don’ts
Psoriasis is an allergic and highly irritating skin condition which needs to be managed and treated well. Follow its do’s and don’ts to relieve the symptoms.
| Do’s | Don’ts |
| Eat healthy diet | Consume alcohol or smoke |
| Bath every day | Scrath or scrub lesions |
| Apply prescribed moisturiser on your skin | Let skin injuries happen |
| Maintain healthy weight | Get exposed to pollution, dirt, and cold weather |
| Use limited sunlight | Use unreliable skin products |
Its possible to relieve psoriasis symptoms by avoiding the psoriasis trigger factors and taking prescribed medicines on time. If precautions are not taken, the psoriasis symptoms might flare up, resulting in the severity of the disease. All of this will drastically affect a person's capability to perform normal daily activities and cause harm to the overall well being.
Psoriasis Care at Medicover Hospitals
Medicover’s dermatology department consists of reputed skin specialists who provide specialized care and treatment modalities for various skin disorders. Our skin specialists are highly experienced in treating many skin problems such as skin infections, allergies, acne, rash, ulcers, atopic dermatitis, psoriasis, and others. We provide dermatological consultations, dermato surgical, and aesthetic procedures to cure various skin conditions..
