Psoriasis is the chronic disease of the skin due to rapid multiplication of the skin cells due to autoimmune response. Normally cells divide and shed off in one month but in psoriasis this division happen in three to four days and old cells pile up on the skin. It will eventually result in red patches, dry flakes or scales on knees, elbows and head. It can develop anywhere on the body and periods of recurrence and remission follow one after the other. The time period varies in between recurrence and remission.
Types of psoriasis[i]
Psoriasis is classified into the following types:
- Plaque psoriasis
Red patches covered with silver or white scales found on the knees, elbows, scalp characterize the plaque psoriasis. It is most common of all the types occurring in almost 80% of the patients with psoriasis.
- Guttate psoriasis
Small pinkish individual spots on the thorax, arms and legs occurs found commonly in children and adults are associated with guttate psoriasis. Respiratory disorders i.e., infections du to Streptococcus pyogenes, tonsils, any injury, use of beta blockers or drugs for malaria can trigger this type of psoriasis.
- Inverse psoriasis
It usually affects armpits, breasts, buttocks and groin region with shiny red sooth abrasions. It can be due to fungal infections.
- Pustular psoriasis
It is rare condition and is more prevalent in adults on the soles of hangs and feet. White pus-filled blisters areas surrounded by inflamed akin cells.
- Erythrodermic psoriasis
Most severe condition affecting only one percent of the patients. It is characterized by red patches on whole skin with intense itching or burning sensation. Certain drugs, infections, and heatstroke can set off this psoriasis.
Erythrodermic psoriasis hampers the chemical balance causing loss of proteins and fluids leading to pneumonia, edema, heart failure, etc. a patient is needed to be hospitalized for few days.
Signs and symptoms
Generally, the symptoms vary depending on the type of psoriasis from mild to severe. In mild psoriasis, three percent body is affected. In moderate three to ten percent body is affected and in severe condition nearly ten percent body is affected. common symptoms associated with psoriasis are:
- Red inflamed patches on the skin
- Scales either white or brown on the patches
- Itching and burning on the affected area
- Cracked dry skin
- It can be followed by arthritis or swollen joints in few patients
- Bleeding when patches are scratched
Causes of psoriasis
The cause of disruption of normal immune function is not apparent. Certain triggers and risk factors that activate the immune response are:
- Risk factors
- Genetic factors: Genes control all the activities of the body. Psoriasis is triggered when certain genes controlling the activity of the immune systems become dysfunctional and cause cells to undergo multiple mitotic divisions. It results in inflammation of the cells generating an autoimmune response. Nearly 40 percent of the patients have a family record of psoriasis.
- Alcohol consumption
- Smoking
- Triggers of psoriasis
- Cold weather
- Sunlight
- Infections like pneumococcal, tonsil, HIV, etc.
- Any injury to the skin
- Medications for certain disease like malaria, high bp, heart attacks, bipolar disorder, etc
- Hormonal changes such as those occurring during puberty, pregnancy or menopause
- Stress
- depression
- Obesity
Psoriasis is interlinked with various other diseases like:
- Eye diseases
- Diabetes
- High blood pressure
- heart problems
- IBD: Inflammatory Bowel Disease
- swollen joints or arthritis
- stress/anxiety, and depression
Diagnosing psoriasis
There are two ways to diagnose psoriasis: physical examination or by conducting biopsy.
- Physical examination
Psoriasis is a topical disease and it can be easily differentiated from rest of the skin conditions. The severity of the disease can be estimated from rashes and scars.
- Biopsy
In biopsy, a small sample of the skin is taken to assess the severity of psoriasis under a microscope. Earlier prognosis will help to lessen the severity of the disease.
How to treat psoriasis?[ii]
There are various oral, topical and injectable medicines used to treat psoriasis. Treatment plan depends on the type and intensity of the disease. If a patient do not respond to one treatment, it will be switched to another one.
- Topical treatment
These aim at reducing inflammation, deceleration of call growth and itching relief. Most of the topical medicines are either nonsteroids or steroids. Topical ointments are:
- Corticosteroids: these are most commonly prescribed by the doctors and are sold as gels, ointments, foam, sprays, etc. they are recommended to be applied on alternate days or on weekends to prevent recurrence even if the symptoms have disappeared.
- Retinoids: are more expensive than other topical ointments, they are synthetic vitamin A used to prevent the growth of cells and itching. They are irritating to the sensitive skin.
- Calcineurin inhibitors: help minimize the effects of plaque and inverse psoriasis.
- Salicylic acid
- Different moisturizers
- Oral or Injectable medicines
These are recommended in case of moderate to severe psoriasis when topical treatment fail to prevent the progression of the disease. These medicines are used for limited time period as they present some potential side effects. They are alternated with other medicines.
- Steroids
- Retinoids: to slow down the growth of cells
- Methotrexate: recommended in case of extremely severe psoriasis
- Cyclosporines: used for all types of psoriasis
- Biologics: target T lymphocytes to stop the autoimmune response
- Phototherapy
Utilization of ultraviolet radiations or sunlight or laser therapy target the white blood cells that cause the proliferation of the healthy cells. Phototherapy is either used alone or in combination with other treatments.
- Alternative options
Use of aloe vera extract, fish oil supplements, Oregon grape, essential oils is proved effective in reducing the severity of psoriasis. Itching, scaling, inflammation can be lessened by using these. Essential oils help manage stress and anxiety.
Combination therapy is usually employed to treat psoriasis where two or more treatments are used simultaneously beginning from mild treatment to more rigorous one depending on the severity as well as treatment efficiency.
Non-medical treatments
There are few strategies that can lessen the impact of disease like quitting smoking, stress reduction, exercise, yoga, healthy diet, limiting alcohol, etc.
[i] https://www.webmd.com/skin-problems-and-treatments/psoriasis/understanding-psoriasis-basics
[ii] https://www.healthline.com/health/psoriasis#psoriasis-treatments
