Psoriasis

Psoriasis (sore-EYE-ah-sis) is a chronic, noninfectious, autoimmune disease that appears on the skin when skin cells seem to grow too quickly. It occurs when the immune system sends out imperfect signals that accelerate the growth cycle of skin cells. The body does not shed these excess skin cells, consequently the cells accumulate on the surface of the skin and develop lesions. It commonly results in red, scaly patches to emerge on the skin, although some patients have no dermatological signs.

The scaly patches caused by psoriasis which are called psoriatic plaques, are areas of inflammation and excessive skin growth.

Psoriasis is a chronic persistent condition varying in severity from minor localized patches to complete body coverage. Fingernails and toenails get frequently affected. This is called psoriatic nail dystrophy and can be found as an isolated symptom. Psoriasis can also bring about joints’ inflammation known as psoriatic arthritis. 10 to % of people with psoriasis suffer from psoriatic arthritis.

Psoriasis is viewed as a non-curable, long-term (chronic) skin condition which has a variable course, periodical improvement and deterioration. Sometimes psoriasis may disappear for years and stay in diminution. Some people experience worsening of their symptoms especially in the colder winter months. Many people observe improvement in warmer months, climates, or with increased sunlight exposure.

Causes

The cause of psoriasis is not clearly known. There are two main hypotheses regarding the process that occurs in the growth of the disease, firstly when the immune system overreacts, bringing about inflammation and shedding of skin. Another reason is the genetic predisposition is believed to be another common reason involved. Psoriasis is found in members of the same family. Researchers are taking into account of large families affected by psoriasis to find out how it is transmitted from parents to their offspring and what might trigger the condition. Other factors that may contribute to the development of psoriasis, worsening the situation, or make it return, include:

Climate: Cold, dry weather aggravates the situation. Hot weather, sunlight, and humidity may contribute to the improvement of symptoms.

Skin injury: An injury to the skin can develop psoriasis patches anywhere on the body, including the place of the injury including injuries to your nails or nearby skin while trimming your nails.

Stress and anxiety: Stress can result in psoriasis to flare up suddenly or can aggravate the symptoms.

Infection: Infections such as strep throat can cause psoriasis to come out suddenly (guttate psoriasis), particularly in children.

Certain medicines: Certain medicines, for example NSAIDs, beta-blockers, and lithium, have been found to worsen the psoriasis symptoms. Whenever your doctor prescribes any medicines for you, inform him or her about your psoriasis.

Symptoms

The typical symptoms of psoriasis are raised, red patches of skin having loose, silvery scales on the top, usually on the knees or elbows. Psoriasis occurs in various forms that differ in their severity, duration, location, shape and type of scales. The most common forms are described below:

Plaque psoriasis or psoriasis vulgaris: This is the most familiar form of psoriasis characterized by raised, inflamed, red lesions topped with a silvery-white formation of dead skin cells (scales). This is seen mainly on the trunk, elbows, knees, scalp and finger or toe nails.

Nail symptoms include:

Tiny pits in the nails (not found with fungal nail infections)

Yellowish discoloration of the toenails and sometimes the fingernails

Detachment of the end of the nail from the nail bed

Less often, a formation of skin fragments under the nails

Pustular psoriasis: It is an uncommon form of psoriasis having small pustules (whitehead-like lesions) found all over the body or restricted to the palms, soles and other separate areas of the body.

Guttate psoriasis: It is quite frequent in children. It is characterized by numerous small, red, drop-like scaly macules that form rapidly over a wide area of skin. This may appear following an infection, most commonly Strep throat.

Inverse psoriasis: This occurs in the armpit, under the breast, in skin folds, around the groin, in the cleft between the buttocks and around the genitals. It is usually pink in color and irritated but the thick scale seen in other forms of psoriasis is not visible here.

Some dermatologists categorize psoriasis as mild, moderate, or severe. Mild psoriasis occurs when the scaling spreads over less than 5-10 percent of the body, moderate psoriasis consists of scaling over 10 to 20 percent of the body and severe psoriasis is considered to be scaling over 20 percent of the body.

In 5 percent of all psoriasis sufferers, arthritis will occur. This condition is termed as psoriatic arthritis which is inflammation of a joint, generally accompanied by pain, swelling and changes in joint structure.

Exam & Test

Usually there is no need for special tests. If it is difficult to diagnose the condition simply by observing your skin, your doctor may remove a small skin sample (biopsy) and send it to a lab for study. If you have joint pain, X-rays may be carried out to diagnose psoriatic arthritis. Blood work may help prohibit other forms of arthritis.

Guttate psoriasis is a less common type of psoriasis and appears more on the trunk of the body than on the arms or legs. If you have these papules, your doctor may carry out a throat culture to look for strep throat.

Treatment

At present there is no possible treatment for psoriasis to cure it completely. But many types of treatment are available, such as products applied to the skin, phototherapy, and oral medicines, which can help limit psoriasis.

Topical (skin applied) medications

The list includes topical corticosteroids, vitamin D analogue creams (Dovonex), topical retinoids (Tazorac), moisturizers, topical immunomodulators (tacrolimus and pimecrolimus), coal tar, anthralin, and others. Basic treatment often includes combining treatments and products that you can avail without a prescription, including:

Creams, ointments, and lotions to moisturize the skin

Shampoos, oils, and sprays to treat psoriasis of the scalp

Some exposure to sunlight

Phototherapy:This is used alone or along with other therapies to treat moderate to severe psoriasis.

UVB light therapy:It is often useful to improve psoriasis. UVB treatment is usually performed thrice a week. Treatment of psoriasis with UVB and medicines spread on the skin, such as tar or calcipotriene, is safe and effective to use.

Psoralen and UVA light therapy (PUVA): This combines a medicine and ultraviolet A light (UVA) for psoriasis treatment. First, you use a medicine, called a psoralen and may take it as a pill or apply it on your skin as a lotion, or use it as bath salts. The medicine makes the skin more susceptible to UVA light. Then you walk into a chamber where your skin is exposed to UVA light. PUVA treatment usually is carried out for weeks before the psoriasis symptoms disappear.

Excimer lasers: This treatment is used to treat a small, restricted area of psoriasis. They deliver UVB light directly to the psoriasis without exposing normal skin.

Though treatment with UVB seems safer than PUVA, but it is less effective.

Oral Medicine-If you have moderate to severe psoriasis, your doctor may prescribe oral medicine, like methotrexate, some retinoids, and cyclosporine. Oral medicines also may be helpful if topical medicines and phototherapy are not controlling your psoriasis satisfactorily.

Biologics

Biologics are medicines quite similar to or the same as proteins produced by the body. These drugs are made from living material such as human, plant, animal, or microorganism. They put impact on parts of the body\’s immune system to avert inflammatory disorders. These medicines, such as alefacept and etanercept, block the harmful reaction of the body\’s immune system that causes psoriasis. Although biologics may not prove more effective in comparison to other treatments for psoriasis, they may be safer for organs like liver or kidneys that some oral medicines can harm. Unlike drugs that repress the complete immune system, biologics can fight more definitely and target only those chemicals that cause psoriasis. Currently, the four main classes of biologic drugs for psoriasis are identified; these are:

1.TNF-alpha blockers (tumor necrosis factor),

2.Drugs that block T-cell activation and the movement of T-cells,

3.Drugs that decrease the number of activated T-cells, and

4.Drugs that interfere with interleukin chemical messengers of inflammation.

Prevention

We cannot prevent psoriasis. But following the tips given here may improve symptoms or help reduce the number of psoriasis flare-ups:

Keep skin lubricated using oils, creams and petroleum jelly preparations.

Use a humidifier in the home.

Get out in the sun. But be sure that you don’t get sun burns. Exposing only the areas of your body with active psoriasis may be most suitable.

Get out in the sun. But be sure that you don’t get sun burns. Exposing only the areas of your body with active psoriasis may be most suitable.

Bathing in tepid water may help reduce scaling.

Use mild soaps or soap-free cleaners.

Avoid scratching and picking skin, and also skin injuries such as cuts or scrapes because an injury to the skin can develop psoriasis patches to form anywhere on the body, including the place of the injury. This involves injuries to your nails or nearby skin at the time of trimming your nails.

Avoid stress and anxiety because stress may cause psoriasis to flare up suddenly or can make symptoms worse. But this is yet to prove.

Infections like strep throat can cause a particular type of psoriasis known as guttate psoriasis to appear suddenly, especially in children.

Some medicines, including beta-blockers and lithium, have been found to make psoriasis symptoms worse. When your doctor prescribes any medicines for you, tell him or her that you have psoriasis.

Limit alcohol to no more than 2 drinks a day for men or 1 drink a day for women. Alcohol use can cause symptoms to flare up.

Don\’t smoke. Smoking may make you more likely to get psoriasis and may make it more severe. Smoking may also make your symptoms last longer.

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