Psoriasis: What you need to know?
Psoriasis is often a term associated with skin diseases, but contrary to popular belief is a non-contagious skin condition in which skin appears dry, red, with thick plaques around the infected area. Psoriasis can range from mild to severe condition which needs immediate medical attention. Psoriasis can occur throughout the body but is more common around the skin tissue surrounding elbows, knee caps and scalp. It is basically caused due to abnormal number of lymphocytes in the blood.
Psoriasis primarily being chronic skin disorder affects 1% to 3% of the world’s population annually characterized by episodic flare-ups, bright red patches bordered by a silvery, flaky scale externally along with inflammation. The skin cells grow at a rapid rate of days rather than getting replenished in weeks, the body unable to shed the extra skin accumulates them to form lesions.
Causes of Psoriasis and Triggers
There are various causes of Psoriasis, some definite while others act as triggers
- Genetic Mutations: – One possible cause for psoriasis is linked to the genes and their mutational changes. Mutations in chromosome 6, called PSORS-1, is a major factor involved in psoriasis. There have been 9 possible mutations that largely affect T-helper cells.
- Autoimmunity of Immune System:- Usually the function of T- Cells is to assist in protective immunity against pathogens but in Psoriasis T-cells become overactive and set of an immunity storm that cause inflammation and skin cells to mature in days rather than weeks.
- Environmental Causes: Environmental factors too seem to play an important role in causing psoriasis. Climatic changes have a profound impact with majority of psoriasis cropping up in winter.
- Skin Injury: Psoriasis can begin after the onset of certain skin diseases eczema and lichen planus or 2 – 6 weeks after onset of injury. Injuries that trigger psoriasis include Skin Abrasions, Sunburns, etc
- Stress:- Sudden stressful events are known to trigger psoriasis, studies have been conducted linking high stressors with normal cohorts and it was found that stressful individuals were twice as likely to get psoriasis.
- Infection: Bacterial, fungal and viral infections too have been responsible for psoriasis , psoriasis flares were seen after onset of Streptococcal infections that cause strep throat , tonsillitis, cellulitis or strep throat, and impetigo
- Vitamin Deficiency:- Vitamin deficiency and vitamin related disorders such as dermatitis, fissures are reported to trigger psoriasis flare ups.
- Drug Triggers:-Following drugs are known to aggravate psoriasis conditions
- Chloroquine — used in treatment of malaria
- Antinflammatory drugs
- ACE inhibitors — used in treating blood pressure, drugs include monopril, captopril etc
- Lithium – Used in treating bipolar disorders
- Beta blockers – also used in treating high blood pressure, drugs include lopress
- Genetic Predisposition :- Some races are genetically more inclined to get psoriasis, A study conducted in the United States found the prevalence of psoriasis was 2.5% in Caucasians and 1.3% in African Americans
- Triggers of Psoriasis: -
- Factors that can trigger psoriasis include
- Impaired liver functions and liver disorders
- Metabolic disorders of protein digestion
- Alcohol consumption
- Smoking and drug abuse
- Stress and anxiety related disorders
- Nutritional and vitamin deficiencies
- Excess intake of saturated fats
- Infections and illness
- Intake of some drugs as mentioned above
Types of Psoriasis:-
Some common types of psoriasis are discussed below
Psoriasis Symptoms and Signs
General features of most common type of psoriasis are listed below
- Plaques: A common feature in plaque psoriasis, plaque infected areas are raised and may be few to several in number. Can either be oval , round or irregular in shape , smaller plaques can conjoin with others to give appearance of large infected area. Can usually be seen in and around arms , elbows , trunks and joints. Plaque psoriasis can occur along with fissures in some cases while in others it may be visible as a halo or ring.
- Red color: One standout feature of psoriasis is the reddish color due to increased blood flow out into the tissues, the complete red color is salmon colored with a blue tinge in and around the legs and arms.
- Scale: Seen in most forms of psoriasis, scales are visible which are indication of dead skin tissue, are usually dry , silvery white which fall apart as grains, when these scales are removed the skin underneath has characteristic red smooth glossy look, and can be accompanied by bleeding in some cases.
- Symmetry: Psoriasis has a definite symmetry, and can occur on either sides of the body at same regions , For E.g. Both elbows or arms can be affected at the same time with the same intensity of red spots.
Other general symptoms of psoriasis are as follows:
- Scalp: The scalp can be unusually dry with scaly silvery skin or with crusted plaques in the infected area. Not all psoriasis in scalp can be termed Scalp Psoriasis, variations like seborrheic psoriasis in which the scales are greasy looking can also be seen.
- Nails: Nail discoloration are often seen along with plaque psoriasis, where in pits , indentations or ridges are seen in nails .The pits can appear yellowish in color.
- Droplets on skin: Psoriasis like Guttate psoriasis can be accompanies as tiny red drops on skin and can usually occur after a bacterial infection.
- Pus on patches: Elevated bumps on skin with white tips filled with pus along with patches of dry, scaly skin can be seen in pustular psoriasis.
- Psoriasis in children: Plaque psoriasis can differ in appearance when compared to adults with skin less scaly and predominantly appearing in and around the diaper region.
- Psoriasis in Joints: In addition to inflammations and scaly skin psoriasis affects the joints causing them to be swollen like in arthritis along with stiffness. Can also be accompanies by inflammatory eye conditions, such as conjunctivitis.
Tests and Diagnosis for Psoriasis:-
The diagnosis for psoriasis in most cases is straightforward.
- Physical exam and medical history: A routine physical examination involving examination of skin scalp nails and folds of your skin may be sufficient to diagnose psoriasis.
- Skin biopsy: In certain cases a skin biopsy may be taken to determine the exact kind of psoriasis or to enable the doctor to distinguish from other infections or disorders. The skin excised is usually observed under microscope.
- X Rays :- If the doctor suspects psoriatic arthritis he may recommend an X ray test to be done on the infected joints
Treatment for Psoriasis:-
Following is the list of treatment options used for different kind of psoriasis
- Topical Creams and lotions :- Have been the popular choice of medication for psoriasis, they include topical corticosteroids, moisturizers, topical retinoids, vitamin D analogue creams, topical immunomodulators, coal tar and others.While topical corticosteroids are used as first-line treatment for limited or small areas of psoriasis, Vitamin D analogue cream sold as calcitriol are more useful in treating psoriasis. The advantage of calcitriol is that it is not known to overly thin the skin like topical steroids. Therapeutic concentrations of salicylic acid, lactic acid, urea, and glycolic acid are sold as anti psoriasis moisturizers. Other treatment options include immunomodulators such as tacrolimus and pimecrolimus, coal tar anthralin etc.
- Oral Medications:- Oral medications choice include acitretin, cyclosporine, methotrexate, mycophenolate mofetil, and others, while corticosteroids are avoided as they aggravate flare diseased conditions.
- Biologics Injections and Infusions : Since Psoriasis is a disorder chiefly associated with immune system, a new class of drugs called biologics have been developed which modulate or suppress the immune system from over reacting in psoriasis. Currently available biologic drugs include alefacept (Amevive), adalimumab (Humira), infliximab (Remicade), etanercept (Enbrel), and ustekinumab (Stelara). Stelara an antibody is effective in psoriasis by blocking the interleukins that are responsible for the overproduction of skin cells and inflammation
- TNF blockers: Prevent inflammation and T- cells from being hyper responsive, TNF blockers include Enbrel (etanercept), Remicade (infliximab) and Humira (adalimumab).
- Drugs that decrease the number of activated T-cells: Various drugs such as Amevive (alefacept) are available that act directly on activated T – cells and are often administered intramuscularly.
- Light Therapy: A new form of alternative medicine called phototherapy or light therapy has been developed, one of which widely used in psoriasis treatment in the PUVA, (Psoralen + UVA), Variants involving UVB have also been used. Psoralens are generally given orally as a pill or topicallyin form of a bath or lotion. After a brief incubation period, the skin is exposed to a wavelength involving ultraviolet light called UVA Both the psoralen and the UVA light must be administered within one hour of each other for a response to occur. Natural sunlight is also used as phototherapeutic agent to treat psoriasis which involve giving short daily controlled exposures of affected skin to natural sunlight There are also multiple newer light sources like lasers and light activated medications like photodynamic therapy that have been used to treat psoriasis.
- Diet and Supplements for Psoriasis: Certain foods are known to be causative trigger factors for psoriasis; hence dieticians claim alternate treatments involving dietary supplements can be useful in treating psoriasis. Avoiding fatty food, intake of Fish oil, evening primrose oil, milk thistle, vitamin D, and oregano oil have all been variously reported to improve psoriasis.
- Hydrotherapy for Psoriasis :Water therapy can supply heat, moisture, and minute amounts of key minerals to the skin; it can also help relieve some of the symptoms such as itching and burning sensation of psoriasis.Dead Sea, has earned a great reputation with psoriasis sufferers from around the world. They go there to bathe in the mineral- and salt-rich waters and sunbathe under the unique natural ultraviolet spectrum of light. Bathing in warm water, high in mineral like sulfur may aid in healing.
- Detoxification therapy: Principle is to getrid of the body’s lingering toxins and waste products and help enable the skin cells to function properly again. It can also aid in removing have high levels of endotoxins which are one possible cause for psoriasis.
- Herbal Medicine for Psoriasis: Many herbs are important in the treatment of psoriasis, including sarsaparilla (which binds with endotoxins), Coleus forskoli, Psoralen coryliforia, and many others.
- Aromatherapy for Psoriasis: The essential oils of bergamot, calendula, or lavender can be mixed with carrier oils and massaged into the skin.
- Hypnotherapy for Psoriasis: Hypnotic trances may be used to offer the subconscious mind suggestions regarding pain control, skin healing, and stress reduction.
- Traditional Chinese Medicine for Psoriasis: Effective treatment may include herbal therapy and acupuncture directed toward the organ system that has the imbalance of vital life energy triggering the skin lesions.
- Yoga and Meditation: Though not a direct treatment it can help relieve stress which is one of the causative factors for psoriasis.