Psoriasis is a chronic, noncommunicable and debilitating disease. It can occur at any age, but is most common in the age group 50 to 69. The etiology of psoriasis is not clear, though autoimmunity and genetic predisposition are thought to be the main causative factors. Psoriasis can also be provoked by triggers, like trauma, throat infections, sunburn, certain medications, stress etc.
Psoriasis mostly involves the skin and nails. Skin lesions are localized or generalized, raised red plaques which are usually covered with white or silver scales. Lesions can also cause itching and pain. Some patients also develop psoriatic arthritis that leads to joint pain. It can also cause inflammation in the eyes, heart, kidneys, and lungs.
Treatment of psoriasis is based on managing the symptoms. Topical and systemic therapies and phototherapy or a combination of these methods are generally used. The need for treatment is usually lifelong and is aimed at long phases of remission.
Psoriasis causes physical and emotional burden and adversely affects quality of life. Social exclusion and stigma are challenging for people suffering from psoriasis and their families. It is not psoriasis that causes the exclusion, it is largely the people’s wrong perception that the disease is contagious, which needs to change.
While researchers do not know the exact cause of psoriasis, the immune system and genetics are found to be the key factors. The immune system normally attacks disease causing germs, but in psoriasis, like any other autoimmune disease, it begins to attack healthy cells as well. Normally, the skin cells completely grow and shed in about 30 days, however, in psoriasis, this happens in 3 to 4 days. Instead of falling off the skin cells accumulate on the surface of the skin. Genetic factors are also found to influence the type of psoriasis and its response to treatment.
Also called psoriasis vulgaris, plaque psoriasis is the most common type of psoriasis. It causes thick, raised and discolored patches or plaques with a silvery scaly buildup on the skin. These plaques can be itchy and sometimes painful. They sometimes tend to crack and bleed as well. The characteristic feature of this type of psoriasis is smaller plaques joining to become larger plaques. These plaques mostly occur on the elbows, knees, lower back and scalp.
Mostly beginning in childhood or teenage years, guttate psoriasis is the second most common type of psoriasis. The word guttate comes from the Latin word "gutta," meaning drop. The lesions appear as tiny pink colored bumps on the skin that usually appear suddenly. It is mostly linked with a recent streptococcal infection. It can affect the legs, arms and torso and in some cases, can develop on the scalp, face as well as ears. Guttate psoriasis usually clears out in a few weeks or months without any treatment and may never return. Rarely, it may resolve and reappear later as patches of plaque psoriasis.
Inverse psoriasis is also known as intertriginous psoriasis or flexural psoriasis as it mostly appears in the skin folds such as armpits, area under the breasts, genitals and buttocks. It is more common in obese people or those with deep skin folds. Inverse psoriasis is characterised by smooth, raw-looking patches which are sore & painful in nature. It is also possible for people with inverse psoriasis to have another type of psoriasis on other body parts at the same time.
Pustular psoriasis is a rare type of psoriasis characterised by red swollen skin with pus-filled bumps. The pus is made of white blood cells. This type of psoriasis usually appears on the feet and hands. This is the reason why it may also make it difficult or painful for you to walk or do any activities that involve your hands or legs. In rare cases, these pus-filled bumps can become widespread and cover the whole body along with other symptoms like malaise, fever, chills, severe itching, rapid pulse, and bodyache. These bumps appear as brown dots after drying up.
This type of psoriasis leads to burnt skin appearance that causes severe itching along with fever, chills, and muscle weakness. Although this condition is very rare, it can be very serious and life-threatening that requires urgent medical attention.
As the name suggests, it affects the nails that include both fingernails and toenails. It causes tiny dents (nails pits) in the nails, discoloration (white/yellow) of the nails,and rough nails. It also causes buildup of skin cells beneath one or more nails, which lifts up the nail.
When psoriasis affects the joints, it is known as psoriatic arthritis. It may lead to swollen and tender joints (especially in a finger or toe), heel pain, swelling on the back of your legs, and stiffness of the joints (especially in the morning which usually wears off during the course of the day). Disease can be grave enough to permanently damage the affected joints. Psoriatic arthritis is a systemic rheumatic disease that can not only cause inflammation of the skin and joints, but also in the eyes, heart, kidneys, and lungs.
Some of the common symptoms include:
Small or large raised, inflamed patches of skin that appear pink or red on light skin and brown or purple on dark skin
Presence of flaky skin with whitish-silver or gray scales
Dry skin that may crack, peel or bleed
Burning, itching, or soreness near the patches
Presence of pus filled boils (pustular psoriasis)
The patches may be symmetrical (guttate psoriasis) and are generally seen over large joints
Thickened, pitted or ridged nails
Painful, swollen joints
Rarely, the entire body may have redness and scaling, associated with fever and other symptoms.
Not every patient will experience all of the symptoms. Symptoms usually depend on the type of psoriasis. Many patients with psoriasis go through rhythmic cycles of symptoms. Severe symptoms might be seen for a few days or weeks, and then during the phase of remission the symptoms may disappear for some time. Later, in a few weeks or due to exposure to some trigger, the symptoms may flare up again. However, the duration of both flare ups and remission is difficult to predict.
Psoriasis is commonly associated with several risk factors and triggers such as:
Stress
Anxiety and depression
Smoking
Alcoholism
Obesity
An injury, cut, scrape or sunburn on the skin
Infection, such as streptococcal throat infection
Certain medicines, such as interferon, antimalarials, nonsteroidal anti-inflammatories lithium or beta-blockers
Stopping oral corticosteroids or strong topical steroids
Cold weather, where people have less exposure to sunlight and humidity and stay in hot, dry indoor air.
Hormonal changes
Immune response of an individual or immune disorders such as AIDS
The diagnosis of psoriasis includes physical examination, blood tests and skin biopsy.
Your doctor may examine your skin, nails, and scalp to check for the presence of lesions and flakes characteristic of psoriasis.
There are no blood tests or imaging studies that can aid in the diagnosis of psoriasis. However, if your doctor suspects psoriatic arthritis or if you have symptoms of psoriatic arthritis, such as swollen and painful joints, you might be asked to undergo blood tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels.
A skin biopsy, in which a skin lesion is removed from the affected area and sent for microscopic examination, to determine the exact type of psoriasis and to rule out other skin disorders. It is a painless procedure done on an OPD basis.
Additionally, psoriasis area and severity index (PASI) might be recommended. This is the gold standard for assessing the severity of psoriasis. It combines the assessment of the severity of lesions and the extent of the affected area in a single index score.
As the exact cause of psoriasis is not fully known, the prevention of this skin problem is aimed at controlling the risk factors. These include:
Boosting your immunity and lowering your risk of infections
Keeping your skin hydrated by drinking loads of fluids
Keeping skin moisturised especially those who have extremely dry skin
Avoiding sun bathing and extremely cold conditions
Managing stress and anxiety
Quitting smoking and avoiding heavy alcohol consumption
Talk to your doctor when taking lithium, high blood pressure medications, steroids etc.
The symptoms of many skin conditions are similar, which makes it difficult to diagnose the root cause of the disease. This is why if you have the early symptoms of psoriasis such as redness and itching of the skin which are similar to that of eczema or atopic dermatitis, then consult a doctor.
Although most people tend to go to a general practitioner (family doctor) to diagnose and get treated, the specialists who can also help in the diagnosis and treatment include are
Dermatologist
Immunologist
You may also like to read about how to choose your skin specialist.
The treatment is aimed at:
Stopping the skin cells from growing quickly
Removing scales and softening the skin
Creams and ointments are used for mild to moderate psoriasis. In more advanced stages of the disease, topical creams are combined with injectable medicines, oral medicines and light therapy (phototherapy).
1. Topical medications
Corticosteroids are the most frequently prescribed medications for treating mild to moderate psoriasis. Topical medications are available as ointments, creams, lotions, gels, foams, sprays and shampoos. Topical corticosteroids might be applied once a day during flares, and on alternate days or weekends only to maintain remission.
Retinoic acid is available as a gel and cream and applied once or twice daily. The most common side effects are skin irritation and increased sensitivity to light. These are not recommended when you're pregnant or breast-feeding.
Calcineurin inhibitors such as tacrolimus and pimecrolimus reduce inflammation and plaque buildup. They can be helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.
Other topical medications used are salicylic acid and coal tar. Salicylic acid is used to get rid of dead skin cells while coal tar works by reducing inflammation and scaling.
2. Light therapy
This psoriasis treatment uses natural or artificial ultraviolet light. It involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light either alone or in combination with medications. Ultraviolet (UV) light, which is found in sunlight, slows the rapid growth of skin cells.
3. Oral and injectable medications
When psoriasis becomes severe, the doctor may prescribe oral or injected drugs. These include:
Methotrexate: Usually administered weekly as a single oral dose, methotrexate decreases the production of skin cells and suppresses inflammation. People taking methotrexate long term need ongoing testing to monitor their blood counts and liver function. Men and women should stop taking methotrexate at least three months before attempting to conceive. This drug is not recommended when you're breast-feeding.
Retinoids: Retinoids are pills used to reduce the production of skin cells. These are not recommended when you're pregnant or breast-feeding.
Ciclosporin: It treats psoriasis by suppressing the immune system. Cyclosporin increases your risk of infection and cancer. People taking cyclosporine need ongoing monitoring of their blood pressure and kidney function. These drugs are not recommended when you're pregnant or breast-feeding.
Steroids: Injection of steroids such as triamcinolone are given right into the lesions if the psoriatic patches are persistent.
Other medications: Thioguanine and hydroxyurea are medications that can be used when other drugs can't be given.
In severe cases, surgical treatment may also be recommended.
Since psoriasis is a chronic disease, there are various measures that can be taken to keep the disease in control and to improve the quality of life. Here are some simple things that you can do:
Having a bath daily helps to remove scales and also calms inflamed skin. You can add bath oil, colloidal oatmeal, Epsom salts or Dead Sea salts to the water and soak. Avoid hot water and harsh soaps and use lukewarm water and mild soaps.
Make sure you apply a heavy, ointment-based moisturizer while your skin is still moist. For very dry skin, oils may be preferable. During cold, dry weather, you may need to apply a moisturizer several times a day.
Exposing your skin to a controlled amount of sunlight can significantly improve lesions. But remember that too much of the sun can trigger or worsen outbreaks and increase the risk of skin cancer. Always consult your doctor for advice on sun exposure.
It is very important that you protect your healthy and unaffected skin from sun damage. Make sure that you apply sunscreen with an SPF of 30 and above and reapply every two hours.
Since alcohol intake can worsen the symptoms, it is best to restrict your alcohol intake or give it up altogether.
People who are diagnosed with psoriasis can develop various complications such as psoriatic arthritis. This is a rheumatic disease leading to swollen joints and a loss of function in some joints.
Other complications include
Obesity
High blood pressure
Type 2 diabetes
Heart diseases
Metabolic syndrome
Inflammatory bowel disease
Eye problems like conjunctivitis, blepharitis, and uveitis
Other autoimmune diseases such as celiac disease, sclerosis and Crohn's disease
Cancer like lung and skin cancer
People with psoriasis also go through discrimination, self-image issues and low self confidence. Along with discomfort and pain of psoriasis, these issues can lead to anxiety and depression.
You can try natural remedies to help in keeping your psoriasis in control. However it is always advisable to consult your doctor before trying any home remedies for psoriasis. Some of the remedies include:
Aloe vera is known to provide relief from the symptoms of psoriasis when applied externally as well as when consumed internally.
Epsom salts/ Dead sea salts have been found to alleviate itching and burning. Add dead sea salt to warm water and soak for about 15 minutes.
Vinegar, a strong disinfectant, helps in relieving scalp itch. Dilute vinegar with water in 1:1 ratio and apply on the affected regions.
Turmeric (in the form of supplement or sprinkled on the food) has been found to be effective in controlling the flare-up of the disease.
Homeopathy is a safe and reliable method of treatment for Psoriasis. It uses natural medicine, which is free from side-effects, and a majority of cases can be treated with these remedies.
1. Arsenic album
It is indicated for silver scales in people with psoriasis. The chief indicator for using arsenic album is the presence of dry, rough, red papular eruptions with scales on it. The eruptions cover most parts of the body, except face and hands. Arsenic album also works well in cases of guttate psoriasis (a type of psoriasis that shows up on your skin as red, scaly, small, teardrop-shaped spots).
2. Graphites naturalis
Graphites naturalis is useful for scalp psoriasis and cracked skin. In such cases, eruptions with scales appear on the scalp. Cases where graphites naturalis works well tend to have patches of sore, dry, rough skin with scales.
Arsenic iodatum: Arsenic Iodatum is used when there is shedding of large scales from the skin eruptions.
Sulphur: Sulphur helps in cases with severe itching and burning in the psoriatic skin lesions. Sulphur is also a remedy for skin ailments with a history of excessive use of ointments in the past.
Petroleum oleum: Petroleum oleum is a very suitable remedy for psoriasis where deep cracks appear on the skin.
Merc sol: Merc Sol is a medicine for Psoriasis of the scalp.In typical cases, the scalp is covered with abundant white scales. The base underneath the scales is raw.
Sepia succus: Sepia Succus is a beneficial medicine for psoriasis characterised by the presence of big oval lesions on the skin. The lesions are reddish papules, the eruptions are present over the face, chest, back, arms and legs.
Bathe with care. Do not use hot water or harsh soaps that will deprive your skin of natural oils.
Keep skin moist. Moisturize your skin well with essential oils, moisturizers and creams.
Wear sunscreen if you have to stay in the sun for a longer span. Sunburns may worsen the condition.
Include anti-inflammatory foods in your diet. These include foods rich in omega 3 fatty acids such as fish, flax seeds, walnuts, chia seeds, soy beans.
Add colorful veggies and fruits such as spinach, carrots, bell peppers and blueberries to reduce inflammation.
Avoid foods such as red meat, processed foods, fatty foods, milk products and foods that are a rich source of arachidonic acids.
Exposing your skin to a controlled amount of sunlight can significantly improve lesions.
But remember that too much sun can trigger or worsen outbreaks and increase the risk of skin cancer.
Always consult your doctor for advice on sun exposure.
Try and figure out your triggers and then take steps to minimize their occurrence. For example if smoking is causing the flare ups, consider quitting it, if sun exposure makes your lesions worse avoid going out during peak hours or wear protective clothing .
Since alcohol intake can worsen the symptoms, it is best to restrict your alcohol intake, or give it up altogether.
It is important to stick to your medications that have been prescribed by your doctor. These include topical medicines, light therapy (phototherapy) and oral and injectable medications.
Psoriasis can take a toll on your mental well being, making you prone to stress, anxiety and even depression.
Take out time each day to practice yoga or meditation for 10-15 minutes.
You could also do some deep breathing exercises to help relieve your stress
You could join yoga classes or practice some simple yoga postures at home.
These therapies have a positive influence on coping with psoriasis.
