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Psoriasis

Overview

Psoriasis is a skin condition associated with patches of abnormal skin. The patches may appear red, itchy, flaky, often covered with silver scales mostly on the scalp, trunk, elbow, and knees. The exact appearance of psoriasis might depend on each person and the type of psoriasis, but the overall idea is that the person has abnormal patches of the skin. The disease itself is a long-term autoimmune disease. The cause and mechanism of psoriasis are quite complicated, it has no cure, and the patient may undergo periods where the skin disease flares up or goes into remission. Psoriasis is not contagious, i.e., it cannot be passed from one patient to another.

Causes

Psoriasis is a multifactorial disease which means it is a combination of genetic (if one of your parents has it, you are more likely to have this disease which you have inherited from your parents)  and susceptibility factors such as type 2 diabetes, obesity, depression, anxiety, cardiovascular diseases, and metabolic syndrome.

It is thought to be an autoimmune disease in which the body’s defense system gets confused and attacks its own cells. 

Types

  • Plaque psoriasis: It is the most common type, also called psoriasis Vulgaris. It presents as raised and inflamed red patches of skin covered in a silver scale commonly seen on the elbow, knee, scalp, lower back, hands, feet.
  • Guttate (Latin for droplet ) psoriasis: It is common in childhood and presents as small psoriatic papules common on the trunk of the body, and proximities usually occur during or after streptococcal infection.
  • Inverse psoriasis: It is located in folded areas of skin such as the armpit, groin, elbow, knee. There isn't as much scaling, but there are a lot of glossy red patches, and this type of psoriasis is seen more in obese patients.
  • Pustular psoriasis: In this type, there are pus-filled lesions with red borders, usually in hands and feet, This is a more serious form of psoriasis
  • Psoriatic arthritis: Some patients with psoriasis also develop inflammation of the joints. Inflammation on the entire finger or toe is called dactylitis. This is a very painful condition. Involvement of nails may also occur in the form of pitting. 

Risk Factors

Some of the risk factors of developing psoriasis are;

  • Bacterial or viral infections
  • Being Overweight
  • Alcohol consumption
  • Tobacco usage
  • Genetic inclination
  • Caucasians
  • Stress
  • Injury to the skin 

Epidemiology

More than 125 million people are affected worldwide. Up to 3 % of the world population is living with psoriasis. More than 1/3 of patients with psoriasis suffer from its mild to severe form. Approximately 7.4 million people in the United States of America have psoriasis. According to the WHO, males and females are equally affected.

Signs And Symptoms

Psoriasis may present as:

  • Skin that may bleed or itch
  • Red, inflamed patches on the skin
  • Silver-colored scales
  • Dry, cracked skin
  • Hard nails
  • Stiff joints 

Diagnosis

History and physical examination are the main tools to making a diagnosis. Examining the typical lesions on the skin may point towards the diagnosis. Another telling sign is when psoriatic plaques are scraped, pinpoint bleeding can be seen from the skin below. This is known as the Auspitz sign.   

  • Skin biopsy: If the symptoms are unclear, the doctor may need a biopsy by taking a skin sample. This sample is sent to the lab to rule out other disorders.

There are no specific blood tests or diagnostic procedures for the disease. 

Differential Diagnosis

Treatment

Psoriasis is a chronic disease without a cure. The goals of treatment are to reduce the symptoms and halt the progression of the disease. The following substances are effective in the management of symptoms and the psoriatic lesions;

  • Topical therapy: Corticosteroids, vitamin D analogs, certain emollients (petroleum jelly, mineral oils), salicylic acid, moisturizer, and topical retinoids are applied directly on the lesions, which show some resolution in up to eight weeks.
  • Systemic medication: Medicines such as methotrexate, cyclosporin (Sandimmune), biologics, retinoids are immune suppressive medications.
  • Ultraviolet therapy (sunlight or ultraviolet lamps) is also quite successful.
  • Diet modification: The patients are advised to obtain a high amount of fish oil with EPA acids and DHA acids.
  • Coal tar is a thick black by-product of coal. It can slow down the growth of skin cells and ease inflammation. It also helps with itching and scaling.
  • Probiotics and certain vitamin supplements play a huge role in maintaining good gut health, which also improves the symptoms of psoriasis. 

Prognosis

Psoriasis is a long-term disease. It has no cure. There are periods of relapse and remissions in this disease. Psoriasis is known to improve in warm weather and worsen in cold weather. The disease has a poor prognosis if it appears early in life with a family history or concomitant HIV infection. Stress is also a poor prognostic factor. Although psoriasis is not a life-threatening disease, it's quite debilitating. It also has psychological consequences for patients who suffer from low self-esteem, depression, and anxiety. These patients should also be treated for these symptoms.

Lifestyle Modifications

Several studies have revealed some of the precipitating factors of psoriasis which should be avoided to cope with the illness like;

  • Avoid alcohol and dairy.
  • Managing stress as it is beneficial to reduce flare-ups.
  • Some medications trigger the disease, such as high blood pressure medication, antimalarial medication, and lithium, so these medications should be avoided.
  • It is advisable to lose weight and eat a healthy diet rich in Omega -3 fatty acids.
  • Avoid red meat, refined sugar, dairy products, and junk or processed food as they have been known to cause flare-ups.
  • Exercise can also lower chronic inflammation; therefore, it is beneficial to adopt exercise if the patient is suffering from the disease and for overall general well-being.

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