Overview: Psoriasis is a common condition of the skin, in which the skin cells’ life cycle gets accelerated. This results in the accumulation of cells on the skin’s surface. The extra skin thus found forms scales and red patches, which can be itchy and painful.
Psoriasis can be said as a chronic disease and the main objective of the treatment employed here is to terminate the quick growth of skin cells.
There is no definite cure for psoriasis, but its symptoms can be managed if the individual takes some measures for improving it.
The signs and symptoms differ for each individual. But the common signs and symptoms include:
- Red patches on the skin
- Small sized scaling spots (in children)
- Bleeding of dry cracked skin
- Nails will be thickened, pitted, or ridged
- Stiff and swollen joints
Types of Psoriasis
Some types undergo cycles, from flaring up for a few weeks or months, to a time where it subsides or entering into complete remission. Some of the several types include:
This is the most common type of psoriasis that causes dry, red skin lesions (plaques) covered in silvery scales. The occurrence can be anywhere in the body, ranging from soft tissues inside the mouth to genitals.
Psoriasis can also affect both fingernails and toenails, resulting in pitting, discoloration, and abnormal nail growth. The affected nails might loosen and fall from the nail bed, which is termed as onycholysis. In severe cases, the nail might crumble.
This type mainly affects children and young adults. The trigger for this is a bacterial infection like strep throat. It is characterized by small, scaling lesions on arms, legs, and scalp.
The region that is mainly affected are the skin in the armpits, groin, around the genitals, and under the breasts. This can be identified by smooth patches of red, inflamed skin which gets worse with sweating and friction. This can be initiated by fungal infections.
This is a rare type, can cause widespread patches in the body or in small areas in hand, feet or fingertips. But the time required for it to develop is short and it may also cause fever, diarrhea, severe itching, and chills.
It is the least common type of psoriasis that can cover the entire body with a red, peeling rash. This can cause itchiness or severe burning sensation.
In addition to the normal symptoms of psoriasis, like inflamed and scaly skin, psoriatic arthritis shows the typical signs of arthritis like swollen, painful joints. Symptoms can span from mild to severe and it can affect any joint. Although this disease isn’t crippling as other forms of arthritis, it can lead to permanent deformity in serious cases.
Causes of Psoriasis
Though the cause for psoriasis is not fully understood, it is generally believed to be related to an immune system problem with T cells and other WBC like neutrophils in the body.
Generally, T cells travel through the body to fight against foreign substances like virus or bacteria. But when psoriasis is present, mistakenly the T cells attack the healthy skin cells, as if to fight an infection or heal a wound.
The overactive T cells can initiate an increase in the production of healthy skin cells, more T cells, and other white blood cells like neutrophils. When these travel through the skin, it causes redness and pus in pustular lesions in certain cases. The psoriasis-affected region has dilated blood vessels which gives redness and warmth in the skin lesions.
This process becomes an ongoing cycle in which the new skin cells are pushed to the outermost layer of the skin in the duration of a few days rather than in weeks. This causes the skin to build up, making it look like thick, scaly patches until treatment stops the cycle.
The cause for the malfunction of T cells in people with psoriasis is not entirely known. Researchers believe that both environment and genetics play a role.
Triggers for psoriasis
Psoriasis can start or get worse because of a trigger, and identifying them will help to avoid and take measures. The factors that may trigger are:
- Infections like strep throat or skin infection
- Injury to the skin like a cut, bug bite, or a severe sunburn
- Heavy drinking
- Vitamin D deficiency
- Certain medication, like lithium for bipolar disorder, beta blockers for high blood pressure, antimalarial drugs, and iodides
Psoriasis can affect anyone, but the following factors increase the chances of developing it.
- Family history
- Bacterial and viral infections
Once psoriasis is present, there is a high chance for developing certain diseases including:
- Psoriatic arthritis
- Eye conditions like conjunctivitis, uveitis, and blepharitis
- Type 2 diabetes
- High blood pressure
- Cardiovascular disease
- Metabolic syndrome
- Autoimmune diseases like celiac disease, sclerosis, and Crohn’s disease
- Parkinson’s disease
- Kidney disease
- Emotional problems like depression
In most of the cases, the diagnosis for psoriasis is straightforward.
Usually, doctors can diagnose psoriasis by taking the medical history of the individual and performing a physical examination on skin, nails, and scalp.
In rare cases, doctors may suggest a biopsy of skin under local anaesthesia.
Treatment for psoriasis can be divided into three types namely: topical treatment, light therapy and systemic medications.
When creams and ointments are used alone, they can treat effectively mild and moderate psoriasis. If the disease is more severe, a combination of creams and oral medications or light therapy might be administered. Topical treatments include the following:
- Topical corticosteroids
- Vitamin D analogues
- Topical retinoids
- Calcineurin inhibitors
- Salicylic acid
- Coal tar
Light therapy (phototherapy)
This treatment involves natural or artificial ultraviolet light. This can be administered alone or combined with other medications. Some of which belongs to this type are as follows:
- UVB phototherapy
- Narrowband UVB phototherapy
- Goeckerman therapy
- Psoralen plus ultraviolet A (PUVA)
- Excimer laser
Oral or injected medications
If the condition is severe, the doctor may suggest oral or injected drugs. This can be called as a systemic treatment. It can also can severe side effects if used for a long time. Some of them are:
If the above drugs cannot be administered, then thioguanine and hydroxyurea can be used
Although the choice of the treatment largely depends on the type and severity of psoriasis along with the areas of skin that are affected, the traditional method is to start with the mildet treatments and progress to stronger ones. In cases on pustular or erythrodermic psoriasis, systemic therapy is administered from the beginning. The main objective is to find the most effective way to decrease cell turnover with fewer side effects.