Psoriasis Article

“Psora” a desquamative condition was first described around 100 BC. Psoriasis is a long standing skin disease which can also affect the joints and have associated comorbidities. Recent times have seen an increased incidence in psoriasis.

Multiple factors are responsible for psoriasis and genetic predisposition predominates. About 1/3 of people who have psoriasis also have a family member afflicted with the disease. The basic default lies in overstimulation of the skin cells ; produced rather quickly these immature cells stack up and results in a thick, red skin which is scaly and irritable (psoriasis plaque).A normal skin shows mature cells which multiply one in a month, but in a psoriatic plaque the immature cells multiply rapidly within 3-5 days. This overstimulation of skin is linked by research based studies to an increased activity of the immune system which produces a protein called as TNF- alpha usually triggered in response to an infection or foreign protein.

The red scaly psoriatic plaques may remain localized and limited to a particular part of skin in some people or have a widespread expression covering a large surface area in others. On the skin bony points of hands, feet, sacral area and back are most common but folds of the body, palms, soles, scalp, nails, face and even oral cavity may be involved by psoriasis.

By severity and extent psoriasis may be a mild affliction covering less than 10% of body surface area (BSA) or the moderate variety may cover 10- 30% BSA or can be widespread covering more than 30% BSA labeled as severe disease.

A person suffering from psoriasis may not have active disease all the time and there are often phases of symptom free intervals where the disease is said to be in “remission”. In certain situations psoriasis may remit on its own, but the disease free interval is unpredictable in duration and recurrence often a rule. There may be persons who are in remission from psoriasis for years where as others who do not remit for years!

• Infections
• Stress
• Cold climate
• Injury/trauma
• Certain medications
• Alcoholism
• Cigarette smoking

Left untreated active psoriasis can worsen in severity by grades and rarely lead to potentially severe forms like “erythroderma” where almost entire skin is affected with red scaly itchy surface or tender pus filled blisters may cover the skin surface called as” pustular psoriaisis”, here if large areas of skin get involved this is a potentially life threatening variety of psoriasis and warrants immediate hospitalization.

Psoriasis can affect not only the skin surface but in 30% cases arthritis can coexist making routine day today tasks mundane and difficult for a person. When spine and small joints of hands and feet are affected it can lead to painful and often crippling immobility for a person. Psoriatic patients have a significantly higher prevalence of other co morbid diseases too e.g.

• Depression
• Diabetes
• Hypertension
• Cardiovascular diseases

These comorbidities further limit the response to medical treatments and pose a challenge to disease control.

Men as well as women have an equal tendency to be affected by psoriaisis and the incidence of psoriasis is on rise in urban population due to stressful lifestyles. The disease can resurface between 15 to 40 years of age but psoriasis among children and middle age is not uncommon either. Early onset psoriasis is more common in first-degree relatives indicating a genetic association and it follows an irregular course and shows a strong tendency to become widespread.

Psoriasis is easy to diagnose by a dermatologist and when in doubt a simple skin biopsy procedure can help one to confirm if you are suffering from this condition. Clinical evaluation and Imaging studies are of great value in detecting psoriatic joint involvement.

Dealing with psoriaisis is the journey with onself, the world, the family, the relatives and the health care physician for an affected person. It has deep psychological impact on the person’s mental, physical, professional, social and emotional capabilities

A large number of social factors hound a psoriatic individual and often frustration, embarrassment, low self esteem, social stigma teemed with prolonged medical therapies and unpredictable remission often tempts a person to try over the counter and quack remedies which claim cure.

• Genetic disease with an immune system malfunction
• Psoriasis is not contagious and cannot spread by touch or intimate contact, sharing of utensils or living under one roof
• It is not an infection
• No food is responsible for causing psoriasis
• There is no cure for psoriasis and often long term control can be obtained in many patients.
• Ample therapeutic options are available to bring remission in psoriasis and when properly selected, in most cases the lesions clear up in couple of months.
• Maintenance therapy is equally important.

Dermatologists now have more therapeutic options available than ever before to control psoriasis.
The treatment goals for are
Patient information and education
Achieve control and optimal clearance
Maintain remission to prevent reactivation
Prevent complications

Dos & Don’ts in psoriasis

• Keep skin well moisturized throughout the day, since cooler climate is detrimental to psoriasis, so are air conditioners!
• Use soaps that are moisturizing and not drying. Heavy moisturizing post bath will help to reduce scaling.
• Avoid hot water baths, mild warm baths are sufficient.
• If the scalp is affected medicated shampoos containing tar, cortisone, salicylic acid along with antifungal agents help to loosen and wash out the scales.
• Scratching should be avoided as it may introduce infection and if severe can be relieved by antihistamines .Scratching can trigger new psoriasis plaques too.
• Psoriasis affected nails are thick, pitted and discolored .They readily crumble too. Avoid heavy detergent exposure or gardening by wearing gloves. Keep nails short, groomed and clean. Manicure and pedicure should be avoided by persons with psoriasis as propensity for bacterial and fungal infections is high in nails or nail folds after such procedures.
• Hands and feet should be checked and any cuts should be treated. Often adequate moisturizing does the job and for thick scaly skin ointments are preferred over creams. A way to make the creams work better in thick scaly psoriasis is to cover it with plastic cling films for 20 mins after applications. This softens and loosens the dead cells and allows better penetration of the applied creams/ointments, gives excellent symptomatic relief.
• Refrain from self medication.
• Abstain from alcohol and smoking.
• Follow a healthy diet pattern and keep a check on weight
• Regular exercise keeps cardiac risks down and helps arthritis.

The treatment options that are chosen are in accordance with severity of the disease If one has is mild psoriasis, it can be managed by topical therapies and moisturizing applications alone. Moderate psoriasis may improve with topical therapies or may need additional phototherapy with or without oral medications. Phototherapy is conducted by using light sources (UVA and UVB rays). Severe psoriasis needs to be treated with certain disease modifying drugs and newer biologics drugs .Oral medications work by reducing the accelerated skin multiplication.

Research supports continued reliance on fixed dose, rotational newer therapies for mild to moderate and drugs like methotrexate, Acetretin, cyclosporine and biologics for moderate, severe and life threatening types of psoriasis. The advent of biologics has revolutionized the treatment of psoriasis. And newer biologic drugs work by targeting specifically the TNF alpha cytokine responsible for initiating the disease process there are a number of biologics available for treating psoriasis and psoriatic arthritis. Some of them are approved by FDA for use in psoriasis and psoriatic arthritis.

No one treatment works for everyone and there is no way of predicting which treatment will work or which will not. Patient’s life style management is as important as therapeutic intervention in psoriasis. Thus various factors governing the treatment of choice are crucial and play an important role in choosing these treatments. Professional dermatology opinion and services should be sought for addressing all grades of psoriasis. With proper education, information and medical care the worst psoriasis can be overpowered and life can be lived to the fullest.

THE INFORMATION IN THIS ARTICLE REFLECTS THE VIEWS OF THE AUTHOR ONLY. A QUALIFIED HEALTH CARE PROFESSIONAL SHOULD BE CONSULTED BEFORE USING ANY THERAPEUTIC PRODUCT DISCUSSED. ALL READERS SHOULD VERIFY ALL INFORMATION AND DATA BEFORE TREATING PATIENTS OR UTILIZING ANY THERAPIES NOTED IN THIS PROGRAMME.