Psoriasis

About Psoriasis

Psoriasis is a skin condition characterized by inflamed, red, raised areas that often develop as silvery scales. Psoriasis is a persistent, long-lasting or chronic disease. You may have periods when your psoriasis symptoms improve or go into remission alternating with times when it worsens.

Occurrence

Can occur at any age, but it is generally seen between 20 to 50 years of age. In children, the onset may be at around 8 years.
Often associated with a positive family history of Psoriasis.
It can affect any area of the body, the most common being, the scalp, elbows, knees, back, nails, palms and soles.

Causes

The exact cause of psoriasis is still unknown. It is a common skin disease and affects the life cycle of skin cells. Psoriasis causes cells to build up rapidly on the surface of the skin resulting in abnormal fast-growing and shedding of skin cells. The skin cells multiply quickly, causing the skin to shed every three to four days (normal skin turn overtime is 52 to 59 days). Psoriasis is not contagious. Thus you cannot get psoriasis by swimming in the same pool or by eating from the same plate.

Common Triggers

Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Some of them include

Infections, such as streptococcal sore throat infection
Injury to the skin, such as a cut or scrape, bug bite, scratching, rubbing called as Koebner Phenomenon
Stress
Cold weather
Smoking
Heavy alcohol consumption
Certain medications – including lithium, which is prescribed for bipolar disorder; high blood pressure medications such as beta blockers; anti-malarial drugs and iodides.

Symptoms

Pruritis or itching is a reasonably common symptom especially in scalp and anogenital psoriasis. The following are the most common symptoms of psoriasis. However, these could vary depending on the form and severity of the disease.

Type	Symptoms
Plaque Psoriasis	This is one of the most common forms of psoriasis. It consists of dry, round to oval, red, raised, skin lesions (plaques) covered with silvery scales. It can occur anywhere on the body but is commonly seen on elbows, knees, trunk, arms, legs and scalp.
Guttate Psoriasis	This is usually triggered by a bacterial infection such as streptococcal sore throat infection. They consist of multiple, small red spots that are water-drop shaped and appear commonly on the trunk. But other areas of the body may also be involved.
Scalp Psoriasis	Psoriasis on the scalp appears as red, itchy areas with silvery-white scales. The border of these areas are often red and inflamed. You may notice flakes of dead skin in your hair or on your shoulders, especially after scratching your scalp.
Inverse Psoriasis	Lesions tend to occur in the various skinfolds of the body like the armpits, groins, below the breasts and around the genitals. It appears as smooth patches of red, inflamed skin in the skin folds.
Nail Psoriasis	Psoriasis can affect fingernails and toenails in 25% of cases. The signs for this are Pitting of nail plate and abnormal nail growth. Discolouration and yellow-brown spots known as 'oil-drop signs' under the nail plate. Loosening of nails that separate from the nail bed (onycholysis).

Diagnosis

With the development of silvery scales, the physician can usually diagnose psoriasis with a medical examination of the nails and skin. A skin biopsy also helps in the confirmation of the diagnosis.

Treatment

Specific treatment for psoriasis will be determined by your physician based on

Your age, overall health and medical history
Severity of the condition
Your tolerance to specific medications, procedures or therapies
Expectations for the course of the condition
Your opinion or preference

At the present time, there is no cure for psoriasis. Thus, the goal of treatment is to reduce inflammation and slow down the rapid growth and shedding of skin cells. Treatment may include

Ointments and creams

Moisturisers reduce itching and scaling and can help combat the dryness.
Vitamin D cream slows down the growth of skin cells.
Creams containing salicylic acid or coal tar promote sloughing of dead skin cells and reduce scaling, itching and inflammation
Topical retinoids, like acitretin, normalize DNA activity in the skin cells and decrease inflammation
Cortisone (Steroid containing) creams slow cell turnover, reduce inflammation and relieve associated itching. They should strictly be used under the advice of a dermatologist as they have associate adverse effects.

Light therapy (Phototherapy) – This involves exposing your skin to controlled amounts of the artificial UV-A or UV-B light. It slows skin cell turnover and reduces scaling and inflammation.

Oral medications – In case of severe psoriasis or the resistant types, the dermatologist may prescribe oral or injectable drugs. In some cases, oral retinoids may be used.