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Psoriasis

Psoriasis is an inflammatory skin disease, which involves the formation of thick, red and scaly patches on the skin. It is a chronic (long-term) condition and usually occurs in the form of cycles, flaring up for some months and then subsiding. Usually, the elbows, knees, and scalp are affected, but it can also affect the palms, soles, and torso.

There are several types of psoriasis based on their appearance; the common types include:

  • Plaque psoriasis
  • Pustular psoriasis
  • Guttate psoriasis
  • Erythrodermic psoriasis
  • Inverse psoriasis

Symptoms

The signs and symptoms of psoriasis vary from person to person and may commonly include:

  • Red patches covered by thick and silvery scales
  • Dryness and cracking of the skin that may bleed
  • Small scaling spots (usually in children)
  • Itching, burning, and soreness
  • Joint stiffness and swelling
  • Thick, pitted or ridged nails

The patches can be mild, but similar to dandruff-like scaling or can be severe enough to cause eruptions over the large skin surface.

Causes

The exact cause of psoriasis is not stated but was found to be due to an alteration in the immune response. In people with psoriasis, the immune cells known as T-cells mistakenly attack the healthy skin cells during their fight against infection or healing a wound. Additionally, these hyperactive T-cells trigger the production of excess T-cells, skin cells and white blood cells (especially neutrophils); these cells reach the skin surface and lead to redness and pustular lesions. Over a period, these cells form thick, dry, and scaly patches on the skin. This cycle continues until a proper treatment is provided.

The following factors can trigger psoriasis:

  • Injury or infection of the skin
  • Vitamin-D deficiency
  • Alcohol abuse and smoking
  • Stress
  • Use of certain medicines, such as anti-malarial drugs, high blood pressure medicines

Risk factors

The risk of developing psoriasis increases with:

  • A family history of the disease
  • High-stress levels
  • Obesity or overweight
  • Habit of smoking tobacco
  • Weak immune system associated with infections, such as HIV
  • Certain bacterial and viral infections

Complications

The following complications are more likely to develop in a person with psoriasis:

  • Psoriatic arthritis
  • Obesity (especially with severe form of psoriasis)
  • High blood pressure
  • Diabetes
  • Cardiovascular diseases, such as high cholesterol, atherosclerosis, and irregularities in heartbeat
  • Kidney diseases
  • Emotional disturbances
  • Other autoimmune diseases

Diagnosis

The diagnosis of psoriasis is done by physical examination of the skin, scalp, and nails by the dermatologist. Additionally, a family history and medical history of the patient is collected. Rarely, a biopsy of the affected skin is performed, which involves observation of the skin sample under a microscope to understand the root cause.

Treatment

Treatment options for psoriasis include topical preparations, oral medicines, injections, and phototherapy. The doctor will choose appropriate treatment considering several factors, such as the type of psoriasis, severity, side effects of the treatment, and certain patient-related factors.

The following topical creams or ointments may be prescribed either alone or in combinations to treat mild to moderate psoriasis:

  • Corticosteroids to reduce inflammation and relieve itching
  • Vitamin-A derivatives to decrease inflammation
  • Calcineurin inhibitors to reduce inflammation and plaque formation
  • Moisturizers to reduce itching, dryness and scale formation
  • Vitamin-D analogs to slow down the growth of skin cells

The following oral or parenteral medications (systemic treatment) are prescribed to treat severe forms of psoriasis or if other treatments are not effective:

  • Biologics which alter the immune system
  • Vitamin-A derivatives to decrease inflammation
  • Immune suppressant drugs to reduce inflammation and slow down the skin cell production

Phototherapy involves the exposure of the skin to different forms of natural or artificial UV light including:

  • UV rays in sunlight or artificial light
  • UVB phototherapy
  • Psoralen plus ultraviolet A (PUVA)
  • Excimer laser

Prevention

Although prevention of psoriasis is impossible, it can be managed to an extent with some lifestyle and home remedies. The home remedies include:

  • Taking a bath every day
  • Applying moisturizer
  • Exposing skin to low amounts of sunlight
  • Avoiding triggers, such as stress, smoking, and skin injuries
  • Avoiding alcohol consumption
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