Psoriasis: Causes, Symptoms, And Treatment

We all know that a healthy immune system is good. But, do you know that an overactive immune system can cause certain conditions like Psoriasis? Read on to find out more.

By Dr Rinky Kapoor

Psoriasis: Causes, Symptoms, And Treatment

Psoriasis is an unpredictable, non-contagious, persistent skin disorder. It happens when skin cells multiply nearly ten times faster than normal. The underlying skin cells reach the skin’s surface very fast causing raised, red thick patches that are covered with white scales. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-lymphocytes.

Where does it occur?

Psoriasis occurs on the knees, elbows and scalp, and occasionally affects the torso, nails, palms and soles of the feet. It may involve only a localised area or the whole body. In later stages, it can affect the bones and joints, and the internal organs.

Patients are first diagnosed in their early adult years. Worldwide, the prevalence of psoriasis ranges from 0.5 to 11.4 per cent in adults and 0 to 1.4 per cent in children. People with psoriasis are more likely to have diabetes, high blood lipids, cardiovascular disease, and a variety of other inflammatory diseases.

Causes:

Psoriasis occurs mainly due to an autoimmune dysfunction of the skin cells due to a combination of elements that includes genetic, environmental, infectious and stress factors. Defects in immune regulation and the control of inflammation are thought to play major roles. Certain medications like beta-blockers which are given to treat high blood pressure have also been linked to psoriasis.

Signs and symptoms:

Psoriasis has a variable course, periodically improving and worsening. In rare cases, it may spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms during winter.

The symptoms include plaques of red skin covered by loose sliver coloured scales that are sometimes itchy and painful, sometimes cracking and bleeding. Fingernails can be prone to discolouration and pitting of nails that might also crumble or detach from the nail bed.

Types:

  • Plaque psoriasis classically affects skin over the elbows, knees, and scalp.
  • Guttate type has small dots on the entire body generally following a sore throat infection.
  • In the Inverse type red lesions are seen in the body folds.
  • A pustular type has white blisters surrounded by red skin and erythrodermic type has widespread red irritated rash throughout the body.
  • Patients with this form of psoriasis often feel cold and may develop heart failure if they have a pre-existing heart problem.
  • Scalp psoriasis can be severe enough to produce localized hair loss, plenty of dandruff, and severe itching.

Treatment options:

Psoriasis symptoms can be treated with topical ointments, light therapy and oral medications. Nowadays, biological therapy has revolutionised the treatment of psoriasis though it is currently very expensive. Psoriasis is a chronic condition and can outbreak suddenly, repeatedly but can be helped by reducing stress, monitoring diet and reducing sun exposure. If the patient notices any specific psoriasis triggers it would be better to avoid them.

The best treatment is individually determined by the treating doctor and depends, in part, on the type of disease, the severity, and amount of skin involved.

For mild disease that involves only small areas of the body (less than 10 per cent of the total skin surface), topical treatments such as creams, lotions, and sprays, are used. For moderate to severe disease that involves much larger areas of the body (10 per cent or more of the total skin surface) one may require ultraviolet light treatments or systemic treatments such as pills or injections.

Topical treatments include:

  • Corticosteroids
  • Vitamin D analogue creams
  • Retinoids like tazarotene, moisturizers, topical immunomodulators (tacrolimus and pimecrolimus)
  • Coal tar
  • Anthralin, and others.
  • Overuse or prolonged use of steroids may cause problems, including potential permanent skin thinning and damage called atrophy.
  • Moisturizers, with salicylic acid, lactic acid, urea, and glycolic acid may be helpful in psoriasis.
  • Bathing in high-salt-concentration waters like the Dead Sea in the Middle East along with careful exposure to sunlight can be beneficial.
  • Coal tar shampoos are excellent for scalp psoriasis.
  • Oral methotrexate, acitretin, cyclosporine apremilast are used in more widespread disease. Close physician monitoring and regular lab investigations are generally required.

Light therapy, also called phototherapy, is one of the oldest treatment modalities for psoriasis. There are several types:

  • Daily short, controlled exposures to natural sunlight in conjunction with psoralen tablets (PUVASOL)
  • PUVA using a photosensitizing drug and timed artificial UVA light exposure
  • UVB and narrow-band UVB is an artificial light treatment using very limited wavelengths of light given two to three times per week.
  • They are also available as home use lights for a milder disease.
  • Potential side effects of UV lights include skin burning, premature ageing, and possible increased risk of skin cancer.
  • Overall, the prognosis for most patients with psoriasis is good. While it is not curable, it is controllable.

Home remedy for Psoriasis:

Most patients with psoriasis seem to be overweight. Generally, a diet composed of polyunsaturated oils like olive oil and fish oil, cold water fish, seeds, nuts, omega-3 fatty acids, vitamin D, milk thistle, aloe vera, Oregon grape, and evening primrose oil is beneficial for psoriasis.

The more hydrated the skin the lesser the irritation and chances of flare of disease. Sensitive skin moisturizers are great at preventing plaques from forming. Avoid harsh antiseptic and fragranced soaps and perfumes that may irritate the skin. A lukewarm bath with Epsom salt, mineral oil, milk, or olive oil can soothe the itching. Moisturising immediately after a bath helps. Oatmeal baths are also well known for soothing itch. Alcohol and smoking are triggers for many people who have psoriasis.

Recent studies show an association between psoriasis and other medical conditions, including obesity, diabetes, and heart disease. So, a healthy lifestyle, diet and exercise and management of stress are known to prevent the disease to some extent as also flares.

The author is Consultant Dermatologist, Cosmetic Dermatologist & Dermato-Surgeon, The Esthetic Clinics.

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