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Psoriasis

Psoriasis approximately affects 2-3% of the world’s population.

Psoriasis approximately affects 2-3% of the world’s population. According to the World Psoriasis Day consortium, psoriasis has affected 125 million people worldwide. It usually appears between the ages of 15 and 25, but can develop at any age. Psoriatic arthritis develops between the ages of 30 and 50.

Different types of psoriasis
Your doctor can classify psoriasis according to the infected site/location on your body and the severity of the disease:

The plaque psoriasis is the most common type and causes dry and inflamed patches which are often covered with whitish-silvery scales. It may develop on any part of your body such as elbows, knees or scalp.

It affects the nails separating them from the nail bed and in some cases may cause the nail to crumble.

Commonly seen in children and is caused due to an infection that causes small pink spots on arms, legs, scalp, etc.

It causes bright areas of red, shiny, inflamed skin and usually develops under armpits or breasts, in the groin, or around skinfolds in the genitals.

Pustular psoriasis is characterized by white pustules (blisters of noninfectious pus) which is surrounded by red skin. The pus consists of white blood cells.

Pustular psoriasis can occur on any part of the body, but occurs most on the hands or feet.

This type of psoriasis is particularly a severe form that leads to widespread, fiery redness over most of the body. It causes severe itching and pain, and make the skin come off in sheets and generally appears on individuals who have unstable plaque psoriasis.

Few individuals with psoriasis have joint inflammation with symptoms of arthritis which is known as psoriatic arthritis. This causes swollen and painful joints and the symptoms can range from mild to moderate. It may even cause stiffness and progressive joint damage that can lead to permanent deformity.

Severity of psoriasis according to the National Psoriasis Foundation

Mild psoriasis: Psoriasis affecting less than 3 percent of the body.

Moderate psoriasis: Psoriasis affecting 3 to 10 percent of the body.

Severe psoriasis: Psoriasis affecting more than 10 percent of the body.

Causes of psoriasis

The exact cause of psoriasis is not known but is thought to be due to the immune system and genetics.

Immune system: Psoriasis is an autoimmune condition. In case of psoriasis, White Blood Cells (WBCs) known as T cells mistakenly attack the skin cells and may cause the skin cell production to go into overdrive and build up in thick, scaly patches on the skin.

Genetics: Some individuals may inherit genes that can make them more likely to develop psoriasis.

What are factors that trigger psoriasis?

Bacterial or viral infections: If you’re sick, your immune system will fight the infection which might start another psoriasis flare-up. The chances of getting psoriasis is higher in HIV positive patients and children with recurring infections may also be at a higher risk.

Skin Injury or trauma: Any type of skin trauma such as a cut, scrape, surgical wound, burn, etc. may cause a flare.

Obesity: Excess weight may increase the risk of psoriasis. Lesions associated with all types of psoriasis often develop in skin creases and folds.

Stress: It can impact your immune system, high stress levels may increase your risk of psoriasis.

Certain medications: Some medications are considered to trigger psoriasis. They include lithium, anti-malarial medications, high blood pressure medications, etc.

Symptoms of psoriasis

The psoriasis signs and symptoms may vary person to person and the type. Psoriasis can be suspected if you notice symptoms like:

• Red, raised, inflamed patches of skin
• Whitish-silver scales and plaques on the red patches
• Dry skin that may crack or bleed
• Soreness around patches
• Itching and burning sensations around patches
• Thick and pitted nails
• Painful and swollen joints

Psoriasis may occur through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission.

Various treatment options

The primary aim is to reduce the skin inflammation, slow the growth of skin cells and remove plaques. The treatment options are mainly divided into three categories:

• Topical
• Systematic
• Phototherapy

If your psoriasis is mild to moderate doctors would prefer topical treatment. For severe conditions, topical therapy is used in combination with either systemic therapy and/or phototherapy. Additionally, you may be prescribed medications based on the type and severity of psoriasis.

Topical therapy: It is usually the first-line of treatment for mild-to-moderate symptoms and aims to slow down the growth of skin cells, reduce inflammation and soothe itching or discomfort caused due to psoriasis.

Topical corticosteroids: They are highly prescribed to treat mild to moderate psoriasis by reducing inflammation and itching. For sensitive areas, mild corticosteroids ointments are prescribed while for stronger corticosteroid ointments are prescribed to treat tough areas. However, on long-term use it causes skin thinning and it may become less effective. Hence, it is prescribed for a shorter duration to treat flares.

Vitamin D analogues: The synthetic forms of vitamin D slows the skin cell growth and help flatten the plaques and remove scales.

Topical retinoids: They are vitamin A derivates which decrease inflammation and soothe itching. These medications may increase sensitivity to sunlight, so you may be advised to apply sunscreen before going outdoors.

Salicylic acid: It is used in combination with topical corticosteroids or coal tar in medicated shampoos and scalp solutions to treat scalp psoriasis.

Moisturizers: They are used in combination with other medications in the form of ointment/cream to reduce itching, scaling and dryness.

Systemic therapy: In case of severe or resistant psoriasis you may be recommended a systemic therapy. The common medicines used for the systemic therapy are:

Retinoids: This group of drug helps if you have severe psoriasis that does not respond to other therapies. Oral retinoids show side effects such as lip inflammation and hair loss.

Methotrexate: Helps by decreasing the production of skin cells and suppressing the inflammation. At low doses it is well tolerated, however, prolonged use may show side effects like stomach upset, loss of appetite, fatigue and more severe side effects like liver damage, decreased RBCs and WBCs.

Cyclosporine: Cyclosporines are immunosuppressant medicines are effective against psoriasis, but are only prescribed for a shorter duration.

Targeted Therpaies : monoclonal antibodies like Itolizumab are approved for use in treatment of moderate to severe plaque psoriasis.

Phototherapy: Phototherapy uses natural or artificial ultraviolet light and is the simplest and easiest form of phototherapy. It involves exposing your skin to controlled amounts of natural sunlight. Other forms include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with certain medications.

Ultraviolet (UV) rays in sunlight or artificial light: Exposure to ultraviolet (UV) rays in sunlight or artificial light may slow skin cell turnover and reduces scaling and inflammation. Daily exposure to small amount of sunlight may improve psoriasis, but intense sun exposure can worsen symptoms and may cause skin damage.

Broadband UVB phototherapy: It can be used to treat single patches, or widespread psoriasis or treatment resistant psoriasis. It is associated with side effects such as redness, itching and dry skin which can be subsidized by applying moisturizer.

Narrow band UVB phototherapy: It is more effective than broadband UVB, however, it may cause more-severe and longer lasting burns. Its exposure is given two to three times a week until your condition improves.

Excimer laser: It involves a controlled beam of UVB light which is more effective than traditional phototherapy and is used for mild to moderate psoriasis treating only the involved skin without harming healthy skin. Its side effects include redness and blistering.

“Always Keep in Mind: Psoriasis though not treatable, its flare-up can be prevented by proper medications and strictly following your doctor’s instructions.”

Is there a way to prevent psoriasis?

There is no way to prevent psoriasis, however if you are a psoriatic patient, flare-ups can be prevented. Following the doctor’s advice such as use of moistures, taking care of skin and scalp, avoiding dry and cold weather; skin injuries and infections, certain medications, following healthy habits like exercise; well-balanced diet which is high in fruits and vegetables etc. may improve the skin texture and prevent your flare-up.

Living with psoriasis: Tips to manage psoriasis

• Do not delay treatment just because your psoriasis is mild.
• Be informed regarding the disease, triggers and treatment options available which will help to cope up with psoriasis.
• Take medications as prescribed by the doctor.
• Try to cut down excess weight, as obesity worsens psoriasis.
• Avoid alcohol and smoking as it may flare-up your psoriasis.

Useful links:
• https://www.healthline.com/health/psoriasis/facts-statistics-infographic#13
• https://www.psoriasis.org/content/statistics
• https://www.mdedge.com/dermatology/article/178437/psoriasis/update-pathophysiology-psoriasis
• https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840
• https://www.webmd.com/skin-problems-and-treatments/psoriasis/prevent-flare-ups#2
• https://www.pharmacytimes.com/publications/issue/2014/may2014/living-with-psoriasis

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