Psoriasis (1)

It is an autoimmune skin disorder that is characterized by the rapid proliferation of skin cells. It is a non-contagious and chronic disease that makes up plaques of scaly and thickened skin. These scales are normally whitish-silver and are surrounded by red bumps. In normal conditions, skin cells proliferate in and gradually come to the surface and eventually shed off. In a person with psoriasis, T-cells produce certain inflammatory chemicals that stimulate the rapid multiplication of skin cells. Old skin cells do not fall off and new cells accumulate there causing red bumps with white scales around.

Onset

It can affect an individual of any age. The onset pattern of psoriasis includes 2 peaks. The first peak appears in the early 20s and 30s and the second peak appears at the age of 50 years.

Severity (2)

At first, it targets just a few areas of skin but if left untreated, it becomes worst, spreading to other parts of the body as well.

  • Mild psoriasis

It is considered mild if it affects less than 3% of the body. It means patches are seen only on the scalp and limbs. Mild psoriasis is treatable with medications.

  • Moderate psoriasis

It is moderate if it affects 3-10% of the body. It means it targets legs, arms, torso, and scalp. This type of psoriasis is difficult to control through skin medications.

  • Severe psoriasis

If psoriasis affects more than 10% of the body, then it is considered severe psoriasis. In this type, it targets a large face area, soles, and palms. It cannot be managed through skin medications.

Types (3)

  1. Plaque psoriasis

This type accounts for about 80% of all cases. Doctors may call it “Psoriasis Vulgaris”. It causes Inflamed raised red skin surrounded by whitish silvery scales. These patches cause burning and itching sensations. It can appear anywhere but most commonly in the scalp, knees, lower back, and elbows.

  1. Guttate psoriasis

It accounts for less than 2% of all cases and often appears in young adults or children. It causes tiny pinkish-red spots on the skin and often appears on the upper arms, thighs, trunk, and scalp. It lasts for a few weeks and vanishes without any treatment.

  1. Inverse psoriasis.

It is also known as “intertriginous psoriasis”. It is characterized by the formation of red swollen lesions in the body folds, which get worst upon scratching. It targets the armpits, buttocks, and groin.

  1. Pustular psoriasis

It is a very uncommon type and starts in adulthood. One with pustular psoriasis has pustules on some parts of the body. When covers most of the body’s skin then it is called “Generalized pustular psoriasis”.

  1. Erythrodermic psoriasis

It is the least common type but can be very serious. It targets most of the skin areas and causes fiery skin that seems to be burned. A person with this type is at risk of getting other infections, congestive heart failure, and pneumonia.

  1. Nail psoriasis.

It detaches the nails from the bed causing them to be tender and painful. The color of nails changes to yellow-brown. The patient is susceptible to other fungal infections as well.

  1. Psoriatic arthritis

It is a condition where a person suffers from both arthritis and psoriasis. It causes pain and stiffness in joints that are severe in the morning. A patient may also feel sausages like swelling on toes and fingers.

Signs and Symptoms

Signs and symptoms of psoriasis are very apparent in the patient. It depends upon the type of psoriasis. Most common symptoms include:

  • Toenails and fingernails show small pits.
  • Discoloration of nails.
  • Separation of nails from the nail bed
  • Genital lesions
  • Allergic rashes
  • Formation of pustules
  • Excessive dry flakes on the scalp
  • Joints stiffness

Causes

It is an autoimmune disease. Any agent that harms the immune system can also be the cause of psoriasis.  Dermatologists believe that both environmental factors and genetics play a vital role in causing psoriasis.

Psoriatic triggers

Many people who are vulnerable to psoriasis do not show any sign and symptoms for a long time until it is stimulated by some environmental triggers. Some common environmental triggers are:

  • Cold and dry weather
  • Former and current smokers
  • Anxiety and stress
  • Infections such as skin infections or strep throat
  • Excessive alcohol consumption
  • Abrupt withdrawal of systemic or oral corticosteroids
  • Skin injury such as a bug bite, scrape, sunburn
  • Certain medications including medications for high blood pressure, lithium, and antimalarial drugs.

Risk factors

Several factors increase the risk of psoriasis. Such as:

  • Family history.

Psoriasis runs in family. So a child with psoriatic parents is more susceptible to psoriasis. A gap between the generations can also come. For example, it may come from grandfather to grandson without affecting the father.

  • Stress and anxiety

Stress and anxiety suppress the immune system of a person and make him prone to psoriasis.

  • Smoking

Smoking not only initiates psoriasis but also s increases the severity of it.

Diagnosis

  • Physical examination

It is done by examining the apparent symptoms of psoriasis. Doctors check plaque formation in the following areas:

  • Knees
  • Belly button
  • Scalp
  • Ears
  • Nails
  • Lab tests

Only Biopsy is a way to check any skin infection. In this, a small piece of skin is taken and examined for any extra proliferation of skin cells.

Treatment

Common treatments of psoriasis include:

  • Skin moisturizers
  • Steroidal creams
  • Coal tar
  • Retinoid creams

Moderate and severe psoriasis needs extra treatment. Including;

  • Light therapy; in which skin is exposed to ultraviolet light that controls the growth of cells.
  • Methotrexate; this drug is recommended in severe cases only as it also harms the liver and lungs.
  • Retinoids; pills, soaps, creams, and lotions control the growth of skin cells by suppressing the immune system. It is only for those patients who do not respond to other therapy.
  • Enzyme inhibitors; treat and control psoriasis by inhibiting a specific enzyme and slowing down the inflammatory cascade. Example apremilast.

References

  1. https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840
  2. https://www.webmd.com/skin-problems-and-treatments/psoriasis/how-severe-your-psoriasis#:~:text=If%20more%20than%2010%25%20of,on%20your%20quality%20of%20life.
  3. https://www.webmd.com/skin-problems-and-treatments/psoriasis/psoriasis-types