Psoriasis: What It Is, Symptoms, Causes, Types & Treatment

psoriasis

Psoriasis: What It Is, Symptoms, Causes, Types & Treatment

What is Psoriasis?

The question "What is psoriasis?" is often asked. Psoriasis is a chronic skin disease that affects both genders (male and female) almost equally. It affects the life cycle of skin cells and accelerates their growth, leading to the accumulation of cells on the skin surface to form thick, silvery scales and layers of skin called psoriatic plaques that are dry, red, and itchy. The cells that make up psoriatic plaques typically need about 28 days to move from the bottom layer to the outer layer of the skin toward its upper layer. This process occurs for psoriasis patients in a period not exceeding 3 to 4 days.

Psoriasis usually appears on joints such as elbows and knees, but it can also appear in any area of the body, including the hands, feet, neck, scalp, and face. Some types of psoriasis can also affect the nails, mouth, and the area around the genitals.

Types of Psoriasis

To complete the answer about what psoriasis is, it is necessary to understand the types of psoriasis. Psoriasis is divided into 5 types, according to the accompanying symptoms:

Plaque Psoriasis:

 Plaque psoriasis is the most common type, affecting 80% of psoriasis patients. The plaque psoriasis appears as silvery scales, often concentrated on the scalp, knees, elbows, and lower back. These scales can sometimes cause painful itching.

Guttate Psoriasis:

Guttate Psoriasis is a form of psoriasis that appears as small red or pinkish spots, particularly on the trunk and limbs. Guttate psoriasis often develops in childhood or young adulthood and can occur following a bacterial infection such as a respiratory tract infection.

 This type of psoriasis is the second most common form, affecting around 10% of psoriasis patients.

Erythrodermic Psoriasis:

Erythrodermic Psoriasis is the least common type of psoriasis, affecting only about 3% of psoriasis patients. It presents as a widespread, fiery red, peeling rash that covers most of the body and causes severe itching and pain. Potential triggers for this type of psoriasis include:

• Severe Sunburns.
• Inflammations.
• Intake of certain medications.
• Discontinuation of certain psoriasis medications.

Erythrodermic Psoriasis Usually Requires Immediate Medical Attention

Erythrodermic psoriasis can be life-threatening, and prompt medical treatment is crucial.

Inverse Psoriasis:

 Inverse psoriasis (also known as flexural psoriasis) manifests as smooth, inflamed red patches in skin folds, such as the armpits, groin, and under the breasts.

Pustular Psoriasis:

 Pustular psoriasis typically affects adults and appears as non-contagious white blisters filled with pus, often localized to the hands and feet, but it can sometimes spread to other areas of the body.

Psoriasis in Children

Psoriasis is a common condition in children, and the symptoms often become less severe and the flare-ups less frequent as the child grows older. With some dosage adjustments, the same medications used to treat psoriasis in adults can be used to treat psoriasis in children. It is important to help the child cope with the negative psychological impact that psoriasis symptoms, especially on visible areas like the face, can have throughout their life.

 Early diagnosis and treatment of childhood-onset psoriasis can help prevent the loss of self-confidence that may arise from this condition. Therefore, it is crucial to consult a doctor as soon as psoriasis symptoms appear in a child.

Psoriasis Causes

From a scientific perspective, the question "What is psoriasis?" can be answered by understanding the underlying cause of the condition. Psoriasis is an autoimmune disease that arises from a disturbance in the activity of a specific type of white blood cell called T cells. These cells mistakenly attack healthy skin cells, prompting the body to respond by rapidly producing more healthy skin cells.

In normal cases, the body replaces skin cells every 10 to 30 days, but in psoriasis, new skin cells grow every 3 to 4 days. These new skin cells rapidly move to the outer layer of the skin and accumulate, forming thick, scaly layers on the skin's surface. This mistaken attack by T cells also causes redness and irritation of the skin.

The underlying cause that leads to the immune system disturbance and the development of psoriasis remains unclear, but experts believe that genetic factors play a role, with around 40% of psoriasis patients having a family history of the disease.

 

Triggers for Psoriasis

Cutaneous psoriasis, or an increase in the severity of symptoms, often occurs when the patient is exposed to one of the following triggering factors:

- Cold weather

- Excessive alcohol consumption

- Smoking

- Autoimmune diseases, such as HIV/AIDS or rheumatoid arthritis

- Infections, such as strep throat

- Skin injuries, such as cuts, scratches, insect bites, or sunburns

- Psychological stress and tension

- Certain medications, such as those containing lithium, high blood pressure medications like beta-blockers, and antimalarial drugs.

Is Psoriasis Contagious?

In addition to the question "What is Psoriasis?", some may wonder whether psoriasis is contagious and if it can be transmitted from one person to another. The answer is that psoriasis is a non-contagious disease and does not spread from person to person through contact with skin lesions. It is an autoimmune disease that can be inherited genetically within families.

Psoriasis Symptoms

The symptoms of psoriasis vary from person to person and depend on the type of psoriasis the patient is suffering from. The most common symptoms of psoriasis include:

- Appearance of red, inflamed patches on the skin covered with thick, silvery scales.

- Dry, cracked skin that may bleed.

- Itching, burning, and pain around the patches.

- Changes in nail thickness and pitting.

- Swollen and painful joints, with 10% to 30% of psoriasis patients developing psoriatic arthritis.

- Scalp and scalp hair involvement.

Most psoriasis patients experience flare-ups of symptoms, where the condition persists for a few days or weeks and then subsides. It is possible for the psoriatic arthritis symptoms to disappear completely and become unnoticeable, but they often return within weeks or months, or when the patient is exposed to triggers that can induce psoriasis on the skin.

How is Psoriasis Diagnosed?

Dermatologists perform the following examinations to diagnose psoriasis:

- Clinical examination of the symptoms.

- Skin biopsy, where a small sample of skin is taken and examined under a microscope to determine the type of psoriasis and rule out other disorders.

There are no specific laboratory tests for diagnosing psoriasis, but most doctors can recognize the characteristic psoriatic plaques during the clinical examination, and the patient's symptoms, medical history, and family history also help in diagnosing psoriasis.

Physicians may find it challenging to diagnose the less common types of psoriasis. For instance, physicians can easily misdiagnose inverse or flexural psoriasis, which does not produce any scaling skin, and it is often mistakenly identified as a bacterial or fungal infection.

Coping with Psoriasis: Practical Recommendations

To alleviate symptoms and manage psoriasis, the following guidelines are recommended, although there are no preventive measures to completely avoid developing the condition:

1. Daily bathing: Bathing can help reduce the severity of psoriasis symptoms, but avoid vigorously scrubbing the affected areas.

2. Oatmeal baths: Taking baths with added oatmeal can help soothe and alleviate symptoms.

3. Weight loss: Achieving and maintaining a healthy weight can be beneficial.

4. Skin care: Keeping the skin clean and moisturized, and avoiding irritants, can help manage psoriasis.

5. Sun exposure: Moderate, controlled sun exposure can be helpful, but take care to avoid sunburn.

6. Stress management: Reducing stress and anxiety levels can be beneficial.

7. Nutrient-rich diet: Consuming foods rich in vitamins, especially vitamins D and A, can be beneficial.

8. Healthy, balanced diet: Eating a diet rich in omega-3 fatty acids, whole grains, and vegetables, while limiting processed foods, dairy, and sugars, may help reduce inflammation.

9. Regular exercise: Engaging in regular physical activity can be helpful.

Complications of Psoriasis

Psoriasis can be associated with a variety of complications, including:

Eye Diseases: Psoriasis patients have an increased risk of developing eye conditions such as blepharitis, conjunctivitis, and uveitis.

Psoriatic Arthritis: Approximately 30% of psoriasis patients develop this inflammatory joint condition.

Anxiety, Stress, and Depression: Psoriasis can have a significant impact on mental health.

Parkinson's Disease: Psoriasis patients may be at a higher risk of developing Parkinson's disease, likely due to the negative effects of chronic inflammation on neural tissues.

Hypertension: Psoriasis increases the risk of high blood pressure, which can subsequently raise the long-term risk of heart attack and stroke.

Cardiovascular Disease: Individuals with psoriasis have an elevated likelihood of developing heart and vascular diseases.

Type 2 Diabetes: Severe cases of psoriasis are particularly associated with an increased risk of type 2 diabetes.

Obesity: Psoriasis is often linked to obesity.

Kidney Disease: Moderate to severe psoriasis may increase the risk of kidney disorders.

Autoimmune Diseases: As an autoimmune condition, psoriasis can predispose individuals to other autoimmune disorders, such as inflammatory bowel disease, celiac disease, lupus, and multiple sclerosis.

While psoriasis does not directly cause these comorbidities, they share common inflammatory pathways and the presence of specific cytokine activities.

Treatment of Psoriasis

The goal of psoriasis treatment is to reduce the severity of symptoms such as itching, and prevent skin inflammation, cracks, or secondary infections due to scratching and skin damage. The various psoriasis treatment methods can be divided into 3 main groups:

Topical Psoriasis Treatment

This involves the use of creams and ointments applied to the skin, and is used to manage mild to moderate cases of psoriasis. For more severe cases, topical treatment is combined with oral medications or light therapy.

Topical psoriasis treatments include:

- Corticosteroids to reduce skin inflammation and suppress the immune system's attack on the skin.

- Vitamin D analogs.

- Anthralin.

- Calcineurin inhibitors such as tacrolimus and pimecrolimus.

- Retinoids, which are vitamin A-derived medications.

- Salicylic acid.

- Moisturizing creams.

- Coal tar.

Phototherapy for Psoriasis

Phototherapy involves exposure to artificial or natural (sunlight) ultraviolet light.

Exposure to both Ultraviolet B (UVB) and Ultraviolet A (UVA) rays helps reduce symptoms of mild to moderate psoriasis. In cases of moderate to severe psoriasis, patients benefit from combining light therapy with other medications. However, the use of light therapy with calcineurin inhibitors is contraindicated as it increases the risk of developing skin cancer.

Photochemotherapy, which involves a plant-derived extract called Psoralen with Ultraviolet A radiation, can also be utilized. Psoralen makes the skin more responsive to Ultraviolet A exposure. Despite being one of the most effective treatments, its usage has decreased significantly due to the increased risk of skin cancer, even decades after treatment cessation.

Treatment of psoriasis with oral and injectable medications

The physician may resort to the use of oral medications or injectable medications in cases of severe psoriasis or in cases that do not respond to other types of psoriatic arthritis treatment. Examples of these medications include:

Retinoids.

Cyclosporine, which works by stopping the activity of a type of immune cell and slowing the growth of skin cells.

Methotrexate, the most commonly used, originally developed to treat cancer, it inhibits an enzyme involved in cell proliferation. However, the doses used for treating psoriasis and psoriatic arthritis are much lower than those used for chemotherapy in cancer.

Apremilast.

Medications that affect the immune system (biologic drugs).

Ixekizumab: Trials conducted at the University of Manchester have found this medication to be effective in treating psoriatic arthritis skin disease. Half of the study participants (totaling 2,500 participants) received Ixekizumab, while the other half received a placebo.

 The group receiving Ixekizumab showed rapid and extensive improvements in their condition, outperforming the placebo group. It was found that 40% of the affected individuals experienced complete disappearance of psoriasis after 12 weeks of psoriatic arthritis treatment, while 90% of them showed some degree of improvement.

Edit This Article