Mail: admin@qmedicine.co.in



Psoriasis

psoriasis

Psoriasis is a common condition where there is inflammation of the skin. It typically develops as patches (plaques) of red, scaly skin. Once you develop psoriasis it tends to come and go throughout life. A flare-up can occur at any time. The frequency of flare-ups varies.

The severity of psoriasis varies greatly. In some people it is mild with a few small patches that develop and are barely noticeable. In others, there are many patches of varying size.

What are the different types of psoriasis?

There are different types of psoriasis. However, chronic plaque psoriasis (described below) is by far the most common and typical type.

  • Chronic plaque psoriasis
  • Between 8 and 9 out of 10 people with psoriasis have chronic plaque psoriasis. The rash is made up of patches on the skin, called plaques. Each plaque usually looks pink or red with overlying flaky, silvery-white scales that feel rough. There is usually a sharp border between the edge of a plaque and normal skin. The most common areas affected are over elbows and knees, the scalp, and the lower back. However, plaques may appear anywhere on the skin. But, they do not usually occur on the face.

    There are two variations of chronic plaque psoriasis:

    • Scalp psoriasis: about half of people with chronic plaque psoriasis affecting the skin of their body will also have psoriasis affecting their scalp. However, scalp psoriasis may occur alone in some people. Scalp psoriasis is usually a form of chronic plaque psoriasis. It looks like severe dandruff. The whole scalp may be affected, or there may just be a few patches. If severe, it can lead to hair loss in some people.
    • Flexural psoriasis: this is also a type of chronic plaque psoriasis. It occurs in the creases of the skin (flexures) such as in the armpit, groin, under breasts, and in skin folds. The affected skin looks slightly different to the typical plaque psoriasis. It is red and inflamed but the skin is smooth and does not have the rough scaling.
  • Pustular psoriasis
  • This type of psoriasis usually just affects the palms of the hands and soles of the feet. In this situation it is sometimes called palmoplantar pustulosis. Affected skin develops crops of pustules, which are small fluid-filled spots. The pustules do not contain germs (bacteria) and are not infectious.

  • Nail psoriasis
  • There are pinhead-sized pits (small indentations) in the nails. Sometimes, the nail becomes loose on the the nail bed. Nails may also change colour and the area around the bed of the nail can become orange/yellow.

  • Guttate (drop) psoriasis
  • This typically occurs following a sore throat which is caused by a bacterium (germ). Round/oval plaques of psoriasis are small (less than 1 cm - drop size) but occur over many areas of the body. Guttate psoriasis normally lasts a few weeks, and then fades away. However, it may last for three to four months in some people. In many people, once it goes it never returns.

  • Erythrodermic psoriasis
  • This type of psoriasis causes a widespread erythema (redness) of much of the skin surface, which is painful. Individual plaques of psoriasis cannot be seen because they have merged together. A person with erythrodermic psoriasis may also have a fever. This type of psoriasis is rare, but it is serious and needs urgent treatment and admission to hospital. This is because it can interfere with the body's ability to control temperature and it can cause excessive protein and fluid loss, leading to dehydration, heart failure and severe illness.

How common is psoriasis and who gets it?

About 1 in 50 people develop psoriasis at some stage of their life. Psoriasis is more common in white people.

What causes psoriasis?

Normal skin is made up of layers of skin cells. The top layer of cells (horny layer of the epidermis) is flattened and gradually sheds (they fall off). New cells are constantly being made underneath (in the basal layer of the epidermis) to replace the shed top layer. Cells gradually move from the basal layer to the top horny layer. It normally takes about 28 days for a cell in the basal layer to reach the top layer of skin and to be shed.

People with psoriasis have a faster turnover of skin cells. It is not clear why this occurs. More skin cells are made which leads to a build-up of cells on the top layer. These form the flaky plaques on the skin, or severe dandruff of the scalp seen in scalp psoriasis.

Aggravating factors:

  • Stress.
  • Infections.
  • Medication.
  • Some medicines may possibly trigger or worsen psoriasis in some cases. Medicines that have been suspected of doing this include: beta-blockers (propranolol, atenolol, etc), antimalarial medication, lithium, anti-inflammatory painkillers (ibuprofen, naproxen, diclofenac, etc), angiotensin-converting enzyme (ACE) inhibitor medicines, and some antibiotics.

  • Smoking.
  • Trauma. Injury to the skin, including excessive scratching, may trigger a patch of psoriasis to develop.
  • Sunlight. Most people with psoriasis say that sunlight seems to help ease their psoriasis.
  • Hormonal changes. Psoriasis in women tends to be worst during puberty and during the menopause.
  • Alcohol. Drinking a lot of alcohol may also cause a flare-up in some people.
Are there any other problems related to psoriasis?
  • Joint problems. Around 1 or 2 in 10 people with chronic plaque psoriasis also develop inflammation and pains in some joints (arthritis).
  • Inflammatory bowel disease.
  • Obesity. Psoriasis also seems to be more common in obese people.
How is psoriasis diagnosed?

Psoriasis is usually diagnosed by the typical appearance of the rash. No tests are usually needed. Occasionally, a biopsy (small sample) of skin is taken to be looked at under the microscope if there is doubt about the diagnosis.

What are the common treatments for chronic plaque psoriasis?

Treatment aims to clear the rash as much as possible. However, as psoriasis tends to flare up from time to time, you may need courses of treatment on and off throughout your life.

Many of the treatments are creams or ointments. As a rule, you have to apply creams or ointments correctly for best results. It usually takes several weeks of treatment to clear plaques of psoriasis.

If you have psoriasis, you may also get some benefit from quitting smoking and also limiting your alcohol intake.

Moisturisers (emollients)

These help to soften hard skin and plaques. They may reduce scaling and itch. There are many different brands of moisturising creams and ointments. A moisturiser may be all that you need for mild psoriasis.

Vitamin D-based treatments such as calcipotriol, calcitriol and tacalcitol

These are commonly used and often work well. They seem to work by slowing the rate at which skin cells divide. They are creams, ointments or lotions that are easy to use, are less messy.

Steroid creams or ointments

These are other commonly used treatments. They work by reducing inflammation. They are easy to use and may be a good treatment for difficult areas such as the scalp and face. However, one problem with steroids is that in some cases, once you stop using the cream or ointment, the psoriasis may rebound back worse than it was in the first place.

Coal tar preparations

These have been used to treat psoriasis for many years. It is not clear how they work. They may reduce the turnover of the skin cells. They also seem to reduce inflammation and have anti-scaling properties. Traditional tar preparations are messy to use, but modern formulas are more pleasant. Coal tar preparations should not be used during the first three months of pregnancy. However, they can be used later in the pregnancy and during breast-feeding.

Dithranol

This has been used for many years for psoriasis. In most cases a daily application of dithranol to a psoriasis plaque will eventually cause the plaque to go. However, dithranol irritates healthy skin. Therefore, you need to apply it carefully to the psoriasis plaques only. To reduce the chance of skin irritation, it is usual to start with a low strength and move on to stronger ones gradually over a few weeks.

Salicylic acid

This is often combined with other treatments such as coal tar or steroid creams. It tends to loosen and lift the scales of psoriasis on the body or the scalp. Other treatments tend to work better if the scale is lifted off first by salicylic acid.

Tazarotene

This is another cream that is sometimes used. It is a vitamin A-based preparation. Irritation of the normal surrounding skin is a common side-effect. This can be minimised by applying tazarotene sparingly to the plaques and avoiding normal skin. Tazarotene treatment must not be used if you are pregnant because of potential risks of harm to the developing baby. It should also not be used during breast-feeding.

For scalp psoriasis

A coal tar-based shampoo is often tried first and often works well. Some preparations combine a tar shampoo with either a salicylic acid preparation, a coconut oil/salicylic acid combination ointment, a steroid preparation, calcipotriol scalp application, or more than one of these.

Other treatments

If you have severe psoriasis then you may need hospital-based treatment. Phototherapy (light therapy) is one type of treatment that can be used. This may involve treatment with ultraviolet B (UVB) light. Another type of phototherapy is called PUVA - psoralen and ultraviolet light in the A band. This involves taking tablets (psoralen) which enhances the effects of UV light on the skin. You then attend hospital for regular sessions under a special light which emits ultraviolet A (UVA).

If psoriasis is severe then a powerful medicine which can suppress inflammation is sometimes used. For example, methotrexate, ciclosporin, acitretin, infliximab, etanercept, efalizumab, ustekinumab and adalimumab.

What is the prognosis (outlook) for psoriasis?

Psoriasis affects different people in different ways. In general, plaque psoriasis is a chronic (persistent) condition with flare-ups that come and go. Some people have a number of years where they are free from psoriasis and then it may flare up again.


Alphabetical Index of Health Topics

If you already know your diagnosis, you may search for the health topic alphabetically here. Hold your cursor over the health topics link in the line below.

Write A Comment

 

Topic of the Month

Womb Transplant

womb-transplant

The new game changer in infertility. Know more about this revolutionary technique.

Continue Reading »

Health Video of the Month

Womb Transplant

Disclaimer: This health video may contain graphic material and viewer discretion is advised.