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PSORIASIS

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Psoriasis: types, causes, and treatment

What is Psoriasis?

Psoriasis is a chronic (long-lasting) skin disease characterized by patches of abnormal skin that causes skin cells to grow too quickly, resulting in thick, white, silvery, or red patches of skin. They most often appear on the knees, elbows, scalp, hands, feet, or lower back. They may vary in severity from small and localized to complete body coverage.

Psoriasis is a common skin disorder affecting about 2% of the population and most common in adults. But children and teens can get it too. Having psoriasis can be embarrassing, and many people, especially teens, avoid swimming and other situations where patches can show. But there are many types of treatment that can help keep psoriasis under control. 

Psoriasis is non-contagious; thereby it can’t be spread by touch from person to person.

What happens with your skin suffering from psoriasis?

The skin is a complex organ made up of several layers of different types of cells. Those in the outer layer – the epidermis – gradually change, as they move towards the surface where they are continually shed. This process normally takes between 3 and 4 weeks. In psoriasis, this rate of turnover is dramatically increased within the affected skin, so that the process may take as little as 3 to 4 days.

What are the causes of Psoriasis?

The exact cause of psoriasis is not clear. 

Genetic or Hereditary: Genetically inherited, because certain genes are found in families who are affected by psoriasis. About 1/3 rd of people who have psoriasis have one or more family members with the condition.

Immunological: Immune system disorder that causes the skin to regenerate at faster than normal rates. This rapid turnover of cells results in scales and red patches

Environmental factors:

Infection: Infections such as streptococcal infection of throat or skin infections can cause psoriasis to appear suddenly, especially in children.                                                                                                  

Weather conditions: Cold and dry climate can trigger flares of psoriasis. Usually, sunlight improves the condition, though occasionally, it may make it worse. 

Sunlight exposure-intense exposure to the sun can worsen psoriasis.

Skin injuries: An injury to the skin can cause psoriasis patches to form anywhere on the body, including the site of the injury. This includes injuries to your nails or nearby skin while trimming your nails.

Lifestyle changes: 

Emotional or physical stress: Stress may cause psoriasis to appear suddenly or make symptoms worse.

Smoking may likely to worsen psoriasis.

Alcohol: A high alcohol intake can cause symptoms to flare-up. Alcohol consumption may decrease the effectiveness of some psoriasis treatments.

Certain medications: such as non-steroidal anti-inflammatory drugs (NSAIDs), high blood pressure (beta-blockers) medications, anti-malarial drugs, and lithium, have found to aggravate psoriasis. Rapid withdrawal of oral or systemic corticosteroids

What are the sign & Symptoms of psoriasis?

Mild Psoriasis the rash may be asymptomatic with small areas red scaly patches… 

Moderate to severe cases, the skin gets inflamed with raised red areas topped with loose, silvery, scaling skin. If psoriasis is severe, the skin becomes itchy and tender. And sometimes large patches form and may be uncomfortable. The patches can join together and cover large areas of skin, such as the entire back. 

It can also affect the fingernails and toenails, causing the nails to pit, change color, and separate from the nail bed. Dead skin may build up under the nails. 

After a quite long period in some people, psoriasis causes joints to become swollen, tender, and painful. This is called psoriatic arthritis. 

Symptoms often disappear (go into remission), even without treatment, and then return (flare-up). A dermatologist can usually diagnose psoriasis by looking at the patches on your skin, scalp, or nails. In some cases, psoriasis can be hard to treat, require different combinations of treatments. In a few, the treatment for psoriasis may continue for a lifetime.

What are the types of Psoriasis?

Plaque psoriasis

The most common form of psoriasis that affects almost 80% cases among psoriasis and also referred to as Psoriasis Vulgaris. It appears as well-defined areas of raised red skin that have flaky, silvery-white scales on the top buildup by dead skin cells. The scale loosens and sheds regularly. These lesions are itchy and usually occur on the scalp, elbows, knees, and lower back.

Guttate psoriasis

This type is usually erupting after 2-3 weeks of sore throat triggered by a streptococcal bacterial infection. The lesions appear as drop-like or small pink patches with fine silver-white scales over the upper arms, thighs, and scalp of the individuals.  

Inverse psoriasis: also called intertriginous psoriasis, appears as smooth, pure red lesions in a body skin fold, most commonly in the armpits, groin near the genitals, under the breasts, under the buttocks, or in abdominal folds. Sweat and rubbing together may irritate these inflamed areas.

Pustular psoriasis

The lesions appear as white pustules surrounded by red skin; though filled with pus but are non-infectious. The lesions initially appear as redness of the skin, followed by pustules and slight scaling. This condition is associated with constitutional symptoms like fever, chills, nausea, and muscular weakness.

Erythrodermic psoriasis 

It is a very rare form, appears as diffuse widespread bright red skin peeling away involving almost 70-80% of the body. It is accompanied by severe itching or burning sensation. 

Nail psoriasis

Nail psoriasis can cause discoloration or alteration in the nail bed, leading to separation of the nail from the nail bed. This results in small pits forming on your fingernails or toenails. Moreover, in some cases, the chalky material is deposited under the nails 

Palmo-plantar psoriasis

It is a variant of psoriasis that characteristically affects the palms of the hands and the soles of the feet. It appears as thickened red skin, pustules, or mixed features and can involve partially or entirely skin.

Psoriatic arthritis

The skin involvement is accompanied by inflammation of the joints. Psoriatic arthritis usually involves the small joints of hands and foot. The condition presents as discoloration, stiffness, and pain over the joints or pipe-like swelling of the fingers and toes and joints.

What are the preventive measures for psoriasis getting exacerbated?

DO’s

•Keep your skin moist

•Use an emollient or moisturizer 

•Use luke-water while bathing

•Pat your skin gently to dry

•Short expose to sunlight

•Use broad-spectrum sunscreen

•Use mild soap

•Do reduces the stress

Don’ts 

•Do not scratch or scrub the lesions

•Do not smoke or drink alcohol

•Do not get emotional or physical stress

•Do not get skin injured

•Do not get exposed to infection

•Do not harsh soap

•Ignore small flare-ups

•Do not expose to intense sunlight

What are the treatments of Psoriasis?

Currently, there is no cure. However, Dermatologists and other researchers are continuously testing new drugs and treatments.

The goal is to reduce inflammation and to control the shedding of the skin. Moisturizing creams or lotions loosen scales and help control itching. The skin professional may suggest different types of treatment. Treatment is based on a patient’s health condition, age, lifestyle, and the severity of psoriasis. 

1.Topical treatments:

There are plenty of topical applications available in the market, which on use avoid systemic side effects.

Corticosteroid creams: Topical steroids are the most frequently used medications for treating mild to moderate psoriasis. Mild corticosteroid creams (hydrocortisone) are usually used for sensitive areas like the face or skin folds, and for treating widespread patches. Stronger corticosteroid cream or ointments like clobetasol are used for smaller or tougher areas of the skin such as palms or soles.

Corticosteroid creams work by reducing the inflammation and by inhibiting the overproduction of cells. It instantly provides relief from itching. 

Long-term use or overuse of strong corticosteroids can thin the skin and cause skin atrophy.

Vitamin D analogs: Synthetic forms of vitamin D, such as calcipotriene and calcitriol inhibit the skin cell growth and can be used alone or with topical corticosteroids.

Retinoids: Tazarotene is available in a cream or gel base and applied once or twice daily. The most common side effects are skin irritation and increased sensitivity to light. Retinoid cream is not recommended for a pregnant or breast-feeding mother.

Salicylic acid: It can be used alone or in combination with a steroid to enhance the ability of other medications to more easily penetrate the skin. It smoothes and softens the skin by encouraging the shedding of scales. Moreover, salicylic acid shampoos and scalp solutions are commonly used to reduce the scaling of scalp psoriasis. 

Coal tar: Coal tar available in various forms and helps in reducing scaling, itching, and inflammation. 

Coal tar preparations can irritate the skin and not recommended for pregnant or breast-feeding women and over sensitive skin like face or genitals.

Anthralin: It is another tar product, available in a cream-based and used to inhibit skin proliferation or cell growth. It also removes scales and makes the skin smoother. It can irritate and stains the skin, therefore it should not be used on the face or genitals. It should be used for a short period of time and washed off.

Topical Calcineurin inhibitors: such as tacrolimus or pimecrolimus works by reducing the inflammation and plaque buildup. They are useful in areas of thin skin around eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.

1.Light therapy

Light therapy is a first-line recommended treatment for moderate to severe psoriasis, either alone or in combination with other medications. It involves exposing the skin to controlled amounts of natural or artificial light. Multiple sessions of treatments are required for the desired results.

Sunlight: Daily exposure to sunlight might improve psoriasis. It is the safest way to use natural light for psoriasis treatment.

Narrowband UVB phototherapy: Controlled doses of UVB narrowband light from an artificial light source can treat widespread psoriasis or that doesn’t improve with topical treatments. The therapy is more effective and safest treatment available. It is advised two or three times a week until the skin improves. 

Psoralen +UVA (PUVA) also called photochemotherapy: This treatment combines a plant-derived substance called psoralen with UVA light therapy. After you take psoralen by mouth or apply it to the affected skin, you’re exposed to ultraviolet A (UVA) light.

PUVA is a more aggressive treatment, often used for severe cases of psoriasis. Side effects such as nausea, headache, burning and itching, freckles, increased sun sensitivity, and increased risk of skin cancer.

308 Excimer System:

308 Excimer laser is used to treat chronic and localized psoriasis plaques. It is usually recommended twice a week and hardly requires a little session to have the desired result.

It is a handheld system enables you to apply high, therapeutically-effective doses of monochromatic UVB light while leaving healthy skin unexposed and protected. It requires fewer sessions than does traditional phototherapy. UVB radiation has an immune-modeling effect which can normalize pathologically altered cellular activities.

1.Oral or injected medications

This medication is used for moderate to severe psoriasis or other treatments haven’t worked. Due to potential side effects, some of these medications are used for only short periods and might be alternated with other treatments. Most of these below-mentioned drugs, to be avoided during pregnancy or while breastfeeding and to be stopped 3 months prior to conception.

·Methotrexate: The most commonly used drug and usually recommended weekly as a single oral dose. Methotrexate decreases the production of skin cells and suppresses inflammation. Long term use needs to monitor their blood counts and liver function.

·Cyclosporine: It is recommended for severe psoriasis, suppresses the immune system, and to be taken orally. Requires monitoring of their blood pressure and kidney function.

·Retinoids: Acitretin is used to reduce the production of skin cells. Side effects might include dry skin and muscle soreness. 

·Biologics: There are several drugs approved for the treatment of moderate to severe psoriasis in people who haven’t responded to first-line therapies. These are usually given injection forms, works by altering the immune system which disrupts the disease cycle. Few of the biologics commonly used are etanercept, infliximab, adalimumab, etc 

Biologics must be used with caution, as they carry the risk of suppressing your immune system and increase the risk of serious infections such as tuberculosis

·Other medications: Thioguanine and hydroxyurea are medications that can be given if other drugs can’t be given. Apremilast is the recent, effective, and quite a safe drug given by the oral route. 

·Steroids: Intra-lesional triamcinolone injection is advice for a small, persistent psoriatic patch if the other treatment did not work.

 

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