Psoriasis

Overview

Psoriasis is a skin disease that results in itchy, scaly patches on the knees, elbows, trunk, and scalp. Psoriasis is a common, chronic disease with no cure. It can be painful, disrupt your sleep, and make it difficult to concentrate. The condition goes through cycles, peaking for a few weeks or months and then subsiding for a while. Infections, cuts or burns, and certain medications are common psoriasis triggers in people with a genetic predisposition to the condition.

In a chronic condition, when there is continuous inflammation in the body, the state also harms other organ systems and tissues. Nearly 30% of psoriasis patients are likely to develop psoriatic arthritis due to continuous inflammation. Thus, it is crucial to start psoriasis treatment early to avoid damage to the joints and skin.

Inflammation and redness in the skin are pretty common phenomena. Additionally, whitish-silver scales with darker skin tones can be observed in people with psoriasis. The typical symptom of psoriasis is the development of scales on joints, knees, and elbows.

When to consult a doctor?

Below is the condition under which a person must consider consulting a doctor immediately.

• Spreads to multiple places

There is no fixed location in the body where an individual can observe psoriasis scales. However, in mild conditions, one can see these scales on the hands and legs. If the scales spread to other body parts like thighs, chest, and back, it might be time to visit a doctor.

• Extreme pain and discomfort

The psoriasis scales are not painful in the initial days. However, the chronic condition causes extreme discomfort and pain, primarily when the disease affects the limbs. It is essential to see a doctor and get medications to reduce inflammation.

• Changes the appearance of the skin

Even though an individual cannot control psoriasis, it is essential to work on how the skin looks. This is important for people who need to maintain their physical appearance while working in the hospitality or entertainment industry.

• No improvement with regular treatment

Patients usually feel the difference after seeking medications from a dermatologist. In some chronic cases, the patients remain troubled by the symptoms because the drugs don’t improve the condition. Hence, it is time to consult with an immunologist to work on the root cause of the problem.

Diagnosis

Since the condition is readily visible on the skin’s surface, it involves only two major diagnostic procedures before starting the treatment. Below are the two ways in which one can diagnose psoriasis:

• Physical examination: Psoriasis is a skin condition with typical symptoms. Hence, doctors can diagnose the condition through physical examination by observing the scales on the skin. During this examination, the doctor might ask the individual to uncover the areas showing symptoms. Additionally, the patient might have to discuss if there is a family history of this problem that could indicate genetic inheritance.

• Biopsy: Sometimes, the symptoms of psoriasis are unclear, and the doctor might require a biopsy to confirm the condition. A small skin sample is taken to conduct the biopsy. The doctor might inject local anaesthesia that will numb the area and make the procedure less painful. After the sample collection, it will be sent to the laboratory, and the technician will diagnose the type of psoriasis the patient has. Additionally, this process helps rule out other skin conditions that show similar symptoms.

A doctor might discuss treatment options based on the physical examination and biopsy.

Treatments

The primary purpose of psoriasis treatment is to work on the rapid renewal of skin and stop it from proliferating. The treatment also involves removing the scales to improve the skin's texture.

Keeping in mind all the factors like location, severity, and type of psoriasis, a doctor may suggest one of the many treatments available for the condition. Below are some of the treatment options an individual can choose from:

Topical Therapy

• Corticosteroids: These are one of the most common topical solutions for many skin conditions. It helps treat psoriasis in mild and moderate stages by applying gels, oils, and ointments (e.g., Clobetasol and Hydrocortisone). Additionally, a corticosteroid is suitable for sensitive places like the face, skin folds, and widespread patches of psoriasis. The medication is available in mild and more potent forms, which works on the condition accordingly.

• Vitamin D Analogues: These are recommended by physicians in combination with corticosteroids. An individual can find them as calcipotriene and calcitriol, which are responsible for slowing down skin growth. It may cause less irritation while healing the patch.

• Retinoids: While retinoids are known to heal the skin quickly, these are also light-sensitive compounds (E.g., Tazarotene). Hence, individuals might have to protect themselves from direct sunlight when using this medication. This will help the individual in overcoming the skin irritation caused by the medicine. Additionally, retinoids are not given to women who are planning a baby, already pregnant, or breastfeeding their newborns.

• Salicylic Acid: These are available in shampoos that reduce the skin surface's scaling. Additionally, it is helpful with other topical medications as it promotes the absorbance of medicines so they can work effectively. The doctor adjusts the strength of the solution in the prescription depending on the condition.

• Anthralin: It is one of the most effective skin growth inhibitors that are useful for people with psoriasis. Apart from this, it also reduces the skin surface’s scaling and helps heal the skin texture faster. However, it is essential to use anthralin mindfully to avoid extreme skin irritation. Doctors recommend anthralin for short-term application because it stains anything it comes in contact with.

Light Therapy

Many doctors and physicians recommend light therapy with medication and topical formulas. This therapy includes exposing the skin to controlled natural or artificial light.

Below are some options for light therapy:

• Sunlight: Moderate daily exposure to natural sunlight can improve psoriasis. As much as it is safe to expose the skin to natural light, consulting a doctor helps get the best out of this therapy.

• UVB broadband: Controlled exposure to UVB rays from an artificial source helps treat single or isolated psoriasis patches. This therapy is recommended to people who find topical treatment ineffective. Initially, the treatment might have side effects such as itchiness or inflammation in the skin.

• Psoralen plus ultraviolet A: Psoralen is a light-sensitizing medication that allows UVA rays to penetrate deeper into the skin. Even though this is an aggressive treatment, it significantly improves the skin’s texture.

Oral Medications/Injections

Oral or injectable medications are helpful for people with moderate to severe forms of psoriasis. Additionally, oral medications are recommended if other treatments are not improving the condition.

Below are some of these oral medications that may be useful in treating psoriasis:

• Steroids: Small doses of steroids may help treat psoriasis patches limited to a particular location in the body. 

• Retinoids: Retinoids are available in the form of pills that help in controlling the production of skin cells (e.g., Acitretin). Side effects of the medications include dry skin and muscle soreness. However, this is not recommended for pregnant and breastfeeding women as it might harm the foetus or the baby. 

• Biologics: These are the injectable drugs that modify the immune system of the body and interfere with the disease cycle to bring an improvement in the condition. Doctors have recommended many medicines to improve moderate or severe psoriasis in people (e.g., Apremilast). Additionally, it is helpful for people who are not finding the first-line therapies responsive. 

• Cyclosporine: This drug is typically advisable for people with severe psoriasis as it is an immunosuppressant drug (e.g., Cyclosporine). While it may not heal the skin or alter the immune system, it helps in making the immune system dysfunctional, ultimately reducing inflammation. The doctors do not recommend these drugs in the first place because they expose the patient to several health hazards.

• Etanercept, infliximab, and adalimumab injections can be used for diseases that can not be treated by first-line treatment.

In addition to chemical compositions, many people use natural aloe vera extract, fish oil, and Oregon grape extract to treat the condition.

Risks and Complications if Left Untreated

Nearly 30% of psoriasis patients start showing symptoms in their childhood. Below are some risk factors for psoriasis:

• Family history: Sometimes, people develop psoriasis abruptly if the condition runs in the family. If one or both parents are suffering from psoriasis, their children also become vulnerable to this disease at some point in their lives.

• Smoking: Smoking tobacco interferes with the immune system and triggers the onset of the disease. Additionally, if an individual is already suffering from the condition, tobacco smoking might increase the severity of the disease.

If an individual is unaware of the symptoms and leaves them untreated, then it might impose the following complications:

• Cause arthritis that might expose the patient to extreme pain and inflammation in the joints

• Might develop eye conditions like conjunctivitis or uveitis 

• Temporary or permanent changes in the texture or colour of the skin 

• Develop type 2 diabetes

• Become obese due to regular consumption of steroid-based medications 

• Cardiovascular diseases 

• Increased risk of other autoimmune diseases like celiac disease, Crohn’s disease, or inflammatory bowel disease

• Mental health conditions, including low self-esteem and depression

Additional information

Locations of Psoriasis

Below are some familiar locations in which individuals might observe the condition:

• Genital Psoriasis: This is one of the most common types of psoriasis, and it affects the skin in the genitals, inner thighs, and upper thighs.

• Scalp Psoriasis: Nearly 60% of people show symptoms on the scalp, affecting the hairline, forehead, neck, back of the head, and skin around the ears.

• Facial Psoriasis: Almost 30% of people suffer from facial psoriasis. It can also affect the eyebrows, nose, upper lips, and upper forehead.

• Hands, Feet, & Nails: In some conditions, psoriasis leads to breakage of nails, scaliness in foot skin, and dents in the nails. Most people with psoriasis have changes in their nail texture.

• Skin Folds: Areas like the underarms, the back knees, and the back of elbows might show irritation due to rubbing and sweating.

Types of Psoriasis

Below are some common types of psoriasis any individual might come across:

• Guttate Psoriasis: It includes small, round, and red-coloured spots due to inflammation. It appears on the legs and arms and can spread to any other area in the body. 

• Pustular Psoriasis: These are pus-filled bumps that show extreme inflammation in the skin. 

• Plaque Psoriasis: In this type of psoriasis, the plaque becomes inflamed and itchy and can spread to any area in the body. It shows red or silvery scales on the affected area. 

• Inverse Psoriasis: This shows deep red skin with a smooth texture and causes severe itching.