Psoriasis

Psoriasis is a chronic autoimmune skin disease that causes rapid accumulation of skin cells, scaling, redness, and inflammation. Psoriasis is not contagious and often has a genetic component. Psoriasis can occur on any part of the body and varies in severity. 

 Types of Psoriasis:

1. Psoriasis Vulgaris: - 

• Most common form. 
• It is characterized by raised red patches covered with silvery-white scales.
• Typically seen on the scalp, elbows, knees, and lower back

2. Guttate Psoriasis: - 

• appears as small, drop-like sores on the trunk, arms, legs, or scalp. 
• Often provoked by bacterial infections such as streptococci.

3. Psoriasis Inversa: - 

• occurs in folds of skin (e.g., under the breasts, around the groin area). 
• Smooth, shiny red patches without scaling;

 4. Pustular psoriasis: -

• characterized by white pustules (pus-filled blisters) surrounded by red skin. 
• It may be localized to the hands and feet or spread over the entire body.

5. Erythrodermic Psoriasis: - 

• Rare and severe form, causing extensive redness, scaling, and desquamation. 
• It can be life-threatening and requires immediate treatment.

6. Nail Psoriasis: -

• Fingernails and toenails are affected, causing depression, discoloration, thickening or peeling of the nail bed.

7. Psoriatic Arthritis: -

•  Joint pain, stiffness and swelling, often with skin symptoms. 

General Skin Symptoms: - 

• Red inflamed patches on the skin.
• Silvery-white scales or plaques.
• Dry, cracked skin may bleed. 
• Itching, burning, and pain in affected areas. 

 Nail changes: -

• Pitted, raised or thickened nails. 
• Nail detachment from nail bed. 

 Joint Symptoms(in psoriatic arthritis): - 

• Joint pain, swelling, stiffness. 
• Decreased range of joint motion. 
• Morning stiffness lasting several hours. 

Causes and Triggers :

 Causes: Psoriasis is an autoimmune disease, which causes rapid cell turnover (3-7 days instead of the usual 28 days) as the immune system mistakenly attacks healthy skin cells. The result is an accumulation of skin cells and characteristic scaling.

 

Triggers :

• Stress: Stress exacerbates symptoms. 
• Infections: e.g., streptococcal or respiratory infections. 
• Weather: Cold, dry weather can aggravate symptoms. 
• Injuries: wounds, cuts, sunburn (Kevner's phenomenon). 
• Medications: beta-blockers, lithium, antimalarials. 
• Lifestyle: smoking, alcohol consumption, obesity. 

 Diagnosis : 

Physical Examination: - 

• Based on the appearance of the skin, scalp, or nails.

Skin biopsy: - 

• Rarely, a small sample of skin may be examined under a microscope to confirm the diagnosis and rule out other conditions. 

Treatment:

 There is no cure for psoriasis, but there are a variety of treatments aimed at reducing symptoms, reducing flare-ups, and improving quality of life. 

Topical Treatments: 

1.Corticosteroids: -

•  Reduce inflammation and itching.
• Examples: hydrocortisone, betamethasone; 

2. Vitamin D analogues: -

•  slow skin cell growth. 
•  Examples: calcipotriol, calcitriol.

3. Cole tar: -

• reduces scaling, itching and inflammation.

4. Salicylic acid: -

•  removes scaling and promotes the effects of other treatments.

5. Hydrating agents and emollients: - 

• moisturizes skin and reduces scaling.

  Phototherapy:

1. Ultraviolet Phototherapy: - 

• irradiate skin with controlled amounts of ultraviolet B.

 2. PVA Therapy: - 

• use UVA light in combination with a photosensitizer (psoralen).

 Systemic Therapy (moderate to severe): 

1. Medications: - 

• Methotrexate: methotrexate: reduces inflammation and suppresses the immune system.
• Cyclosporine: suppresses the immune system. 
• Acitretin: retinoid that normalizes skin cell growth.

 2. Biologic Therapy: - 

• Targets specific immune pathways involved in psoriasis.
• Examples: adalimumab, infliximab, etanercept, secukinumab, ustekinumab. 

Complications - 

Psoriatic arthritis: - 

•  may cause permanent joint damage if untreated.

Increased risk of other diseases: -

•  Cardiovascular disease, type 2 diabetes, metabolic syndrome.
•  Anxiety, depression, low self-esteem. 

 Infections: - 

• Open or cracked skin can become infected.

 

Prevention and Management - 

Avoid Triggers: - 

• Identify and minimize stress, injuries, and irritants that aggravate symptoms. 

 Maintain a healthy lifestyle: - 

• Eat a balanced diet, exercise, avoid smoking and alcohol. 

 Skin Care - 

• Use gentle cleansers, moisturize frequently, and avoid harsh chemicals.

 - Regular checkups: - 

• Monitor symptoms and consult a health care professional to adjust treatment as needed. 

Prognosis :

Psoriasis is a lifelong disease with periods of remission and flare-ups. With effective management, most individuals can control symptoms and maintain a good quality of life. Newer therapies, especially biologic agents, have significantly improved the prognosis of patients with moderate to severe psoriasis.