Psoriasis is a non-contagious, autoimmune skin disease, characterized by inflamed hyperproliferative lesions covered with micaceous silvery-white scales of dead skin. Psoriasis occurs mostly in fair-skinned people and is exceedingly rare in dark color people. Around four million, Americans are suffering from Psoriasis, out of which 10%-15% are children under the age of 10. The average age of onset of Psoriasis is 28 years, although an individual may acquire it at any stage of his or her life.
There are two onset periods of the disease.
- Type I Psoriasis – depends on the family history, and the onset is late teens.
- Type II Psoriasis – does not depend on family history, and the onset is early 40s.
Description of Psoriasis:
Every three to four weeks, new mature skin replaces the old dead skin. In individuals with psoriasis, the skin matures within a week and tries to replace the dead skin too fast. This difference in rate of production and replacement results in raised patches of dead skin on elbows, arms, folds of buttocks, chest, back, nails, legs and fingers.
In its mildest form, psoriasis covers less than 5% of body’s surface, in its moderate form, it covers 5%-30% of body’s area and in its severest form it covers more than 30% of body’s surface.
Types of Psoriasis:
Psoriasis has many forms depending upon the area affected, severity, scales pattern and the duration of disease.
1. Pustular Psoriasis:
Pustular Psoriasis has the following characteristics:
- Mostly occurs in adults.
- Formation of blister-like pustules or lesions filled with non-infectious pus. These lesions are surrounded by red patches of skin.
- Can be localized or widespread.
- May be the initial symptom of psoriasis.
Generalized Pustular Psoriasis is a widespread form of pustular psoriasis with the following characteristic features:
- Widespread and extremely painful patches of red skin develop suddenly.
- Pustules may develop within few hours.
- Pustules dry and peel off within two days.
- Can be life-threatening affecting kidney and heart.
- Also known as Von Zumbusch pustular psoriasis.
Palamor plantar psoriasis (PPP) is another type of pustular psoriasis having the following features:
- Most common in individuals between 20 to 60 years of age.
- Formation of large-size pustules on the side of the heel or at the base of the thumb.
- Pustules dry and peel off and the activity of disease will reduce for a while after that.
Acrodermatitis continua of Hallopeau is a form of Palamor plantar psoriasis (PPP) in which painful lesions are formed on fingernails and toe nails deforming them and causing disability in the individual.
2. Plaque Psoriasis:
Plaque psoriasis (also known as psoriasis vulgaris) is the most common type of psoriasis displaying the following features:
- Formation of small, red bumps that enlarge, become inflamed and form flaky scales.
- Scales underneath the surface are clumped together, but the surface scales can be flaked off easily.
- When top scales are removed the tender skin below bleeds and form plaques.
- Mostly occurs on elbows, scalp, knees, feet and trunk, although it can occur anywhere on the body.
3. Guttate Psoriasis:
Guttate psoriasis is derived from Latin word “Gutta,” which means “drop”. Guttate psoriasis has the following characteristics:
- Formed as small reddish drop-like dots (0.5 to 1.5mm size) that may enlarge and form scales.
- Dots may disappear or clear up without treatment or may re-emerge in the form of plaque psoriasis.
- Mostly occurs on scalp, legs, arms and trunk.
- Most common in children and chronic in adults.
- May be triggered by throat infection.
4. Nail Psoriasis:
Nail Psoriasis may display the following features:
- Pitting of toenails or fingernails – these may be the first signs.
- Inflammation of skin around the nails.
- Nails may come out of the nail bed.
- Nails may thicken, become yellowish and may even crumble.
5. Scalp Psoriasis:
At least, 50% of all psoriasis cases are related to scalp psoriasis. People suffering from scalp psoriasis have flaky scales or plaques covering their skull.
6. Erythrodermic Psoriasis:
Erythrodermic psoriasis is one of the two types of psoriasis that is life threatening in nature. The other is Generalized Pustular Psoriasis. Erythrodermic psoriasis has the following characteristics:
- Widespread severe scaling, pain and itching.
- Upsets the body’s chemical balance and causes severe illness.
- Mostly occurs in persons having a history of plaque psoriasis.
7. Inverse Psoriasis:
Inverse psoriasis generally occurs in areas where the skin folds such as groin, armpits and underside of breasts. The lesions are smooth and inflamed, and the disease can be debilitating.
8. Psoriatic Arthritis:
Psoriatic arthritis affects about 30% of psoriasis patients. The characteristic features of this disease are as follows:
- Swelling in the ankles and toes.
- Swelling or discomfort or pain in joints, wrists, ankles, lower back and knees.
- Inflammation of eye or conjunctivitis (pink eye).
Causes and Symptoms of Psoriasis:
The exact causes of psoriasis are unknown. However, research has revealed that psoriasis is the culmination of effects of defective genes, triggered by the irritants in environment. Malfunctioning of immune system can trigger the disease. Factors that can aggravate the disease include:
- exposure to cold temperatures
- subjected to emotional stress
- subjected to physical and mechanical stress such as leaning on knees
- exposure to chemicals
- family history of psoriasis
- intake of steroids and medications
- intake of alcohol
- Koebner Phenomenon – A condition in which skin lesions appear on lines of trauma (direct injury of skin) in psoriasis patients
- some type of bacteria may cause psoriatic arthritis in psoriasis patients
Diagnosis of Psoriasis:
Diagnosis of Psoriasis includes the following:
- examination of nails, scalp and skin
- analysis of skin cell under the microscope
- blood tests to differentiate psoriatic arthritis from other types of arthritis
Treatment of Psoriasis:
The aim of treatment of psoriasis is to lower the growth of new skin cells and reduce the inflammation. The treatment depends upon various factors and the dermatologist experiment with different combinations of treatment to know the effective treatment for a particular patient. Treatment based on the severity of the condition is as follows:
For mild psoriasis the treatment includes:
- topical application of steroid’s cream and ointments.
- injection of steroids directly into the skin in case of a lesser number of lesions
- applying FDA approved water-base gel, tazarotene (Tazorec), which has properties similar to that of vitamin A
- daily limited exposure to natural sunlight without causing sunburns
- use of bathing oils and moisturizers to soften the skin and removal of scales
- to soften the skin a cup of oatmeal is added to a tub of water before washing or bathing
- to remove the dead skin, salicylic acid, an ingredient of aspirin, is used
For moderate psoriasis the treatment includes:
- use of ultraviolet light B (UVB)alone or in combination with topical treatment
- to treat localized or widespread psoriasis, Photochemotherapy (PUVA) is used. Photochemotherapy is a combination of exposure to Ultraviolet light and medication.
- to treat widespread psoriasis in individuals who did not respond to PUVA treatment an intensive treatment is suggested. In this treatment, the patient is exposed to Ultraviolet light B (UVB) and other treatments for six to eight per day for two to four weeks.
For severe psoriasis the treatment includes:
- Taking Methotrexate (MTX), either in pill form or injection form, to treat severe psoriasis or psoriatic arthritis cases. However, care should be taken as Methotrexate can cause liver damage.
- Using medications such as etrentinate (Tegison) and isotretinoin (Accutane). Tegison is also used in PUVA and UVB treatment. These medications have properties similar to those of Vitamin A. However, both Accutane and Tegison have the same side effects including eye inflammation, nose bleeding, hair loss, bone spurs and birth defects. It is advised that pregnant women should not use these medicines.
- Taking NSAIDs (nonsteroidal anti-inflammatory drugs) drugs such as aspirin or acetaminophen (Tylenol) to treat psoriatic arthritis.
- Treating individuals with stubborn psoriasis, diabetic patients, African Americans, or young children with FDA approved drug Cyclosporin emulsion (Neoral).
- Taking Accutane.
Other treatments for psoriasis include:
- Using coal-tar shampoos, but there is a risk of skin cancer.
- Applying topical creams containing calcitriol, a form of Vitamin D.
- Applying topical creams containing Hydrocortisone. However, they have side effects such as causing inflammation of hair follicles (folliculitis).
- Applying an ointment called Capsaicin (Capsicum frutecens) to reduce the inflammation and decrease the production of new skin cells.
Alternative Treatments for psoriasis:
Alternative psoriasis treatments include:
- Avoiding taking of animal products containing high saturated fats, as they increase the inflammation.
- Taking daily, two 500mg tablets of evening primrose oil (Oenothera biennis). However pregnant women and patients having liver problems should avoid taking it.
- Eating foods, including celery (to clean kidneys), lemon (to clean liver), turkey, fish, lettuce and parsley.
- Bathing in salty warm water.
- Bathing or soaking in warm water containing German chamomile (Matricaria recutita).
- Drinking hot tea made from the following herbs. At least, three cups must be taken per day. The herbs may be taken individually or in combination.
- Oregon grape (Mahonia aquifolium)
- Burdock (Arctium lappa) root.
- Balsam pear (Momardica charantia) and
- Bandelion (Taraxacum mongolicum) root.
- Taking nutritional supplements such as lecithin, folic acid, Vitamin E, Vitamin A, Zinc and Selenium.
- Increasing the amount of hydrochloric acid in the stomach.
- Drinking at least eight glasses of water daily.
Prognosis for Psoriasis:
Psoriasis is not completely curable. However, it can be controlled with the use of proper diet and medication, and patients can live a normal life.
Prevention of Psoriasis:
Prevention of psoriasis includes:
- Taking plenty of rest, avoiding too much work and mental stress.
- Checking with a dermatologist when the first symptoms of psoriasis appear.
- Avoiding scratching the affected area. At the onset of psoriasis the affected area should be cleaned with warm water and alkaline soap.
- Eating large quantities of fruits and vegetables.
- Maintaining good bowel habits.
- Avoiding the consumption of alcohol and caffeine products such as tea and coffee, and soft drinks.