Psoriasis

What is Psoriasis?

Psoriasis is a long-lasting skin disorder that causes skin cells to multiply too quickly, resulting in red, scaly patches. These patches typically occur on the outer side of arms and legs, scalp, and lower back. Psoriasis can also impact joints and eyes.

There’s no permanent cure for this condition, and its severity can vary over time, with episodes of increased symptoms. Many people with psoriasis may experience poor quality of life and mood-related issues such as depression due to their condition. There are different forms of psoriasis, but the most common type is plaque psoriasis, characterised by red patches with white scales, particularly located on the body, arms, legs, and scalp.

About 10% of individuals with psoriasis, predominantly women, may also develop eye-related issues. However, it’s unusual for the eyes to be affected without any signs of psoriasis on the skin.

What Causes Psoriasis?

Psoriasis is a condition seen in about 0.2% to 4.8% of people. The exact cause isn’t known, but it’s believed to be a type of immune system disorder involving cells known as T lymphocytes. Certain inherited traits seem to be related to its occurrence. Psoriasis is also found frequently in certain racial and ethnic groups, linked with particular immune system-related genes known as HLA antigens.

Physical damage, chemical exposure, or radiation can cause psoriasis flare-ups. Also, some medications such as chloroquine, lithium, beta-blockers, steroids, and NSAIDs can make psoriasis worse. Interestingly, psoriasis typically improves in the summer and gets worse in the winter.

Many factors can trigger psoriasis, including infections, stress, alcohol use, smoking, obesity, and low calcium levels in the blood.

Risk Factors and Frequency for Psoriasis

Psoriasis is a skin condition that happens across the globe, but the number of people affected varies from place to place. in the United States, it affects around 2% of the population. There are higher rates of the condition in the Faroe Islands, but fewer cases in Japan. There have been no reported cases among Aboriginal Australians or South American Indians.

Psoriasis can appear at any age, but it typically begins either between ages 15 and 20, or between 55 and 60.

• Psoriasis is a worldwide skin condition, with the number of cases varying by location.
• In the U.S, about 2% of people have psoriasis.
• The Faroe Islands have high rates of psoriasis.
• There are fewer cases of the condition in Japan.
• No cases have been reported among Aboriginal Australians or South American Indians.
• It can appear at any age, but most people first see symptoms between 15 and 20 or between 55 and 60 years.

Signs and Symptoms of Psoriasis

Psoriasis is a common skin condition that results in red, flaky patches covered with silvery scales, often appearing on the scalp, knees, elbows, and lower back. There are two main types of psoriasis. The first type, often starting before 40, has a family history component. The second type usually occurs after 40 and does not show a family history.

Various presentations of this condition include plaque, guttate, rupioid, erythrodermic, pustular, inverse, elephantine, and psoriatic arthritis. Psoriasis can also show up in different areas like the scalp, palms of hands or soles of feet, genitals, and nails. Also, in psoriasis patients, any skin injury can cause new patches of psoriasis to form, which is known as the Koebner phenomenon.

• The most common type is plaque psoriasis, affecting 85% to 90% of patients. It appears as red plaques with silvery scales on the elbows, knees, scalp, and back. Removing these scales can cause tiny areas of bleeding, a sign known as the Auspitz sign.
• Guttate psoriasis is often seen in children following a throat infection. The skin displays small, red, scaly droplet-shaped patches, usually on the trunk and back. This type has the best prognosis.
• Pustular psoriasis features small pus-filled blisters surrounded by red skin. It can be limited to certain areas or widespread across the body. The generalized type is associated with low calcium levels and involves the whole body covered in sterile pustules on red skin.
• Erythrodermic psoriasis, a severe type, involves widespread redness and peeling skin over most of the body. It’s associated with intense itching, swelling, and pain and can occur after abruptly stopping systemic steroids. This condition can lead to complications such as skin barrier problems, basal metabolic rate disturbances, and circulatory issues potentially leading to heart failure.
• Nails can also be affected by psoriasis, showing pits, oil spots, thickening under the nail, nail damage, and nail detachment.
• Oral psoriasis often presents with a fissured tongue and affects 6.5% to 20% of people with skin psoriasis.
• Inverse psoriasis appears as smooth, red, sharply outlined patches in the folds of the skin such as armpits, groins, under the breasts, and in the buttocks area. The skin can be moist, softened and chafed, and prone to fissures. It may also have an unpleasant smell and be itchy.
• In sebopsoriasis, red plaques with greasy scales typically appear on areas with high sebum production like the scalp, forehead, folds around the nose, mid-chest, and behind the ears.
• Psoriatic arthritis is a chronic inflammatory arthritis affecting 30% of people with psoriasis. It usually affects the joints of the fingers and toes and results in inflammation leading to “sausage-like” swelling. It can also affect the hips, knees and spine.
• Eyelid, conjunctival and corneal psoriasis can lead to lash inversion, eyelid eversion, inflammation of the eyeball membrane, and corneal dryness. The most common eye feature is blepharitis which can result in scarring that turns the eyelid outwards, lash loss, and inverted lashes. In some cases, inflammation in the front of the eye may be seen.

Testing for Psoriasis

Usually, diagnosis is made by clinical morphology and site of lesions. Histopathology is rarely necessary but may help to differentiate psoriasis from another dermatosis if the diagnosis is not easy. Characteristic changes in biopsy show parakeratosis, micro-abscess, the absence of granular lesions, regular elongation of ridges in the form of camel foot appearance, and spongiform pustules of Kogoj with dilated and tortuous capillaries in the dermal papilla.[10][11]

Laboratory studies

• One should order complete CBC, renal, and liver function tests
• Rheumatoid factor
• ESR may be elevated in erythrodermic and pustular psoriasis
• Uric acid levels are high in psoriasis
• If only hand and feet are involved, obtain scrappings for fungal studies
• Pregnancy test
• Hepatitis serology
• PPD

Treatment Options for Psoriasis

The Psoriasis Area Severity Index (PASI) is a common tool used to measure how severe a person’s psoriasis is and to check how well treatments are working. Topical treatments, or creams and lotions that are applied to the skin, are typically used for mild to moderate psoriasis. These can include emollients and moisturizers to help keep the skin hydrated, as well as coal tar, dithranol, corticosteroids, vitamin D and retinoids.

If these topical treatments don’t work, methotrexate might be used. Doctors might also recommend cyclosporine, but this should only be used intermittently. If methotrexate isn’t effective, doctors may switch the patient to biological agents, which may be combined with methotrexate in some cases.

Phototherapy is another treatment option. This involves using light to treat psoriasis. One type is PUVA therapy, which combines a drug called psoralen with exposure to ultraviolet light. Another is called Narrowband UVB light, which is effective without the side effects that can come with psoralen, such as stomach upset, cataracts, and increased cancer risk. This treatment can be used safely in children, pregnant and nursing women, and older adults. It seems to work especially well for a type of psoriasis called guttate psoriasis.

In more serious or extensive cases, as well as when psoriasis affects the nails or causes arthritis, doctors may prescribe systemic drugs, which are drugs that work throughout the body. These can include methotrexate, retinoids, cyclosporine, and fumarates. If you’re taking these, your doctor will likely want to regularly check your blood, liver function and kidney function.

Biologics, which are proteins created in a lab that interfere with the immune response related to psoriasis, can also be used. Examples include infliximab, adalimumab, etanercept, and interleukin antagonists. People taking these must be checked for tuberculosis and hepatitis before starting treatment because there’s a serious risk of infection with these drugs.

Patients with psoriasis in their eyes will likely need strong treatment with corticosteroid eye drops. All patients should try to avoid skin injuries to prevent a reaction called the Koebner phenomenon. Additionally, patients should not use beta-blockers, chloroquine, or NSAIDs, and should avoid alcohol due to the risk of developing a condition called fatty liver. Prolonged use of steroids and other drugs that suppress the immune system can slow down the healing of wounds.

What else can Psoriasis be?

When a doctor is diagnosing skin conditions, he or she might consider a number of different possible issues. These could include:

• Eczema, a condition that makes your skin red and itchy.
• Seborrheic dermatitis, a common skin disease that causes a red, itchy rash with white scales.
• Pityriasis rosea, a skin rash that usually begins as one large spot on your chest, abdomen or back followed by a pattern of smaller lesions.
• Mycosis fungoides, a rare form of lymphoma that appears on the skin.
• Secondary syphilis, the second stage of this sexually transmitted infection, which often presents with a skin rash.

A detailed examination of the skin and possibly various testing may be needed to differentiate and diagnose these conditions accurately.

What to expect with Psoriasis

Psoriasis is a long-term condition that can significantly affect a person’s quality of life, and also impact their family members. It’s characterized by periods of relapses or flare-ups and remissions or symptom-free periods. Approximately 10% of people with psoriasis may develop severe disfiguring arthritis. Between 10 and 60% of patients enter remission at various points.

Besides the physical symptoms, psoriasis is linked with several mental and lifestyle complications such as depression, suicidal thoughts, alcoholism, smoking, substance misuse, and metabolic syndrome, as well as different types of skin cancer. Additionally, patients with psoriasis often have other significant health problems including kidney disease, heart disease, and joint issues. Research has found an association between psoriasis and increased risk of heart-related incidents.

Two types of psoriasis, known as pustular psoriasis and erythrodermic psoriasis, can become life-threatening, while a form known as psoriatic arthritis can negatively impact day-to-day functioning.

Possible Complications When Diagnosed with Psoriasis

Possible Side Effects:

• Additional infections
• Poor cosmetic results
• Development of psoriatic arthritis
• Likelihood of lymphoma
• Higher risk of heart-related problems

Preventing Psoriasis

There are no particular food restrictions for people with psoriasis, but it’s essential for them to maintain a well-balanced, nutritious diet. It is also important for them to understand and try to decrease the risk factors linked with heart disease.

Spending time in the sunshine can prove beneficial, so people with psoriasis are often advised to make time for outdoor activities. Also, keeping weight within a healthy range can help manage the condition.

Medical check-ups to look out for type 2 diabetes, high blood pressure, and abnormal levels of cholesterol are suggested. The help of a psychiatrist could be beneficial too, as depression is a common problem for many people with psoriasis.