Psoriasis

As a chronic skin condition affecting millions worldwide, psoriasis can cause significant physical and emotional distress. Despite its prevalence, psoriasis remains poorly understood, and many people struggle to find effective treatments. In this article, we will provide an overview of psoriasis, its types, and symptoms, as well as discuss the current understanding of this complex condition.

What is Psoriasis?

Psoriasis is a chronic autoimmune disease characterised by inflammation and the rapid overproduction and shedding of skin cells. This leads to the formation of thick, scaly patches, often on the elbows, knees, scalp, and lower back. While not contagious, psoriasis can be painful, disrupt sleep, and reduce quality of life. The precise cause is unknown but believed to involve an interplay of genetic and environmental factors triggering an overactive immune response that attacks healthy skin cells.

Psoriasis presents in various forms, each with unique symptoms and traits:

• Plaque psoriasis: The most prevalent type, features raised, red lesions with silvery-white scales, commonly on the elbows, knees, scalp, and lower back.

• Guttate psoriasis: Primarily affects children, with small red spots appearing on the torso and limbs, often after an upper respiratory infection.

• Pustular psoriasis: Marked by skin blisters filled with pus, usually on the palms and soles, potentially triggered by medications, infections, or stress.

• Inverse psoriasis: Impacts skin folds like the groin and buttocks, worsening with friction and perspiration.

• Erythrodermic psoriasis: Although rare, this type is severe. It causes widespread body redness and scaling, sometimes due to sunburn or certain drugs.

• Psoriatic arthritis: Causes joint pain and inflammation, in addition to skin symptoms.

Some common symptoms of psoriasis include:

• Thick, red skin patches with silvery-white scales that itch or burn

• Commonly appear on elbows, knees, scalp, trunk, palms, and soles of feet

• Dry, cracked skin prone to itching and bleeding

• Thick, ridged, or pitted nails

• Poor sleep quality owing to discomfort

The specific symptoms of psoriasis can vary depending on the type:

• Plaque psoriasis causes red, scaly plaques, most frequently on the scalp, knees, lower back, hands, and feet

• Guttate psoriasis appears as small, reddish, white-scaled spots on the chest, abdomen, arms, and thighs, often triggered by strep infections

• Inverse psoriasis leads to smooth, shiny, red skin in the armpits, groin, genitals, and under the breasts

• Pustular psoriasis causes pus-filled bumps surrounded by red skin, typically on the hands and feet but can be generalised

• Erythrodermic psoriasis is a rare, severe type causing red, scaly skin over most of the body, along with fever, chills, and dehydration

What part of the body will psoriasis affect?

• Scalp: red, scaly patches on the scalp

• Elbows: dry, cracked skin on the elbows

• Knees: red, scaly patches on the knees

• Lower back: dry, cracked skin on the lower back

• Hands and feet: red, scaly patches on the hands and feet

• Nails: thickening, pitting, or separation of the nails

• Joints

The location and extent of psoriasis symptoms can vary significantly from person to person. While some individuals may have only a few small patches, others can experience widespread coverage. Working closely with a dermatologist can help determine the most effective psoriasis treatment plan based on the specific areas of the body affected.

• Genetics: Inherited from parents

• Immune system: Overactive immune response

• Environmental factors:

  • Cold weather

  • Stress

  • Certain medications (e.g., beta-blockers, lithium)

  • Infections (e.g., strep throat)

  • Injury to the skin (e.g., cuts, burns)

  • Obesity

  • Smoking

Other potential causes of psoriasis:

• Hormonal changes (e.g., pregnancy, menopause)

• Certain foods (e.g., gluten, dairy)

• Vitamin deficiencies (e.g., vitamin D)

While the exact cause of psoriasis remains unknown, several risk factors can increase your likelihood of developing this chronic skin condition. Some of the risk factors for developing psoriasis include the following:

• Family history: Having a parent, sibling, or child with psoriasis increases your risk of developing the condition.

• Age: Psoriasis can develop at any age but often first appears between the ages of 15 and 35.

• Smoking: Cigarette smoking not only increases the risk of developing psoriasis but can also make the condition more severe.

• Obesity: Being overweight or obese is associated with an increased risk of psoriasis and can make treatment more challenging.

• Stress: High stress levels can trigger psoriasis flare-ups or worsen existing symptoms.

• Infections: Certain infections, such as strep throat or skin infections, can trigger the onset of psoriasis or exacerbate symptoms.

• Medications: Some medications, including beta-blockers, lithium, and antimalarial medicines, can trigger or worsen psoriasis in some individuals.

Psoriasis, an autoimmune inflammatory disease, can lead to several significant complications beyond its characteristic skin symptoms.

• Psoriatic arthritis is a common complication affecting up to 40% of patients, causing pain, stiffness, and swelling in and around the joints. If left untreated, psoriatic arthritis can lead to permanent joint deformities.

• Patients with psoriasis, especially those with psoriatic arthritis, may experience eye issues such as uveitis, conjunctivitis, and blepharitis, which can lead to vision troubles and potentially permanent vision loss if not treated.

• Scalp psoriasis can result in hair loss, adding to the emotional and psychological impact of the disease.

• Furthermore, psoriasis is associated with a higher risk of lymphoma, cardiovascular and ischemic heart disease, metabolic syndrome, inflammatory bowel disease, and other conditions.

• Living with psoriasis can also lead to anxiety, depression, and significant psychological distress, affecting social and working life.

While there is no surefire way to prevent psoriasis, adopting certain lifestyle habits and taking proactive measures can help reduce your risk of developing the condition or experiencing frequent flare-ups.

• Manage stress: Practice stress-reducing techniques like meditation, deep breathing, or engaging in hobbies to help prevent psoriasis flare-ups.

• Maintain a healthy weight: Adopt a balanced diet and regular exercise routine to maintain a healthy weight, as obesity can worsen psoriasis symptoms.

• Avoid triggers: Identify and avoid personal triggers, such as specific foods, alcohol, or environmental factors that seem to aggravate your psoriasis.

• Moisturise regularly: Keep your skin well-hydrated by applying moisturiser frequently, especially after bathing or showering, to help prevent dryness and itching.

• Protect your skin: Use sunscreen when outdoors and avoid skin injuries, as even minor cuts, scrapes, or sunburns can trigger a psoriasis flare.

• Quit smoking: If you smoke, quitting can help reduce your risk of developing psoriasis or experiencing more severe symptoms.

• Follow treatment plans: Adhere to your prescribed treatment regimen, as consistent management can help prevent psoriasis flare-ups and keep symptoms under control.

Here are some common methods used for diagnosing and testing for psoriasis:

• Physical examination: A dermatologist will closely examine the skin, scalp, and nails for signs of psoriasis, such as red, scaly patches, nail pitting or separation, and joint tenderness or swelling.

• Medical history: The doctor will ask about your symptoms, recent illnesses, stress levels, family history of psoriasis, and other medical conditions to gain a comprehensive understanding of your health.

• Skin biopsy: In some cases, a small skin sample may be taken and analysed under a microscope to confirm the psoriasis diagnosis and rule out other skin disorders with similar appearances.

• Blood tests: While no specific blood test can diagnose psoriasis, tests like a complete blood count (CBC) and liver function tests may be ordered to monitor your overall health and check for any adverse effects from psoriasis treatments.

• Imaging tests: If you have signs of psoriatic arthritis, your doctor may recommend X-rays, CT scans, ultrasound, or MRI to assess the extent of joint inflammation and damage.

Treating psoriasis involves a multi-faceted approach tailored to the severity and extent of the condition. Below are key approaches for the management and treatment of psoriasis:

• Topical therapies: Creams, ointments, lotions, foams, or solutions containing corticosteroids, vitamin D analogues, retinoids, coal tar, or other active ingredients can be applied directly to the skin to reduce inflammation and slow down skin cell growth.

• Systemic medications: For more severe or widespread psoriasis, oral or injectable medications like methotrexate, oral retinoids, biologic response modifiers, immunosuppressants, and PDE4 inhibitors may be prescribed to target the overactive immune system.

• Phototherapy: Controlled exposure to ultraviolet light, either in a doctor's office or using a home phototherapy unit, can help slow skin cell turnover and reduce inflammation in affected areas.

• Newer treatments: TYK2 inhibitors, such as deucravacitinib, have recently been approved for the treatment of moderate to severe plaque psoriasis in adults.

• Lifestyle modifications: Keeping the skin moisturised, maintaining a healthy weight, managing stress, and avoiding triggers like smoking and excessive alcohol consumption can help manage psoriasis symptoms.

Managing psoriasis requires a comprehensive approach focusing on lifestyle modifications and regular medical care.

• Maintaining a healthy lifestyle is crucial, which includes following a balanced diet to reduce the risk of comorbidities like obesity and metabolic syndrome, avoiding smoking and excessive alcohol consumption, and engaging in regular physical activity to keep joints mobile and reduce the risk of cardiovascular diseases.

• Regular medical check-ups with your dermatologist and other doctors are essential to monitor the disease and manage complications early.

• It is important to follow the prescribed psoriasis treatment plan diligently to control psoriasis symptoms and prevent long-term damage.

• Considering counseling or support groups can help address the psychological impacts of living with psoriasis.

• It is crucial to seek medical attention if you experience any new or worsening psoriasis symptoms.

• If you have psoriasis and start experiencing joint pain or stiffness, consult your doctor to rule out psoriatric arthritis.

• Sudden onset or worsening of skin symptoms, such as the appearance of new plaques or the spreading of existing ones, should be reported to your dermatologist.

• If your current psoriasis therapy is not effectively controlling your symptoms, or if you experience side effects from your medications, discuss alternative treatment options with your doctor.

• Seek immediate medical attention if you develop severe skin infections, as psoriasis can increase the risk of skin infections.

• Lastly, if you notice any changes in your vision or experience eye discomfort, consult an ophthalmologist promptly to prevent potential vision loss.

• Psoriasis is a chronic autoimmune disease that primarily affects the skin but can also lead to various complications, including psoriatic arthritis, eye problems, and an increased risk of other diseases.

• The exact reason for psoriasis is not known, but it is believed to involve a combination of genetic and environmental factors that trigger an overactive immune response.

• Common signs of psoriasis include red, scaly patches on the skin, itching, burning, and joint pain or stiffness in some cases.

• While there is no cure for psoriasis, various treatment options are available to manage symptoms and prevent complications, including topical medications, phototherapy, and systemic therapies.

• Living with psoriasis requires a comprehensive approach that includes maintaining a healthy lifestyle, regular medical check-ups, and addressing the psychological impacts of the disease.