Psoriasis

What is psoriasis?

Psoriasis is a skin disorder characterised by red, swollen skin lesions covered with silvery white scales. It is not infectious.

What are the causes?

Psoriasis is an inherited disease. However, there are certain triggering factors such as injury to the skin, vaccinations and certain medications that have been responsible for the development of this condition. It usually takes about a month for new cells to move from the lower layers of the skin to the surface. In psoriasis, this process takes only a few days, resulting in a build up of dead skin cells and formation of thick scales. Excessive alcohol consumption, obesity, lack of or overexposure to sunlight, stress, cold climate and general poor health result in flaring up of psoriasis.

What makes psoriases worse?

Changes in the weather, injuries, illnesses and starting or stopping any medications can all lead to a flare-up of psoriasis. Allergy to certain kind of food and even stress and depression can worsen the condition.

What are the symptoms?

If the skin is scalier than usual, especially on the elbows and knees, it may be psoriasis. That's when one should go to a dermatologist for treatment. Following are the other symptoms of psoriasis

• Skin lesions: formation of pustules, cracking of skin and redness.
  
• Itching.
  
• Small scaling dots on the skin.
  
• Joint pain and aches.
  
• Skin patches: dry, red and covered with silvery scales; may crack and become painful; usually found on the elbows, knees, trunk, scalp, hands and nails.

Additional symptoms that may be associated with the disease are nail abnormalities, lesions on the genitalia, burning, itching and discharge from the eyes.

What are the different types of psoriasis?

Different types of psoriasis exhibit different characteristics that may change over time. One form may change to another, or several forms may exist at the same time.

• Plaque psoriasis: This is the most common type of psoriasis. It is characterized by raised, red lesions covered with silvery white scales. The scales are caused by a building up of dead skin cells. It may appear on the knees, elbows, scalp, trunk or any other skin surface.
  
• Guttate psoriasis: It is characterised by small red dots of psoriasis. The lesions may have some scaling. It may appear suddenly following a bacterial or viral infection or the administration of drugs like ketoconazole and salicylic acid.
  
• Inverse psoriasis: This is usually found in the folds of the skin in the armpits, groin or under the breast. It appears as smooth, red lesions without scaling and may cause irritation due to rubbing and sweating.
  
• Pustular psoriasis: It is characterised by blisters filled with pus on the skin. The blisters are not infectious. It may be found on the hands and feet or may be spread all over.
  
• Psoriatic arthritis: About 10% of the patients with psoriasis may develop a form of arthritis called psoriatic arthritis. This may cause redness and swelling, primarily on the hands, feet, knees, hips, elbows and spine. It may cause stiffness, pain and joint damage.
  
• Nail psoriasis: Psoriasis can affect the toes and fingernails causing pits of various size, shape and depth. The nails may turn thick and yellow. They may turn red and crumble easily.

How is the condition diagnosed?

The diagnosis is usually based on the appearance of the skin. A skin biopsy or a culture of skin patches may be needed to confirm psoriasis. A blood test may be done to confirm the presence of antigens that cause the problem.

How is psoriasis treated?

Sometimes, psoriasis may go away on its own but most of the times it requires treatment. But there isn't a definite cure to it. Medications, skin lotions and light therapy are used, in solitude or combined form, depending on the severity of the condition.

Treatment focuses on control of symptoms and prevention of secondary infection. Severe cases involving large areas of the body, may require intensive treatment. The disorder may be acutely painful. The body may lose fluids and may become susceptible to infections of the internal organs. The condition may further deteriorate resulting in septic shock and death in some cases.

Treatment includes painkillers, sedatives, intravenous fluids and antibiotics. Medicated shampoos or lotions that contain coal tar, cortisone or other corticosteroids, lubricants, antifungal medications, phenol, antibiotics, sodium chloride and other ingredients may be prescribed.

Other treatments include moderate exposure to sunlight or phototherapy. The skin may be sensitised to light by the application of coal tar ointment or by taking oral psoralens (a medication that causes the skin to become sensitive to light). The person is then exposed to ultraviolet light. Sunburn should be avoided as it can worsen the condition.

Maintaining general good health can help reduce the risk of flareups. Adequate rest and exercise, a well balanced diet and treatment of infections can help in making the treatment effective. It is recommended that general skin hygiene should be maintained by taking daily baths. Oatmeal baths may be soothing and may help to loosen the scales.

What is psoriatic arthritis?

About 10 percent to 30 percent of people with psoriasis also develop psoriatic arthritis - condition that causes pain, stiffness and swelling in and around the joints. Early recognition, diagnosis and treatment of psoriatic arthritis can relieve pain and inflammation. Without treatment, psoriatic arthritis can be disabling and crippling. If you have psoriasis and any of the following symptoms, consult the doctor immediately:-

• Generalised fatigue
  
• Tenderness, pain and swelling over tendons
  
• Swollen fingers and toes
  
• Stiffness, pain, throbbing, swelling, tenderness in joints
  
• Difficulty in moving
  
• Morning stiffness and tiredness
  
• Redness and pain in eyes
  
• Nail infections

The treatment options for psoriatic arthritis include nonsteroidal anti-inflammatory drugs (NSAIDs), including over-the-counter medications such as aspirin and ibuprofen and drugs that help to decrease inflammation, joint pain and stiffness. For sever cases of psoriatic arthritis, disease-modifying antirheumatic drugs (DMARDs) are prescribed.