Understanding Psoriasis: Causes, Symptoms, and Effective Treatments

What is Psoriasis?

Psoriasis is a chronic skin condition that has affected about 3% of the US population and approximately 125 million people worldwide. It causes rashes that are itchy with scaly areas of skin, most commonly found on knees, elbows, and trunks. It is a condition that can affect any age group with a predilection for adults and has a waxing and waning nature with triggers that can be different for each person.

What are the symptoms of Psoriasis?

Psoriasis manifests with various symptoms that can vary in severity from person to person. The most common symptoms include:

1. Appearance of thick, red, and scaly patches of skin, often covered with silvery-white scales. These patches, known as plaques, are typically itchy and may be painful.
2. Psoriasis commonly affects the elbows, knees, scalp, lower back, and nails, but it can occur anywhere on the body.
3. Nail changes, such as pitting or discoloration, are also common.
4. You might also experience joint pain in your larger joints, like knees, known as psoriatic arthritis.

What are the causes of Psoriasis?

Psoriasis is considered an autoimmune disorder, where the immune system mistakenly attacks healthy skin cells. T-cells, a type of white blood cell, become overactive, leading to inflammation and causing the skin to grow and mature at an accelerated rate. It usually takes about a month for new skin cells to grow and replace the older ones. But this process happens very fast in psoriasis, and new skin cells mature within 3 to 4 days, forming thick and scaly skin.

What are the types of Psoriasis?

There are different types of psoriasis depending on their morphological pattern and location.

1. Plaque psoriasis: It is the most common type of Psoriasis, representing approximately 80% to 90% of cases. This type manifests as elevated, reddish areas of skin that are coated in scales that are silvery white. The patches often emerge on the scalp, trunk, and limbs, notably the elbows and knees. They normally form symmetrically over the body and may cause itching and burning sensation.
2. Guttate Psoriasis: This type is marked by small, red dots, usually on the torso or limbs, and typically affects children or young adults. This type usually appears after an upper respiratory tract illness caused by Streptococcus.
3. Inverse Psoriasis: This type of psoriasis appears in skin folds, such as under the breasts, armpits, or the groin area. It is characterized by smooth, red, and inflamed patches of skin and is particularly prone to irritation and discomfort due to friction and sweating.
4. Erythrodermic Psoriasis: This is a rare but severe form of psoriasis that can affect the entire body. It causes widespread redness, inflammation, and scaling of the skin. Erythrodermic psoriasis can be life-threatening and requires immediate medical attention.
5. Pustular Psoriasis: Pustular psoriasis is marked by the formation of pus-filled blisters (pustules) surrounded by red skin. These pustules are not infectious but can be painful and may appear on localized areas or across the entire body. There are two main forms of pustular psoriasis: localized and generalized pustular psoriasis.

Complications of Psoriasis

• Psoriasis is commonly associated with significant medical and mental health problems such as anxiety, depression, and low self-esteem.
• Psoriasis-related inflammation can affect the body’s other organs and tissues.
• Psoriatic arthritis can occur in one out of every three patients with Psoriasis.
• Psoriasis-Arthritis symptoms include swelling, stiffness, and discomfort in the joints and the tissues around them. Along with these conditions, people living with Psoriasis may also be at an increased risk for Crohn’s disease, diabetes, metabolic syndrome, obesity, osteoporosis, uveitis (inflammation of the middle of the eye), liver disease, and kidney disease.

Triggers for Psoriasis- Explained

Psoriasis is a complex condition, and its triggers can vary from person to person. While the exact cause of psoriasis remains unclear, several common triggers and exacerbating factors have been identified:

1. Stress: Emotional stress is a well-recognized trigger for psoriasis flare-ups. High-stress levels can lead to an overactive immune response, exacerbating the condition.
2. Infections: Certain infections, especially streptococcal throat infections, can trigger or worsen guttate psoriasis in some individuals.
3. Skin Trauma: Injuries to the skin, including cuts, burns, insect bites, or friction, can trigger the development of psoriasis lesions, a phenomenon known as the Koebner response.
4. Medications: Some medications, such as certain antimalarial drugs, beta-blockers, and lithium, can exacerbate psoriasis or induce the condition in susceptible individuals. If you have psoriasis or a family history, you must inform your healthcare provider about your condition to explore alternative medications when necessary.
5. Alcohol and Smoking: Excessive alcohol consumption and smoking have been linked to a higher risk of psoriasis and more severe symptoms. Reducing or quitting these habits has been shown to decrease the symptoms, thus making them important triggers to avoid.
6. Hormonal Changes: Hormonal fluctuations during puberty, pregnancy, and menopause can affect psoriasis symptoms. Interestingly, some women experience relief during pregnancy but may notice flare-ups after giving birth.
7. Weather and Climate: Cold, dry weather conditions can worsen psoriasis symptoms, while warm, humid climates may provide relief.

How can a diagnosis of Psoriasis be made?

A dermatologist or healthcare provider typically diagnoses psoriasis through clinical examination and medical history assessment. Since psoriasis has a characteristic appearance that your doctor can recognize, no test is usually required to diagnose it. However, the diagnosis can sometimes be challenging and mistaken for other disorders like eczema. That is when a skin biopsy may be performed. During a skin biopsy, your doctor will remove a small sample of skin tissue and send it for examination under a microscope.

Treatment of Psoriasis - Explained

The treatment of psoriasis aims to alleviate symptoms, reduce inflammation, and slow down the skin cell turnover that characterizes the condition. Treatment options for psoriasis can vary depending on the type, severity, and individual patient preferences. Here are some common treatment approaches:

Topical Treatments

1. Corticosteroids: These anti-inflammatory creams or ointments can reduce redness, itching, and scaling. They are often used for mild to moderate psoriasis.
2. Topical Retinoids: Retinoids are substances derived from vitamin A, and these creams can help slow skin cell growth and reduce inflammation.
3. Calcineurin Inhibitors: If you have psoriasis on sensitive areas of the skin, such as the face and genitals, then your doctor may prescribe you topical calcineurin inhibitors like tacrolimus and pimecrolimus. These drugs help to reduce inflammation.

Phototherapy (Light Therapy)

1. UVB Phototherapy: You would be exposed to controlled doses of ultraviolet B (UVB) light that slows down skin cell turnover and reduces inflammation. UVB treatment can be administered in a hospital or home using a prescribed UVB lamp.
2. Psoralen plus Ultraviolet A (PUVA) Therapy: PUVA involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. It’s effective for severe psoriasis but requires careful monitoring due to potential side effects.

Systemic Medications

1. Oral Medications: In cases of moderate to severe psoriasis, oral medications like methotrexate, acitretin, or cyclosporine may be prescribed. These medications work by suppressing the immune system or regulating skin cell production.
2. Biologics: Biologic drugs, such as TNF-alpha inhibitors (e.g., adalimumab, etanercept) and IL-17 inhibitors (e.g., secukinumab, ixekizumab), target specific parts of the immune system responsible for psoriasis inflammation. They are often used for severe psoriasis and psoriatic arthritis.
3. Apremilast: This oral medication is a phosphodiesterase-4 inhibitor that helps reduce inflammation and treats moderate to severe psoriasis.
4. Combination Therapies: Some individuals may benefit from combining treatments, such as topical creams and phototherapy or biologics, along with other medications, to achieve better symptom control.

Lifestyle and Home Remedies for Psoriasis

Certain lifestyle changes can complement medical treatments and reduce psoriasis flare-ups:

1. Moisturizers: You should keep your skin well-hydrated with moisturizers, which can help reduce dryness and itching.
2. Stress Management: Stress reduction techniques, such as meditation and yoga, is a crucial part of the treatment as they can help prevent stress-related flare-ups.
3. Avoid Triggers: You should identify and avoid specific triggers, such as certain foods or environmental factors, that may help manage psoriasis symptoms.

How is Psoriasis Prevented?

Preventing psoriasis is challenging because it is a complex condition with genetic and immune system factors at play. However, some strategies may help prevent flare-ups in individuals with an existing diagnosis. Here are some of the measures:

1. Manage Stress: You should practice stress-reduction techniques, such as meditation, yoga, deep breathing, or mindfulness, to lower stress levels, which can trigger or worsen psoriasis.
2. Maintain a Healthy Lifestyle: You are encouraged to consume a balanced diet of fruits, vegetables, whole grains, and lean proteins. Omega-3 fatty acids in fish and flaxseeds may have anti-inflammatory benefits.
3. Infections: You should practice good hygiene to reduce the risk of streptococcal infections, which can trigger guttate psoriasis in some individuals. In such people, it is of utmost importance that any infection in the skin must be treated to minimize the risk of exacerbating psoriasis.
4. Smoking and Alcohol: If you smoke, consider quitting, as smoking has been linked to an increased risk of psoriasis and more severe symptoms. You should also limit alcohol consumption, as excessive drinking can worsen psoriasis.
5. Medications and Triggers: You should discuss your medications with your healthcare provider to ensure they do not exacerbate or trigger psoriasis. In addition to medications, you also should identify and avoid personal triggers, such as stress, injuries, or specific foods, that may worsen your symptoms.
6. Sun Protection: While controlled sun exposure can help some individuals with psoriasis, excessive sunburn can trigger flare-ups. Use sunscreen and protective clothing when spending time outdoors.
7. Regular Checkups: If you have a family history of psoriasis or other risk factors, consider regular checkups with a dermatologist to monitor your skin health.

When to Consult a Dermatologist?

A visit to a dermatologist should be taken into account if:

1. You have symptoms of Psoriasis
2. Your quality of life is significantly impacted, and
3. You have a severe and widespread illness

Questions for your doctor

1. Are there any lifestyle changes that could help manage my symptoms?
2. What triggers my psoriasis flare-ups, and how can I avoid them?
3. Can you recommend any over-the-counter treatments that may help relieve my symptoms in case of flare-ups?
4. Are there any prescription medications that can interact with my current medicines or health conditions?
5. How often should I come in for follow-up appointments, and what should I expect during those appointments?
6. What should I do if my symptoms worsen or I develop new symptoms?
7. Is there a permanent cure for this disease?

References

1. https://www.cdc.gov/psoriasis/
2. https://my.clevelandclinic.org/health/diseases/6866-psoriasis
3. https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845