What is psoriasis?
Psoriasis is a long-term inflammatory skin condition. Here the patient gets red plaques (thickened skin) with white scales all over the body. The cells of skin divide at a much faster rate than normal. It can start at any age including childhood and tends to persist lifelong, fluctuating in extent and severity.
Clinical features of psoriasis:
Psoriasis can affect any part of the skin; the most common sites are scalp, elbows, and knees. Psoriasis usually presents with symmetrically distributed, red, scaly plaques with well-defined edges. The scale is typically silvery white, except in skin folds. Itching is mostly mild but may be severe in some patients, leading to scratching and lichenification (thickened leathery skin with increased skin markings). When psoriatic plaques clear up, they may leave brown or pale marks that can be expected to fade over several months. Nails can also be affected leading to pitting, separation of the nail from its bed, yellowing and ridging of nails.
What causes psoriasis?
Psoriasis is multifactorial; its exact cause is not known. It is classified as an immune-mediated inflammatory disease (IMID) which means that there is an alteration in body’s immune system. Genetic factors are important. Many patients have family members with psoriasis. The patient’s genes affect their type of psoriasis and its response to treatment.
Aggravating factors :
Infections, Injuries such as cuts, abrasions (koebner phenomenon), Stressful event, Obesity, Smoking, Excessive alcohol, Medications such as lithium, beta blockers, antimalarials, painkillers
Patients with psoriasis are more likely (than other people) to have other health conditions listed here.
Joint Damage (Psoriatic arthritis) – Long standing psoriasis affects joints causing inflammation and destruction of the joint.
Pustular Psoriasis- This is a serious condition that presents with widespread sterile pustules on a background of red and tender skin.
Metabolic Syndrome: obesity, hypertension, hyperlipidemia, gout, cardiovascular disease, type 2 diabetes.
It is important to take early and regular treatment of psoriasis from an experienced dermatologist to prevent these dangerous conditions from affecting the patient.
Myths about Psoriais:
There are many misconceptions about psoriasis in minds of general public. We try to clear up some of them here.
There is no Treatment: Psoriasis is like diabetes of skin. It can be controlled very well with drugs but regular treatment from an experienced dermatologist is required. Even full body psoriasis with joint pains can be controlled with the new injections now available which are given under the supervision of an experienced dermatologist.
Oral Steroids are given in the treatment of Psoriasis: This is completely false. Experienced dermatologist never ever gives oral steroids in the treatment of psoriasis. In fact, it is wrong to do so as the patient may land in pustular psoriasis after their withdrawl. We have treated hundreds of patients EVEN THE severest cases without ever giving steroid.
Psoriasis is contagious: This is also not true. Psoriasis does not spread from one person to other. Many patients feel socially outcast as other people are afraid of getting a disease and do not even shake hands with them. Patients try to hide the lesions and are afraid to go out socially.
Treatment of Psoriasis:
Oral Drugs: Methotrexate, Ciclosporin, Acitretin are traditionally the most commonly used drugs.
Phototherapy: Exposure to ultraviolet (UV) radiation, Excimer laser often in combination with topical or systemic agents
Local Application: Emollients, Coal tar preparations, Vitamin D analogue (calcipotriol), Topical corticosteroids, a Calcineurin inhibitor (tacrolimus, pimecrolimus)
Excimer laser: Targeted phototherapy using 308 nm wavelength Excimer laser. It has the advantage of exposure of involved areas only and sparing of uninvolved areas, thus minimizing side effects.
Biologics: These are drugs which interfere with specific parts of the body’s immune system to treat psoriasis. Unlike general immunosuppressants that suppress the entire immune system, biologics can fight more selectively and target only those chemicals involved in causing psoriasis. The biologics being used by us include Etanercept, Infliximab and Itolizumab. These are powerful anti psoriasis injections which can bring even widespread severe psoriasis under control leading to clearance of lesions as early as within 72 hrs.
If you are a psoriasis patient take early and regular treatment from an experienced dermatologist and you will lead a happy life free of skin lesions and other complications without any adverse effect.