Psoriasis is a chronic inflammatory skin condition where the skin thickens and the area swells causing clearly defined areas of raised red patches with silvery-white flaky skin in the middle. This skin condition tends to affect the extensor surfaces of the body and can also involve the scalp, sometimes leading to hair loss, and the fingernails and toenails. Psoriasis cannot be cured – most treatments will offer temporary relief or the condition may go into remission only to recur a short while later.
What Causes Psoriasis?
Psoriasis appears to be an autoimmune condition – there is a lot of evidence to suggest so but this has not been ascertained in every case of psoriasis. The body’s immune cells attack the skin cells causing inflammation which leads to the redness of the skin and itching. The skin thickens (hyperproliferation) due to a faster rate of cell growth and the skin does not slough (shed) off as it should. This results in the characteristic signs and symptoms of psoriasis like dry and itchy skin.
There is a strong genetic link and there are some genes that have been identified in familial cases of psoriasis. However, not every case of psoriasis is hereditary and there may be some environmental factors that may trigger the onset of the condition.
The exact cause of psoriasis is not known but many of the trigger factors have been identified. This includes :
- Infections, particularly after a strep throat.
- Skin injury, sunburn, trauma to the skin like surgical incisions and deep cuts.
- Alcohol consumption.
- Changes of weather, particularly in colder conditions.
- Certain medication like antimalarial drugs, beta-blockers and lithium.
What does psoriasis look like?
Signs and Symptoms of Psoriasis
Psoriasis is often described as thickened patches of skin, with red raised borders and a silvery to white dry skin in the center of the patch. Scaling or flaking of the skin is common. However not every case of psoriasis will appear in this typical manner. In the initial stages, psoriasis may be misdiagnosed for other skin conditions like eczema and even fungal infections of the skin. As the condition progresses, the typical signs and symptoms will become evident, although there may be fluctuations during the course of the condition.
There are different types of psoriasis but they generally appear very similar.
Characteristic features of psoriasis includes :
- Dry, thick skin surrounded by red raised borders.
- Flaking or scaling of the skin, especially upon scratching.
- White to silver scaly skin plaques.
- Itching that may vary in intensity – sometimes it is absent while at other times it can persistent and excruciating.
- Plaques tend to appear on the extensor surfaces of the body – example : outer part of the arm and shin.
- Burning and oozing may occur after excessive scratching or if there is a bacterial or fungal infection of the skin.
- Joint pain and swelling in cases of psoriatic arthritis.
Psoriasis may present differently in areas of the body where it is not commonly seen. Lesions in the flexures of the body, like under the breast in women and in the armpits, often appears red and shiny, yet the skin is not flaky.
On the palms of the hands, it may appear like dry patches which is not clearly demarcated from the rest of the skin and is often misdiagnosed as contact dermatitis.
When the nails are involved, there may be transverse lines on the nail, pitting and thickening of the nail and separation of the nail from the nail bed.
The scalp is often affected and the presentation can vary to such a degree that it may be mistaken for seborrheic dermatitis (cradle cap). Focal hair loss is often present in severe cases.
How is Psoriasis Treated?
Treatment for Psoriasis
There is no cure for psoriasis – proper management aims to keep the condition in remission for as long as possible or reduce the intensity of the symptoms during the active stage.
- Coal tar and moisturizers, sometimes containing salicylic aicd, will help with the dryness and itching.
- Topical (steroid creams, gel, lotion) or oral (tablets, capsules) corticosteroids reduces the itching, inflammation and thickening of the skin. The skin plaques may recur, sometimes worse than it was initially, after discontinuing a steroid application (rebound effect).
- Methotrexate which is an immune suppressant helps to ease the condition but has a wide range of side effects. Psoriasis sufferers using methotrexate will require regular liver function tests. These days, it is the drug of choice for psoriatic arthritis.
- Ciclosporin, another immune suppressant, may be used instead of methotrexate.
- Calcipotriol is a vitamin D agonist which reduces the thickness of the psoriasis plaques and diminishes the scaling.
- Retinoids are a synthetic form of vitamin A which may assist with shedding of the skin.
- PUVA treatment (Psoralens and UVA) is a light therapy that can clear psoriasis plaques, although the effect is usually not permanent.
How is Psoriasis Prevented?
Prevention of Psoriasis
Stress management is an important part in preventing acute aggravations of psoriasis. Reducing or stopping alcohol consumption and cigarette smoking, regular and adequate moisturizing and general skin care may also be helpful for managing psoriasis.
While there is no clear dietary link to psoriasis, eating a health diet with plenty of fresh fruits and vegetable may be useful as these foods have phytochemicals in its peel (‘skin’) which may be beneficial for general skin care. While some psoriasis sufferers do report a significant improvement of their condition after stopping meat and dairy consumption, there is no conclusive scientific evidence to suggest that this will assist every case of psoriasis.
Psoriasis can be quite a debilitating condition, not just physically, but mentally and emotionally as well. The constant itching and embarrassment about the condition can be quite trying, especially on younger sufferers. Joining a support group and interacting with others with psoriasis through a professional organization may help sufferers with the mental and emotional anguish. As with any medical condition, a thorough understanding and in-depth knowledge of the condition, new treatments and scientific breakthroughs in treating psoriasis will also be helpful.
Organizations like the National Psoriasis Foundation can also assist sufferers with finding dermatologists in their area, who specialize in the treatment and management of psoriasis.