What is Psoriasis?
Psoriasis is a disease where skin cells run amok. Normally the skin renews itself in about 24 days which is the time taken by skin cells to work their way from the inner most layer to the surface of the skin. However in cases of Psoriasis the cells reach the surface in just 3-4 days. This causes a huge cluster of thick skin flakes to accumulate on the surface of the skin giving rise to typical appearance in psoriatic lesions.
Psoriasis on the elbow
Although most cases of psoriasis flare-up in winters, summer flare-ups are not uncommon. Summer flare ups are commonly found in people who are allergic to the sun and UV radiation.
What are the symptoms of Psoriasis ?
The psoriasis symptoms differ from person to person and depend on the type of psoriasis. The most common symptoms are
• Red, raised and inflamed lesions
• Silvery white scales
• Small reddish pink spots (seen in children and young adults)
• Dry skin that easily cracks and bleeds
Itching – Psoriasis Itch is the principal and the most bothersome complaint amongst psoriasis patients. This was confirmed by a survey conducted by the National Psoriasis Foundation. Most patients who participated in the survey were of the opinion that if the itch were to be removed they would be at much ease with the disease. The itching is severe enough to cause sleep disturbances, inability to concentrate and mental depression. In addition, the trauma caused due to itching leads to new lesions. Psoriasis patients often have difficulty finding a suitable remedy for their itch. And often the kind of medicines that are required to curb the itching causes drowsiness.
• Burning and Soreness of skin
• Pitting & discoloration of nails
• Painful swollen joints
Not every person will experience all of the above symptoms. Some people may have fewer symptoms depending on the type & severity of their psoriasis.
What are the various types of Psoriasis?
There are many different types of Psoriasis. Finding out which type is an important step towards treating it effectively. The type of psoriasis depends on the location, severity and appearance of the symptoms. Often people may have more than one type of psoriasis at a time.
This is the most common type of psoriasis. It causes raised, red, inflamed skin covered with silvery white scales. These patches are often itchy and may crack and bleed. They can come anywhere on the body but are mostly found on the below areas.
This is the second most common type of psoriasis after plaque psoriasis. It appears as small pink spots on the skin. Guttate psoriasis often starts in childhood or in young adults. It can be triggered by a streptococcal throat infection. It is usually found on below areas
Inverse Psoriasis or Sebo-Psoriasis
This type is seen as bright red, smooth & shiny patches with no scales. Inverse psoriasis is often seen in association with another type of psoriasis elsewhere on the body at the same time. It occurs on skin folds and worsens with sweating or friction caused by tight clothing.
It is commonly seen on below areas
• Behind ears
• Under breasts
• Skin folds around genitals
• Behind knees
Inverse Psoriasis or Sebo-Psoriasis
Pustular psoriasis is characterized by pus filled lesions surrounded by red skin. The lesions are neither infectious nor contagious. They can be found on one or two localized areas or in a generalized form all over the body. The generalized form can be serious; the patient may suffer from fever and chills and may need immediate medical attention. It is seen on below areas
• Extensive body areas
Pustular Psoriasis on the palms
Erythrodermic psoriasis is a particularly severe form of psoriasis that leads to widespread, fiery redness over larger areas of the body. It can cause severe itching, pain and make the skin come off in sheets rather than small scales. Apart from the skin, the Erythrodermic psoriasis can disrupt the whole body chemistry. It can cause the skin to lose its ability to control body temperature leading to wild temperature fluctuations. This may cause fluid retention which causes swelling especially in the ankles. In severe cases people may require hospitalization.
Nail psoriasis can change the way your finger and toe nails look. The nails may become thick and change color or shape. They may turn yellow or brown. Ridges, grooves or pitting may be seen on the nail surface. They can also become tender and hurt. Chalky white material can gather under the nail causing it to separate from the nail bed.
This is a condition where you have both psoriasis and arthritis. About 15-25% patients suffering from psoriasis are likely to suffer from arthritis. The most common symptoms are painful swollen and stiff joints that are worse in the mornings, sausage like swelling of toes and fingers.
What causes Psoriasis?
The exact cause is not known but research suggests that it is caused by a problem with the immune system
Psoriasis is caused by a malfunctioning immune system. The malfunction has to do with white blood cells called T cells. Normally the T cells circulate throughout the body to detect and kill foreign bodies such as viruses or bacteria. However in Psoriasis, the T cells mistakenly attack healthy skin cells and trigger an overactive immune response. This leads to increased production of skin cells which build up in thick scaly patches on the skin surface. Just what causes the T cells to malfunction in people with psoriasis is not clear. Researchers have found that genetic tendency and environmental factors play a role.
Psoriasis is genetically inherited. Having one parent with psoriasis increases the risk of getting the disease, and having two parents with psoriasis doubles the risk. However even with a family history it is not absolutely necessary that one will get Psoriasis. Thus it is often found that people with a positive family history of Psoriasis do not suffer from it whereas people with no trace of psoriasis in the family for 2-3 generations actually suffer from it.
Most people living with Psoriasis experience good days when their skin clears and bad days when psoriasis flares. A trigger is usually what makes Psoriasis flare up whether it is for the first time or the thirtieth time.
• Viral or Bacterial Infections – recurring throat infections such as streptococcal throat infections. The link between Psoriasis and the “long lived” streptococci bacteria has opened up wider options in treating Psoriasis. A study revealed that the remnants of streptococci bacteria which were left in the body following throat infection had the potential of causing psoriasis after a gap ranging from few months to several years. This was confirmed when the doctors found that when killed streptococcal material was injected in the skin of normal persons, psoriasis developed at the site of injection. Further confirmation of this happened when psoriatic patients started responding more favorably to an anti-streptococcal line of treatment.
• Koebnerisation – also known as isomorphic response, refers to the development of new psoriasis lesions following injury to the skin. Studies have shown that about 50% of people with psoriasis develop new lesions due to injuries caused by simple cuts, wounds, abrasions, mosquito bites or simply scratching their skin. The local trauma exposes the skin cells to activated T lymphocytes triggering new lesions. The new lesions occur within 7 to 14 days of injury to the skin.
• Stress – Stress is one of the biggest psoriasis triggers. Psoriasis flares very easily when people are under stress and tends to improve when they are relaxed. In fact many people can trace the beginning of their psoriasis to a stressful period in their life. The reason is simple. When one is stressed the body reacts in a way that increases inflammation. The biggest challenge is a catch-22 situation as having psoriasis in itself can be quite stressful.
• Winter, cold weather or sudden changes in weather – winter tends to be the most challenging season for Psoriasis patients. Winter brings dry air, colder temperatures and reduced exposure to sunlight, all of which make psoriasis worse.
• Smoking – Nicotine and tobacco smoke can cause oxidative stress which can in turn alter the immune system and trigger psoriasis.
• Heavy alcohol consumption – People with Psoriasis should drink little or no alcohol. Several studies have shown that heavy drinkers experience more severe psoriasis symptoms. Excessive use of alcohol can cause deficiency of vitamins A and E which are crucial for healthy skin. Alcohol is a diuretic, apart from dehydrating the skin it can cause liver damage. It is known to cause flare-ups and limits the effectiveness of the ongoing treatment. These are many reasons for patients to say NO to this dangerous cocktail.
• Certain medications — including lithium, which is prescribed for bipolar disorder; high blood pressure medications such as beta blockers; anti-malarial drugs; and iodides.
How is Psoriasis diagnosed?
Psoriatic lesions are very characteristic and have a typical appearance which cannot be missed. However visual diagnosis may need confirmation. Psoriatic lesions are typically found on joint prominences like the finger knuckles, elbows, knees and ankles. Apart from these areas it is also common on the scalp, palms and soles. Psoriasis is also of many types, like Plaque, Guttate, Erythrodermic and Pustular. As each type of Psoriasis requires a slightly different approach, treatment should only begin after a proper evaluation of its type and triggering factors.
What are the complications of Psoriasis?
Psoriatic arthritis – Moderate Psoriasis does not pose major health complications as such. But if left untreated, it can often become severe and affect larger areas of the body. About 10-15% of Psoriatics are at a risk of developing Psoriatic Arthritis where there is inflammation of small joints and often deformities too.
Impact on mind and quality of life – Apart from its effect on the skin, nails and joints, Psoriasis has a tremendous impact on the mind and the quality of life. It interferes with daily activities, those that we take for granted, like going to the gym, swimming or attending ceremonies.
Low self esteem due to Psoriasis affects job performances and schooling. It affects interpersonal relations with family members as well. When it comes to matrimony, Psoriasis patients often wonder whether it is okay for them to get married. Some live in constant fear of passing on the disease to their children and panic on seeing even the smallest of rashes on their child’s skin. Such is the fear psychosis about the disease. However, Psoriasis by nature is non-contagious. It flares up with certain triggers. But at other times, the patients live an absolutely normal life. It is safe for psoriatic patients to get married, have children. They can play with children, cook for the family and even donate blood without the risk of it spreading to any other person.
Cardiovascular disease – A study has confirmed the increased risk of cardiovascular disease in Psoriasis patients, especially those with severe Psoriasis and in their forties and fifties. Psoriasis patients should undergo regular checks to rule out the presence of heart disease and also examine their risk factors like quit smoking, lower stress levels, decrease sodium intake and maintain normal weight.
How can we prevent psoriasis?
Psoriasis wellness is all about prevention rather than cure. It is about adopting a certain lifestyle to suit the body needs. Following the psoriasis wellness can help the patient experience more good days than bad ones. Lifestyle changes play an important role in the prevention and management of Psoriasis. Identifying your triggers is critical for reducing or preventing symptoms of psoriasis. It may not always be possible to prevent psoriasis symptoms. But avoiding triggers can help keep your symptoms to a minimum. Here are some things you can do to prevent psoriasis flare-ups:
Lower stress levels – sleep well, take frequent breaks to unwind. Resorting to meditation, psychotherapy and yoga may help improve coping ability.
Avoid certain medications that trigger psoriasis. Keep your doctor informed about any prescription or over-the-counter medications that you are taking.
Prevent skin injuries – Common skin injuries that trigger psoriasis include sunburns and scratches. Taking good care of your skin can help prevent these types of injuries, like using sunscreens, mosquito repellants etc.
Avoid infections – Infections are known to trigger psoriasis and thus all precautions should be taken to prevent catching infections, like maintaining adequate hygiene, washing hands often, avoiding to share food, drinks with others, limiting exposure to people who are sick.
Eat a healthy diet. Include foods rich in omega-3 fatty acids in your diet. Several studies have shown a benefit for psoriasis patients when omega-3 fatty acids were added to their treatment. A clear and significant improvement in Psoriasis Area and Severity Index (PASI) was seen in the group that was treated with omega-3 fatty acids as compared to the control group. Oily fish like salmons and sardines are rich in omega-3 fatty acids and so is tuna fish. For vegetarians flax seeds, sunflower seeds and sesame seeds are good sources of omega-3 fatty acids. These seeds can be stored in airtight containers and sprinkled over various foods for their beneficial effects. Consumption of folate rich foods like broccoli and cabbage also is helpful. Limit the consumption of red meat, dairy products and alcohol.
Exposure to Sunlight – has a healing role in treating Psoriasis. Exposure to the early morning healing sun has shown to decrease the severity of a Psoriatic outbreak and prevent relapses. Sunlight kills the activated T cells in the skin thereby slowing the growth of skin cells and reducing local inflammation. Patients need only brief exposure just few minutes in a day. Prolonged sun exposure can make symptoms worse & damage the skin. Dietary Vitamin D is also effective.
Exercise – People who are looking for yet another reason to exercise, here’s a good one. It has always been know that overweight people and smokers were at higher risk of psoriasis flare-ups. However in a study, it was found that despite being overweight and other lifestyle habits people who exercised regularly seemed to be protected against psoriasis flare-ups. The study further revealed that the lower risk was due to the fact that exercise lowered inflammation in the body in general, and body-wide inflammation is a common feature of psoriasis. Further exercise also lowers stress which otherwise is a big psoriasis trigger.
Dead Sea bath salts – Several clinical studies have documented the healing effects of bath salts from the Dead Sea in treating Psoriasis. A substantial decrease in discomfort, itching, scaling was reported with no side-effects. The healing property comes from the Dead Sea which contains four times the amount of salt found in any ocean. Apart from salts, it is loaded with a unique blend of minerals like bromide, magnesium, calcium etc which soften the skin and provide the much needed relief from the symptoms of Psoriasis.
What are the treatments for Psoriasis?
There are many effective psoriasis treatment choices. The treatment is decided on the basis of severity of the disease, the extent of areas involved, the type of psoriasis or the patient’s response to initial treatments. This is called the “1-2-3” approach.
Step 1 involves the usage of topical applications, which work by reducing inflammation and sloughing of dead skin.
Step 2 focuses on sun light and UV therapies – When exposed to UV rays in sunlight or artificial light, the activated T cells in the skin die. This slows down the skin cell turnover and reduces scaling and inflammation. Although daily doses of small amounts of sun exposure may improve the skin, intense sun exposure can worsen symptoms and damage the skin.
Step 3 involves oral medications and immune-modulating drugs.
Often individual treatments provide relief but are seldom strong enough to clear lesions over the long term. A combination approach is therefore considered to be treatment of choice.
Effects of psoriasis treatments also can be unpredictable; what works well for one person might be ineffective for someone else. Psoriasis should be faced with a measure of equanimity. When a new patch is noted, it is no cause for fear, for treatment can rid you of it and a cleared patch is no cause for celebration, as a new lesion can occur there or elsewhere someday. The focus is to keep psoriasis from coming in the way of your routine, livelihood and quality of life with the means available.
Many systems of medicine have effective treatments for psoriasis to the point of inducing remissions, but none can cure it as matters stand today. Be wary of quacks in the real world and online who promise you what you wish to believe and love to hear.
The future of Psoriasis treatments – A study carried out by Leicester University may have changed the future of Psoriasis. The study shows that a particular gene variant called CDSN found on chromosome6 is more active in Psoriatic patients. With the exact location of the gene responsible for Psoriasis, being identified, it brings us closer to directly targeting the gene activity leading to better treatment of Psoriasis in the near future.