What is Psoriasis
Psoriasis is a chronic inflammatory skin condition that causes very quick increase in the number of skin cells, resulting in thick, white, silvery, or red patches of skin that look like scales.
Normally, skin cells grow gradually and flake off about every 4 weeks. New skin cells grow to replace the outer layers of the skin.
However, in psoriasis new skin cells move rapidly to the surface of the skin in days rather than weeks. and form thick patches called plaques. The patches range in size from small to large. They most often appear on the knees, elbows, scalp, hands, feet, or lower back. Psoriasis is most common in adults. But children and teens can get it too.
Psoriasis is not contagious. It cannot be spread by touch from person to person.
Causes of psoriasis
Experts believe that psoriasis occurs when the immune system overreacts, causing inflammation and flaking of the skin. In some cases, psoriasis is inherited and is attributed to genetic factors.
People with psoriasis often notice flares and their skin gets worse. Factors that can cause these flare-ups include a cold and dry climate, infections, stress, dry skin, and taking certain medicines.
Symptoms of psoriasis
Symptoms of psoriasis appear in different ways. Psoriasis can be mild, with small areas of rash. When psoriasis is moderate or severe, the skin gets inflamed with raised red areas topped with loose, silvery, scaling skin. If psoriasis is severe, the skin becomes itchy and tender, and sometimes large patches form and may be uncomfortable. The patches can join together and cover large areas of skin, such as the entire back.
In some people, psoriasis causes joints to become, tender, painful, and swollen. This type of psoriasis is called psoriatic arthritis. This arthritis can also affect the fingernails and toenails, causing the nails to pit, change colour, and separate. Dead skin cells may accumulate below the nails.
Symptoms often disappear (go into remission), even without treatment, and then return (flare up).
Types of Psoriasis
Knowing which kind of psoriasis you have, helps you and your doctor make a treatment plan. Most people have only one type at a time.Sometimes, after symptoms go away, a new form of psoriasis will crop up.
Here are the seven types of psoriasis.
This is the most common type. About 8 in 10 people with psoriasis have this kind.
This type often starts in children or young adults. It happens in less than 2% of cases.
Guttate psoriasis causes small, pink-red spots on the skin.
It develops on areas of skin that are bright red and smooth without scales.
A rare type of psoriasis that mostly appears in adults. It causes pus-filled pustules (bumps) surrounded by red skin. It may look infectious, but it is not.
This type is less common, but it is very serious. It affects the greatest part of the body and causes widespread, fiery skin that appears as if it is burnt.
Up to half of those with psoriasis have nail changes.An even more common condition in people who have psoriatic arthritis, which affects the joints.
A condition combining psoriasis and arthritis (joint inflammation). In 70% of cases, people have psoriasis for about 10 years before getting psoriatic arthritis. About 90% of people with it also have nail changes.
Treatments for Psoriasis
The aims of treatments for psoriasis are:
- Stopping the skin cells from growing at a rapid rate, so as to reduce inflammation and psoriatic plaque formation
- Removing the accumulated skin (scales) and smoothing the skin with topical treatments applied to the skin
Psoriasis treatments can be split into three main types: topical treatments, light therapies (phototherapy) and systemic treatments.
Topical Treatments for Psoriasis
Creams and ointments that are applied to the skin to effectively treat mild to moderate psoriasis. For more severe cases, creams may be combined with oral medications or light therapy. The topical treatments for psoriasis include:
- Hydration and lotion.Over-the-counter products to keep the skin hydrated and help control flare-ups. In general, thick oily lotions that trap moisture in the skin.
- Salicylic acid. It removes the “scales” that appear in the patches of psoriasis. It is available as a lotion, gel, soap, and shampoo. It is particularly useful in combination with other treatments. Dead skin cell removal enhances the effectiveness of other medications.
- Coal Tar.Helps in slowing down the rapid growth of skin cells and restore the skin’s appearance. It is available in many different forms. The shampoo is used to help in the treatment of scalp psoriasis.
Tar smells bad and it may irritate the skin and stain clothing. Follow the instructions carefully.
- Topical corticosteroids. Anti-inflammatory creams or ointments that slow down skin cell growth. They are available with different strengths.The weaker formulas are used on sensitive areas, such as the face, neck, groin and armpit. Stronger formulas are used in more demanding areas such as the underarms and knees.
- Vitamin D analogue. Creams, lotions and solutions with calcipotriene that slow down skin cell growth. For long-term use, these products may be safer than steroids, but they may irritate the skin. The doctor may recommend the use of Vitamin D together with a corticosteroid.
- Topical retinoids. Retinoids, such as tazarotene, can help the growth and apoptosis of skin cells. These gels or creams have Vitamin A and are available in different strengths.
Usually you can apply a small amount to each lesion once daily before bedtime.
Doctors do not recommend these products to pregnant women or women who want to become pregnant.
- Anthralin. It slows the growth of skin cells and reduces inflammation. It does not have serious side effects but it can irritate the skin and stains clothes, sheets and skin. It is often used with other medications.
- Calcineurin Inhibitors. Tacrolimus and pimecrolimus help to stop swelling (inflammation). Sometimes used to treat psoriasis when other medicines are ineffective.
Phototherapy for Psoriasis
Phototherapy, or light therapy, involves exposing the skin to ultraviolet light on a regular basis and under medical supervision. Treatments are done in a doctor’s office or psoriasis clinic. Consistency is the key to success.
Read about the different types of phototherapy for psoriasis:
Present in natural sunlight, ultraviolet B (UVB) is an effective treatment for psoriasis. UVB penetrates the skin and slows the growth of affected skin cells. Treatment involves exposing the skin to an artificial UVB light source for a set length of time on a regular basis.
There are two types of UVB treatment, broad band and narrow band. The major difference between them is that narrow band UVB light bulbs release a smaller range of ultraviolet light. Several studies indicate that narrow-band UVB clears psoriasis faster and produces longer remissions than broad-band UVB. In addition, it may be effective with fewer treatments per week than broad-band UVB.
Psoralen + UVA (PUVA)
Like UVB, UVA is present in sunlight. Unlike UVB, UVA is relatively ineffective unless used with a light-sensitising medication, psoralen, which is administered topically or orally. This process, called PUVA, slows down excessive skin cell growth and can clear psoriasis symptoms. Stable plaque psoriasis, guttate psoriasis, and psoriasis of the palms and soles are more responsive to PUVA treatment.
The use of the Excimer Laser is indicated for treating chronic, localised psoriasis, it emits a high-intensity beam of ultraviolet light B (UVB) towards the psoriatic plaques.
The excimer laser can target selected areas of the skin affected by mild to moderate psoriasis, and research indicates it is a particularly effective treatment for scalp psoriasis. A study with a small series of patients demonstrated that laser treatment, combined with a topical steroid, cleared scalp psoriasis that resisted other treatment.
Individual response to the treatment varies. It can take an average of four to ten sessions to see results, depending on the particular case of psoriasis. It is recommended that patients receive two treatments per week, with a minimum of 48 hours between treatment sessions.
Systemic treatment of psoriasis with medications
If you have moderate to severe psoriasis, the doctor may recommend “systemic medications” – a medicine that affects your whole body. They are typically used when the skin condition covers more than 5% to 10% of the body and other treatments, such as phototherapy and topical treatments with creams, ointments and solutions, have not worked.
While systemic therapy can help, many of the drugs may cause serious side effects. Close monitoring by your doctor will be required.
Choosing the Right Therapy
Methotrexate. This drug relieves the symptoms of psoriasis by curbing your immune system (the body’s defense system against microbes) and slowing the rapid growth of skin cells. The drug may be taken either by mouth or in a shot. The usual dose is once a week and the changes may be visible after 4 to 6 weeks.
While receiving methotrexate, regular blood tests should be performed to monitor the blood cells and liver function.
Ciclosporin. Like methotrexate, it lowers the immune system, and also slows skin cell growth. It is often used only for severe cases of psoriasis when nothing else seems to work. Ciclosporin, also spelled cyclosporin, is taken by mouth. While it can help clear psoriasis, ciclosporin’s benefits typically last for as long as you take the medicine.
Hydrea (Hydroxyurea). It has fewer side effects in comparison to some of the more potent systemic medications, but it is also less effective.
Biologics. They affect specific parts of the immune system. They block the action of T-lymphocytes, which are responsible for inflammation in psoriasis. According to the relevant evidence, they have significantly fewer side effects in comparison with conventional systemic treatment.
In general, they are only used in moderate to severe cases of psoriasis and psoriatic arthritis when they are not responding to other treatments.
Is there a permanent cure for psoriasis?
Psoriasis cannot be cured, but is manageable. The goal is to find the most effective way to slow down the excessive growth of cells with the least possible side effects.
Personal care for psoriasis
- Avoid all factors causing psoriasis.
- Avoid stress levels with yoga and other sport activities.
- After the shower or bath, dry your skin smoothly. Do not rub the towel against your skin.
- Avoid soap, as soap can make the skin dry. There are various cleaning products without soap.
- Apply a moisturising cream on the affected areas.
- Wear cotton clothes instead of synthetic ones.