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Psoriasis

Psoriasis is a skin disorder that can interfere with the life cycle of cells, and causes rapid buildup of cells on skin surface. Such cells develop as thick, silvery scales and patches of dry, red, itchy and sometimes painful skin.

Psoriasis is a chronic skin disorder, uncomfortable and disabling if associated with arthritis. Though there is no cure for psoriasis, medications provide significant relief. Using cortisone cream and limited exposure to sunlight can improve the symptoms.

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Symptoms of psoriasis

The symptoms of psoriasis are:

  • Tiny, scaling spots
  • Itching, soreness or burning
  • Dry and broken skin which may bleed
  • Red patches with silvery scales
  • Inflamed and stiff joints
  • Thickened, ridged or pitted nails

Psoriasis may result in either dandruff-like scaling spots or it may lead to major eruptions, covering larger areas. Mild cases have nuisance value while severe ones can be disfiguring, disabling and painful.

Psoriasis may flare up for few weeks, subside and may disappear completely. But it eventually returns in many cases.

Types of psoriasis

  • Plaque psoriasis: Common, painful, itchy, dry, raised, red skin lesions covered with silvery scales that appear anywhere on body, but mostly on soft areas and joints. In severe cases, the joints skin may crack and bleed.
  • Scalp psoriasis: Appears on scalp as itchy, red and silvery, white scales.
  • Nail psoriasis: It affects the finger and toenails causing pitting, abnormal growth, discoloration and loose nail which may separate from nail bed.
  • Guttate psoriasis: Bacterial infection of sores that occur on arms, trunk, legs and scalp. Normally, it affects people below 30 and occurs in repetitive episodes.
  • Pustular psoriasis: Is uncommon and may be either widespread or may occur in smaller patches on the feet, hands and fingertips. It is quick developing and pus-filled blisters appear within hours of the skin becoming tender and red. The blisters dry within two days and recur. It may cause chills, fever, severe itching and fatigue.
  • Inverse psoriasis: Common with overweight people and affects the groin areas and skin around genitals, in armpits and under the breasts. Friction and sweating worsen the condition.
  • Psoriatic arthritis: Apart from inflamed scaly skin, it causes discolored, pitted nails; painful, swollen joints and conjunctivitis. Also causes stiffness, joint damage and can result in permanent deformity.
  • Erythrodermic psoriasis: Is less common and causes red, itchy, peeling rash that covers the entire body. It is aggravated by sunburn, by corticosteroids and other medications.

Causes of psoriasis

The causes of psoriasis are not understood.

It is believed that immune system disorders trigger the condition in people with a genetic predisposition to psoriasis. The immune system has T cells that fight invasions by germs. However, in patients of psoriasis, such T-cells attack the healthy cells.

Overactive T cells can cause dilation of skin cells as well as increased production of white cells and healthy cells. This results in the accumulation of excess of newly produced T cells, healthy cells and white blood cells on the surface of the skin. Such buildup happens rapidly, which prevents the white blood cells, the dead cells and other cells from sloughing off from the skin surface. This cycle of overproduction and excessive buildup of cells on skin surface is what causes the scaly patches associated with psoriasis.

Treatment can interrupt the ongoing cycle. Cause of T cells malfunctioning is not fully known. However, researchers believe that environmental and genetic factors are responsible.

Factors which may trigger or aggravate psoriasis are:

  • Injury and infections
  • Cold weather
  • Stress
  • Alcoholism
  • Smoking
  • Side effects of certain medications such as lithium, beta blockers etc. prescribed for other diseases.

Psoriasis treatment

Psoriasis treatment is focused in the removal of scales and the interruption of cell production cycle.

Psoriasis treatments are of three types, namely topical treatments, light therapy and systemic medications.

Topical treatments

Apply creams, ointments for mild psoriasis. It is combined with oral medications in case of severe conditions.

  • Topical corticosteroids: To reduce inflammation, itching, and suppressing the immune system.
  • Anthralin: To normalize DNA activity, remove scales and smoothen skin.
  • Vitamin D analogues: Calcipotriene and Calcitriol are administered to slow down the growth of skin cells.
  • Topical retinoids: Tazarotene is given to treat acne and sun burn. It develops side effects of irritation.
  • Salicylic acid: Promotes sloughing of dead skin and reduces scaling.
  • Calcineurin inhibitors: Tacrolimus and pimecrolimus treat activities of T-cells, thereby reducing inflammation and plague buildup. Long term use may cause cancer.
  • Moisturizers: Moisturizing creams reduce itching, scaling and dryness.
  • Coal tar: Reduces scaling, inflammation and itching.

Light therapy

It involves exposure of skin to controlled quantities of natural sunlight or the use of artificial ultraviolet B or ultraviolet A light, either alone or with medications.

  • Sunlight: When exposed to limited ultraviolet rays in sunlight or artificial light, the activated T-cells in skin die, reducing scaling and inflammation. Excess exposure can worsen the symptoms.
  • UVB phototherapy: Controlled doses of UVB light improve mild symptoms. The side effects of redness, itching and dry skin are reduced by using moisturizing cream.
  • Goeckerman therapy: It is a combined treatment of UVB and coal tar treatment and tends to be more effective.
  • Narrowband UVB therapy: It is more effective than broadband UVB therapy, but may cause more severe and longer lasting burns.
  • Excimer Laser: This form of light therapy controls scaling and inflammation of mild cases and the side effects are redness and blisters.
  • Photochemotherapy or PUVA: UVA lights penetrate deeper into the skin and psoralen makes the skin more responsive to UVA. It has short term side effects of headache, itching and nausea. The long term side effect is skin cancer.
  • Combination light therapy: Combination of UV light with retinoids improves the effectiveness of treatment.
  • Pulsed dye laser: It is another form of light therapy, used to destroy the tiny blood vessels that cause the plague.

Oral or injected medications

If severe psoriasis is not responding to milder treatments, then oral or injected drugs are prescribed. Due to the severe side effects, it is used for short periods.

  • Retinoids: Administered for a short period when other therapies fail to reduce the production of skin cells. Dry skin, itching, hair loss and birth defects are the side effects.
  • Cyclosporine: Suppresses the immune system. But higher doses for prolonged period cause cancer, kidney problems, and high blood pressure.
  • Methotrexate: Controls production of skin cells and suppress inflammation. It may cause stomach disorder, appetite loss and fatigue. Prolonged use causes severe liver damage and decreased production of white and red blood cells and platelets.
  • Hydroxiurea: Less effective and can be used in combination with other therapies. Side effects include decrease in red and white blood cells and platelets. Pregnant or expectant mothers should not take this medicine.
  • Thioguanine: It is effective with lesser side effects. It causes anemia and birth defects.
  • Immunomodulator drugs: Alefacept, infliximab, etanercept and ustekinumab are biologics drugs that are administered when there is no response to traditional medications. It has to be used with caution because they have strong effects on the immune system and may cause severe infections.

The traditional approach is to start psoriasis treatment with milder medications such as topical creams, ultraviolet light therapy and  then move to stronger ones, if needed. The aim is to slow the cell turnover with least side effects.

Psoriasis images

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