Psoriasis is a multifactorial, chronic, complex inflammatory condition that causes hyperproliferation of skin cells that leads to the formation of scales and plaques on the skin.

Overview (1)

In normal conditions, new skin cells form and old skin cells shed off. This process occurs within a month. In the case of Psoriasis, old skin cells do not shed off and new cells make a pile on the skin surface within few days. It mainly manifests on lumbosacral areas, scalp, knees, elbows, glans penis, and intergluteal clefts. Among Psoriasis patients, the joints of 30% of patients are also affected.

Locations

  1. Genital psoriasis

About 70% of patients suffer from genital psoriasis somewhere in life. The upper and inner thighs, as well as genital areas, are affected by this type of Psoriasis.

  1. Scalp Psoriasis

Among psoriasis patients, 60% are suffering from scalp Psoriasis. In this type, the skin surrounding the ear, the backside of the neck, the forehead and the hairline are affected.

  1. Facial Psoriasis

About 30% of patients suffer from facial psoriasis. Psoriasis may occur at any site on the face such as the upper forehead, the area between upper lip and nose, and eyebrows.

  1. Psoriasis on feet, hands, and nails

Psoriasis can also target nails, hands and feet. If it affects feet soles or handspalms then it is referred to as Palmoplantar Psoriasis. About 12-16% of patients get affected by Palmoplantar psoriasis. Furthermore, approximately 50% of patients get their nails changed.

  1. Psoriasis on skin folds

Psoriasis can also occur on the area where skin folds such as breasts and armpits. These areas get irritated by sweating and rubbing.

Types

  1. Guttate Psoriasis

It roughly targets 8% of total psoriasis patients. Inflammation causes red, round, tiny spots. It can affect any area of the body but mostly appears on the torso, legs, and arms.

  1. Pustular Psoriasis

3% of patients get this type of psoriasis.  Its signs include white, painful, pus-filled bumps surrounded by red and inflamed skin. This type of psoriasis targets certain body areas such as feet and hands.

  1. Plaque Psoriasis

It is the most common type affecting about 80% of patients. It may appearonany part of the body. Symptoms include scaly painful skin, itchy and inflamed patches. In some people affected area gets red with whitish silver scales and in some people affected skin turns purple. It all depends upon the type of skin.

  1. Inverse Psoriasis

About one-quarter of Psoriasis patients suffer from this type. Its symptoms include non-scaly, smooth, deep-red and inflamed skin. It appears on skin folds and becomes itchy due to sweating and rubbing.

  1. Erythrodermic Psoriasis

It is a rare type of Psoriasis affecting only 2% of patients. It causes deep-red inflamed skin followed by the shedding of the affected area in large sheets. It also causes nail changes and dehydration.

Causes

Malfunctioned immune system is thought to be the cause of Psoriasis. Abnormal functioning of the immune system causes multiple proliferation of skin cells at a fast rate. Psoriasis has a certain connection to genes as well. It runs in family but may skip a generation. However, a person with no family history can also suffer from Psoriasis.  Certain triggers cause psoriasis by defecting the immune system. Such as:

  • Stress: stress has a loop relationship with Psoriasis. Both can cause each other. However, relaxation techniques avoid stress from affecting Psoriasis.
  • Skin injury: harmed or injured skin areas are prone to Psoriasis. According to Koebner Phenomenon vaccinations, bug bites, sunburn, and scratches are psoriasis triggers.
  • Others: some other triggers of Psoriasis include Tonsillitis, Streptococcal infections, upper respiratory tract infections, beta-blockers and anti-malarial drugs.

Symptoms

Its signs and symptoms are variable in different patients. Most commonly these are:

  • Patches of red skin surrounded by thick, silvery scales
  • Tiny scaling spots
  • Cracked dry skin that may cause itching and bleeding
  • Soreness, burning and itching
  • Pitted, thickened, ridged nails
  • Stiff and swollen joints

Diagnosis

A doctor can easily diagnose Psoriasis by viewing patches and plaques on skin areas of:

  • Nails
  • Belly button
  • Knees
  • Elbows
  • Ears
  • Scalp

He may also inquire about any family history of Psoriasis to aid his diagnostic process.

Lab test

A biopsy is done where a piece of skin is taken to check for any infection. There is no specific test to diagnose Psoriasis.

Treatment (2)

Therapeutic approaches to treat Psoriasis include slowing down skin cells proliferation and removing scales. The treatment options can be topical, oral or phototherapy.

Topical therapy

  • Corticosteroids

These are the first-line treatment of moderate Psoriasis. Corticosteroids are available in the form of shampoos, sprays, foams, gels, lotions, creams, and ointments. Hydrocortisone ointment (mild corticosteroid) is prescribed for sensitive areas. During flares, it must be applied once a day and to maintain remission it must be applied on weekends or alternate days. Strong corticosteroids such as clobetasol and triamcinolone are used to treat psoriasis at hard-to-treat or less sensitive areas.

  • Vitamin D analogs

Analogs, such as calcitriol and calcipotriene, slow down the rapid proliferation of skin cells. These can be used alone or in combination with corticosteroids.

  • Retinoids

Retinoids such as Tazarotene come in cream or gel form and are recommended to apply twice daily.  Such medication is not recommended in pregnant and breastfeeding women.

 

Oral and IV therapy

  • Methotrexate

This orally administered drug slows down the growth of skins cells and suppresses inflammation.

  • Cyclosporine

It is recommended for a severe type of psoriasis. It treats psoriasis by suppressing the immune system.

  • Biologics

These are given intravenously. It alters the immune system ultimately disrupting the disease cycle.

  • Other medications

Some drugs such as Apremilast, Hydroxyurea and Thioguanine help to reduce the itchiness of Psoriasis. These are given orally two times a day.

Phototherapy

Repeated treatments of phototherapy help to treat moderate to severe Psoriasis. It involves the exposure of skin to limited amounts of artificial and natural light. In some cases, medications are also given along with phototherapy. Lights involved in such treatments are sunlight, UVB broadband, UVB narrowband, Psoralen Plus ultraviolet A, and excimer laser.

References

  1. https://www.psoriasis.org/about-psoriasis/
  2. https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845