Psoriasis Symptoms, Causes and Treatment

Psoriasis is a chronic inflammatory disorder of the skin and joints. This results in patches of thick red skin called plaques. These patches covered with the silvery scales usually occur on legs, knees, elbow, scalp, face, palm, lower back, nails and soles of feet.  The word psoriasis is derived from the Greek word psora that means itching. It is a persistent, common and long term skin disorder.

Types

There are different types of Psoriasis,

1. Plaque psoriasis

It is also known as psoriasis vulgaris. It appears as inflamed red skin covered with silvery scales on knee, elbows, scalp, lower back, feet and hands. It is the most common type of psoriasis.

2. Guttate psoriasis

It appears as an eruption of small papules in the upper trunk and central part of the body. The word guttate is derived from the Latin word Gutta that means drop. It is mostly present in early age. 

3. Inverse psoriasis

It appears as glossy, bright red and smooth lesions in the major folds of skin. This type is mostly observed in obese patients. The lesion scaling is mostly absent. 

4. Pustular psoriasis

In this type, lesions filled with pus appear on the skin. It is mostly present in adults on their hands and feet. It is uncommon but a serious medical condition that requires immediate medical attention.

5. Nail psoriasis

In this type, pinprick holes develop on the nails. The nails may get thick, pitted and change their color or shape.

6. Erythrodermic psoriasis

Erythrodermic psoriasis is also called exfoliative dermatitis. It is a severe, potentially life-threatening condition. In this type, more than 90% of the body surface is red and scaly. One of the most prominent features of erythrodermic psoriasis is erythema. These patches peel off just like burning skin.

7. Psoriatic arthritis

In this type, psoriasis develops along with arthritis/joint pain or inflammation.

8. Flexural psoriasis

 Psoriasis can also occur at flexural sites such as the axillae, groin, sub mammary areas and genitalia. Affected skin areas tend to be clearly differentiated.

Causes

The causes of psoriasis are a combination of environmental and genetic factors. In most cases, there is a genetic predisposition. Almost up to 70% of patients report a family history of psoriasis. There are almost nine chromosomal loci for the susceptibility of psoriasis according to genome wise association studies. Disease susceptibility and severity is greatly affected by multiple genes.

Environmental Factors

There are multiple environmental factors that are responsible for the development of psoriasis.

Alcohol And Smoking

Consumption of alcohol is a major factor that aggravates psoriasis. There is a great association with alcohol, psychological stresses and psoriasis. Almost 90% of patients with psoriasis are smokers at the onset of disease.

Infections

Bacterial infections act as a triggering factor for psoriasis. Streptococcal infections, particularly pharyngitis and HIV infection can aggravate psoriasis. The severity of the psoriasis is greater in these patient populations.

Emotional stress

Emotional stress is an important triggering factor for psoriasis. There is a strong connection between emotional stress and severity of psoriasis. In addition, depression and psychological stress can occur as an outcome of psoriasis.

Drugs

Some drugs have the ability to induce psoriasis. The most common drugs that can cause psoriasis are ß-blockers, antimalarials, non-steroidal anti-inflammatory drugs (NSAIDs), lithium, tetracyclines and rapid withdrawal of some steroids.

Symptoms

The signs and symptoms of psoriasis vary from person to person. The most common symptoms include,

• Red skin patches covered with silvery scales
• Itching
• Burning
• Soreness
• Dry skin
• Skin cracks that can cause bleeding or itching
• Swollen joints in psoriatic arthritis
• Ridged nails in nails psoriasis

Treatment

Topical therapy

First line treatment for psoriasis must include an emollient and topical treatment. If the skin is delicate such as the face then topical steroids can be very effective. Some of the most common topical treatments include,

1. Steroids

Topical steroids are used to reduce the inflammation in psoriasis. They are very easy to apply. Our first priority in psoriasis is to reduce inflammation. Once inflammation is reduced, then we may introduce other treatment options.

2. Coal tar

Coal tar has anti-inflammatory, antibacterial, anti-pruritic and antimitotic effects. Coal tar is an effective option for psoriasis. A wide range of preparations are available including bath preparations, shampoos, creams and ointment.

3. Dithranol

Dithranol is also known as anthralin. It is a derivative of synthetic anthracene. It has an anti-proliferative and anti-inflammatory effect on the skin. It is one of the older treatments used for stable, chronic plaque psoriasis.

4. Salicylic acid

It is used to reduce skin scaling particularly on the palms and soles. It can be mixed with coal tar, steroid or urea to increase its effectiveness.

5. Topical retinoids

Topical retinoids are less effective than vitamin D analogue. The most common side effect of retinoids is irritation.

Phototherapy

 Phototherapy is an effective therapy for the improvement of symptoms on sunny holidays. About 10% of patients reported that they have deterioration in symptoms from sun exposure. Phototherapy has an immunosuppressive effect.  PUVA (psoralens plus UVA light) play a vital role in the treatment of psoriasis.

Systemic therapy

The objective of systemic therapy is to reduce the severity of diseases and improve the quality of life. This is an effective option in severe, intolerant and relapsing psoriasis. Systemic therapy consists of,

• Methotrexate
• Acitretin
• Hydroxyurea/hydroxycarbamide
• Ciclosporin
• Fumaric acid esters

Biological therapy

The biological therapy includes,

• TNF antagonists
• Infliximab
• Etanercept
• Efalizumab,
• Adalimumab
• Ustekinumab

Frequently Asked Questions

Is there a cure for psoriasis?

No, there is no cure for psoriasis. Symptomatic treatment is used to reduce the severity of disease.

What are the risk factors for psoriasis?

Family history, smoking and stress are the major risk factors for psoriasis.