Psoriasis

• Plaque psoriasis:Plaque psoriasis is the most common form of psoriasis which causes raised, dry, red skin lesions that are covered with silvery scales. The plaques can be itchy or painful. They can develop anywhere on the body, including genitals.
• Nail psoriasis: Psoriasis can develop on the toenails and fingernails leading to pitting, discolouration and abnormal nail growth. Psoriatic nails can separate and loosen from the nail bed. In worse cases, nails can crumble.
• Guttate psoriasis: This form of psoriasis attacks young adults and children. It is generally triggered by a bacterial infection as strep throat. It is marked by small, scaling lesions on your legs, trunk, arms and scalp. The lesions are covered with fine scale and they are not thick as plaques.
• Inverse psoriasis: This usually affects the skin of the armpits, under the breasts, in the groin and around the genitals. It causes smooth patches of red, inflamed skin which can become worse with sweating and friction. Fungal infections can stimulate this form of psoriasis.
• Pustular psoriasis: This is the uncommon type of psoriasis which can develop in widespread patches or in smaller areas on feet, hands or fingertips. It usually occurs fast, with pus-filled blisters visible just hours after redness and tenderness of the skin. The blisters can come and go regularly.
• Erythrodermic psoriasis: The least common form of psoriasis. It can cover your whole body with a red, peeling rash which causes itching or burning severely.
• Psoriatic arthritis: Psoriatic arthritis can cause inflamed, scaly skin along with swollen, painful joints. In some cases, the joint symptoms and sometimes nail changes are the first sign of psoriasis. Symptoms can vary from mild to severe and any joint can be affected. This condition is not usually crippling but it can cause stiffness and progressive joint damage which in severe cases results in a permanent deformity.

The common signs and symptoms of psoriasis are:

• Dry, cracked skin which may bleed
• Thickened, pitted nails
• Stiff and Swollen Joints
• Itching, soreness or burning
• Small scaling spots
• Red patches on skin covered with thick, silvery scales

The causes of psoriasis are not completely known. However, they are believed to be relevant to immune system problem with T cells and neutrophils in the body. T cells usually travel in the body to defend against foreign substances. But in psoriasis patient, the T cells attack healthy skin cells mistakenly to fight an infection.

Overactive T cells stimulate the increased formation of healthy skin cells. This leads to redness and in some cases pus in Pustular lesions.

According to researchers both genetics and environmental factors also play a role.

Following are the risk factors for psoriasis:

• Family history: This is the major risk factor. If you have one parent with psoriasis then risk to you increases and if you have two parents with psoriasis then the risk increases even more.
• Viral and bacterial infections: Patients with AIDS are more susceptible to develop psoriasis. Children and young adults with frequently occurring infections have increased the risk of developing psoriasis.
• Stress: High-stress levels can elevate the risk of psoriasis.
• Obesity: Excess body weight can increase the risk of psoriasis. Lesions of psoriasis usually occur in skin folds and creases.
• Smoking: Smoking tobacco increases the risk of psoriasis and in patients with psoriasis it increases the severity of the disease.

Following are the complications associated with psoriasis:

• Psoriatic arthritis: Psoriasis can cause joint damage.
• Eye conditions: Certain eye disorders as conjunctivitis and blepharitis are common in patients of psoriasis.
• Obesity: Patients with psoriasis that have the more severe disease are more susceptible to obese.
• Type 2 diabetes: The risk of type 2 diabetes increases in patients with psoriasis.
• High blood pressure: High blood pressure condition is higher for the patients with psoriasis.
• Cardiovascular disease: The risk of cardiovascular disease is twice higher for the patients with psoriasis.
• Metabolic syndrome: Conditions as high blood pressure, abnormal cholesterol levels and elevated insulin levels increase the risk of heart disease.
• Parkinson′s disease: This chronic condition is more susceptible to develop in the patients with psoriasis.
• Kidney disease: Moderate to severe psoriasis increases the risk of kidney disease.
• Emotional problems: Psoriasis can also cause low self-esteem and depression.

Diagnosis of psoriasis is usually easy. Following are the various ways to diagnose psoriasis:

• Physical exam and medical history: Generally psoriasis is diagnosed by examining skin, scalp and nail. Medical history also helps to diagnose the condition.
• Skin biopsy: Doctor can take a small sample of skin in rare cases to determine the exact form of psoriasis.

Psoriasis treatments clear the skin and decrease the inflammation. Following are the three major types of treatments for psoriasis:

Topical Treatments

Mild to moderate psoriasis can be treated by using creams and ointments alone. If the disease is more severe, then the creams are usually combined with oral medicines or light therapy. Topical psoriasis treatments include:

• Topical corticosteroids: These drugs are frequently prescribed medicines for the treatment of mild to moderate psoriasis. They relieve itching and reduce inflammation and can be used with other treatments.
• Mild corticosteroid Ointments are often prescribed for sensitive areas as a face or skin folds, and for treating extensive patches of damaged skin. Stronger corticosteroid ointment is recommended by the doctor for smaller and less sensitive areas. Topical corticosteroids can prevent working over time. It is generally best to use topical corticosteroids for short-term treatment during flare-ups.
• Vitamin D analogues: the synthetic types of vitamin D retard the skin cell growth. Calcipotriene is a prescription cream which treats mild to moderate psoriasis when used along with other treatments.
• Anthralin: It helps to retard the skin cell growth and make skin smoother by removing scales.
• Topical retinoid: These are vitamin A derivatives which can decrease the inflammation. These medicines are applied after applying sunscreen because they can increase sensitivity to sunlight.
• Calcineurin inhibitors: Calcineurin inhibitors tacrolimus and pimecrolimus decrease the inflammation and plaque buildup.
• Salicylic acid: Salicylic acid causes the removes the dead skin cells and decreases scaling. Sometimes it is used in conjunction with other medicines as topical corticosteroids to enhance its effectiveness. Salicylic acid is accessible in medicated shampoos to treat scalp psoriasis.
• Coal tar: Coal tar decreases the inflammation, scaling and itching. Coal tar is accessible in over-the-counter oils, creams and shampoos. It is also available in higher concentrations on prescription. This treatment is not prescribed for women who are in gestation or lactation period.
• Moisturizers: Moisturizing creams can decrease dryness, itching and scaling. Moisturizers should be applied immediately after a bath to lock in moisture.

Light Therapy (Phototherapy)

In phototherapy, natural or artificial ultraviolet light is used. The simplest form of phototherapy skin is exposed to controlled amounts of sunlight. Other types of light therapy use artificial ultraviolet A (UVA) or ultraviolet B (UVB) light.

• Sunlight: Exposure to ultraviolet rays in sunlight or artificial light retards the skin cell turnover and decreases the scaling and inflammation. Daily exposures to small amounts of sunlight can improve psoriasis. However intense sun exposure can make the symptoms worse and cause damage to the skin.
• UVB phototherapy: Controlled doses of UVB light from an artificial light source can make mild to moderate psoriasis symptoms better. UVB phototherapy can be used to treat single patches and widespread psoriasis. Use of moisturizer can reduce the side effects.
• Narrow band UVB phototherapy: A newer form of psoriasis treatment, narrow band UVB phototherapy can be more effective than broadband UVB treatment. It is generally administered two or three times a week until your skin improves.
• Goeckerman therapy: Some doctors combine UVB treatment with coal tar treatment, which is called as Goeckerman treatment. The combination of these two therapies is more effective as coal tar makes skin more receptive to UVB light.
• Psoralen plus ultraviolet A (PUVA): This therapy involves taking a light-sensitizing medication Psoralen before getting exposure to UVA light. UVA light enters deeper into the skin as compared to UVB light, and Psoralen which makes the skin more responsive to UVA exposure. This treatment constantly improves skin and is frequently used for more-severe psoriasis cases.
• Excimer laser: This type of light therapy is used for mild to moderate psoriasis. It treats only the affected skin without harming the healthy skin. A controlled beam of UVB light is directed to the plaques to control inflammation and scaling.

Oral or Injected Medications

In case you suffer from severe psoriasis or you are resistant to its other forms of treatment, then your doctor can recommend you oral or injected drugs. Due to the severe side effects, some of these medicines are used only for short periods and can be interchanged with other types of treatment.

• Retinoid: These groups of drugs are related to vitamin A which can help in case you have severe psoriasis and you do not respond to other treatments.
• Methotrexate: Methotrexate, when taken orally, helps psoriasis by reducing the formation of skin cells and repressing inflammation. It can also retard the progression of psoriatic arthritis in certain people.
• Cyclosporine: Cyclosporine represses the immune system and it is similar to Methotrexate inefficiency. However, they can only be taken for short-term.
• Biologics: Many of these drugs are approved for treating moderate to severe psoriasis. They include etanercept, infliximab, Adalimumab, ustekinumab, golimumab, apremilast, secukinumab and ixekizumab. Most of these drugs are administered through injection and are usually used for people who fail to respond to traditional therapy.

Alternative Medicine

A number of alternative medicines and therapies are thought to relieve the symptoms of psoriasis as special diets, herbs, creams and dietary supplements. No one has definitively been proved effective. However a few alternative therapies are believed to be usually safe and they can be helpful to certain people in decreasing signs and symptoms, as scaling and itching. Following are some of the alternative treatments that can help the patient with psoriasis:

• Aloe Vera: Aloe extracts cream can decrease the itching, redness, scaling and inflammation. You require using this cream many times a day for a month or more to observe improvements in your skin.
• Fish oil: Omega-3 fatty acids are found in fish oil supplements. They can decrease the inflammation linked with psoriasis.
• Oregon grape: Oregon grape on the topical application can decrease inflammation and relieve symptoms of psoriasis.

Lifestyle and Home Remedies

Self-help measures cannot cure psoriasis, but they can help to improve the appearance and symptoms of psoriasis. Following are the measures that can help you:

• Take daily baths: daily bathing removes scales and relieves the inflamed skin. Avoid hot water and harsh soaps that can make symptoms worse.
• Use moisturizer: Apply a heavy, ointment-based moisturizer after bathing on moist skin. You can prefer oils for very dry skin. They have more staying power as compared to lotions or creams. They are much more effective in preventing water from evaporating from the skin. During cold, dry weather you require to apply a moisturizer many times in a day.
• Expose skin to small amounts of sunlight: A controlled amount of sunlight can be helpful in improving psoriasis; however, too much exposure to the sun can stimulate or worsen the outbreaks. It may also elevate the risk of skin cancer.
• Avoid psoriasis triggers: Find the triggers that worsen your psoriasis and take certain steps to prevent them. Infections, smoking, injuries to your skin, stress and intense sun exposure can also make psoriasis worse.
• Avoid drinking alcohol: Alcohol consumption can reduce the efficiency of various psoriasis treatments.

Coping with psoriasis can be a challenging particularly in cases when the disease covers large areas of the body or is in the area which is easily seen by other people, as hands or face. Following are some ways to cope up with psoriasis:

• Get educated: Gather as much as you can know about the disease. Know about the potential triggers of the disease, so that you can avoid flare-ups. Educate your family and friends so that they can be able to recognize and support you in dealing with the condition.
• Follow recommendations of doctor: In case your doctor recommends some treatments and lifestyle measure then follow them.
• Find a support group: Join a support group. It will help you to find comfort in sharing your experience and meeting people who suffer the same condition.
• Use cover-ups if you need: When you feel self-conscious, cover your affected area with clothing or with the help of cosmetic.