Psoriasis
Health Education

Psoriasis

Authored by DesiMD Doctor on 20 Mar 2013 - 16:21.

Psoriasis

Psoriasis is a chronic inflammatory dermatological disorder. It presents itself with the development of red scaly patches which are either localized or spread all over the body.

Psoriasis is one of the most commonly seen dermatological disorders. It affects between 0,5 % and 3% of the population. Both males and females suffer from it and it can start at any age, usually between 15 and 30 years old. Psoriasis is not a common disease in children under 10 years old.

Psoriasis is associated with genetic predisposition. People having certain genes are at a greater risk of developing psoriasis. Someone having close relatives such as parents or siblings suffering from psoriasis is more likely to develop it. However, genetic predisposition is usually not enough and the disease is often triggered by certain environmental factors. The most common of them are psychological stress, injury of the skin, medications or infection. Certain medications are believed to be able to trigger the development of psoriasis. Some of these medicines are tetracycline antibiotics, synthetic anti-malaria drugs, beta-blockers (drugs used to control high blood pressure), lithium and gold salts. Hormones also play a major role and very often psoriasis can start during puberty or pregnancy.

Psoriasis usually presents with well-demarked raised red patches covered with white scales. The plaques are usually symmetric and vary greatly in size. They can be as small as little dots or cover the whole body. If the scales are removed, the surface of the plaques starts bleeding. The most commonly affected areas are scalp, knees and elbows. However, plaques are often seen on the whole body and especially the sacral region. Nail changes are also common and usually include discoloration, oil spotting, white or yellowish stains and nail pitting. Itching is very common. Sometimes little vesicles filled with pus can appear. Rarely the whole skin may be affected and patients may have fever. This condition is known as erythroderma.

Psoriasis is usually characterized with periods of exacerbations and remissions during which no symptoms may be present. Its gravity also varies in a great extent. Some patients present themselves with minor lesions that almost do not interfere with the quality of their lives. Unfortunately, others are severely affected. 10 to 25% of the patients may develop psoriatic arthritis which manifests itself with joint pains varying from very mild to severe. This type of arthritis is more common among middle-aged and elderly men.

People having psoriasis suffer more often from heart diseases, high blood pressure, metabolic disorders, diabetes and increased level of cholesterol. So they should be regularly scanned for these diseases.

A variety of anti-psoriasis treatments is available. The important thing is that they do not cure psoriasis but manage it. Exacerbations are still possible and continuous special skin care is needed. Patient should also be educated to avoid the factors that trigger and exacerbate the course of psoriasis.

Generally, the treatment is local or systematic. Mild forms of psoriasis are effectively managed only with topical agents. Moisturizers and mild cleansers designed especially for psoriatic patients should be constantly used in order to soothe the skin, prevent drying and alleviate the itching. Usually local corticosteroids are avoided and their use is limited to the face area and the treatment of more severe cases. Depending on the severity of psoriasis, its type and the overall health status of the patient, a dermatologist may prescribe different creams containing dithranol, salicylic acid, vitamin D analogs, coal tar and others. The so called calcineurin inhibitors like Tacrolimus are also gaining popularity in the treatment of psoriasis. Most of the patients can be treated only with local therapy and are able to achieve remissions in this way.

Another popular and commonly used treatment method is phototherapy. Special lamps that produce UVA rays are used. Often the treatment is combined with the use of medicines called psoralens. They increase the sensitivity of skin towards UVA light. Moderate sun exposure and sunbathing also has proved to be effective in the management of psoriasis.

In some cases local treatment is not effective. Systemic treatment usually includes the administration of cytostatic medicines.  Some of the most commonly used are methotrexate, cyclosporine A and retinoids. These drugs are usually very effective but are unfortunately connected with serious side effects.

A new trend in the treatment of psoriasis is the use of biologic agents. They act at molecular level and block specific stages of the pathogenesis of psoriasis. The effect of these medicines is comparable to that of methotrexate and they are not toxic for liver. However, they still pose a risk of suppression of the immune system and their long-term effects are still not evaluated. So their use is reserved for patients with severe psoriasis who do not respond to the treatment with methotrexate or it is contraindicated for them.


 

*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.