Psoriasis: Symptoms, Causes, Diagnosis, Treatment, Complications, Prevention ans Prognosis

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hand with psoriasis

1Overview

The skin is the largest organ in the body, and it’s responsible for protecting the body from harmful environmental hazards. The skin may also suffer from a wide array of conditions. Psoriasis, for one, is a long-lasting and chronic skin disease that comes and goes.

It is a condition wherein the life cycle of the skin cells rapidly occurs, leading to the buildup of cells on the surface of the skin. The skin cells multiply up to 10 times faster than normal, leading to red plaques on the skin covered by white scales. Psoriasis occurs on the elbows, scalp, and knees. It may affect the soles, palms, and torso.

Psoriasis is a common and chronic skin disease with no clear cause and even cure. It has negatively impacted the lives of many people. It affects people of all ages across all countries. According to the World Health Organization (WHO), the reported prevalence of psoriasis in countries ranges from 0.09 to 11.43 percent, making it a serious worldwide problem.

About 125 million people across the globe or 2 to 3 percent of the total population has psoriasis. The prevalence of psoriasis is higher in Caucasians with 2.5 percent than in African Americans with 1.3 percent.

Different Types Of Psoriasis:

Plaque Psoriasis

Plaque psoriasis is the most common type of psoriasis. This causes raised, inflamed and red skin covered with white scales found mainly on the elbows, knees, scalp and lower back.

Pustular Psoriasis

Pustular psoriasis is characterized by the red and scaly skin on the palms of the hands and soles of the feet. There are also small pustules.

Guttate Psoriasis

This type of psoriasis starts during childhood or young adulthood. There are tiny red spots on the limbs and torso. It may be triggered by respiratory infections, stress, skin injury, use of antimalarial medications, tonsillitis, strep throat and beta-blocker drugs.

Inverse Psoriasis

This type of psoriasis appears to be bright red, smooth and shiny parts of the skin without scales. These are usually found in the groin, armpits, skin folds around the buttocks and genitals, and under the breasts.

Nail Psoriasis

Psoriasis can also affect the finger nails and the toe nails. This could cause abnormal nail growth and discoloration. In severe cases, the nails may crumble.

Erythrodermic Psoriasis

Erythrodermic psoriasis is the least common type and can cover the entire body with peeling rash. This is very painful, can itch or burn intensely.

Psoriatic Arthritis

This is a form of psoriasis that affects the joints. Psoriatic arthritis can cause swollen and painful joints.

2Symptoms

The symptoms of psoriasis depend on the type you have. However, the common signs and symptoms include:

  • Plaques of red skin, covered with loose and silvery scales
  • Itchy and painful
  • The lesions may crack and bleed
  • Small scaling spots are commonly seen in children
  • Thickened, ridged and pitted nails
  • Swollen and stiff joints

The symptoms come and go. During attacks or flares, these symptoms may appear. However, after several weeks, they can go in remission.

3Causes

The exact cause of psoriasis is still unknown. However, many studies have linked psoriasis to an immune system problem with the T cells and neutrophils, a type of white blood cells. In a normal person, the T cells defend the body against potential pathogens like bacteria and viruses. However, in an autoimmune disease, the T cells attack the healthy skin cells by mistake.

When there are overactive T cells, they can stimulate the production of healthy skin cells, increased white blood cells particularly neutrophils and T cells. They all travel to the skin causing redness and pustular lesions.

As a result, the process becomes a cycle, especially in response to stress and other infections. Recent studies have shown that some abnormality in the immune system is the cause of psoriasis. About 80 percent of people who experience flare ups report a recent emotional trauma or stress like losing a loved one, losing a job or break-ups.

4Diagnosis

In most cases, the doctor or dermatologist will conduct a physical examination and medical history. Your doctor can land on a diagnosis after taking the medical history and examining the skin, nails, and scalp.

The dermatologist may ask about the changes in your symptoms, how often do you have flare ups, stress or embarrassment caused by psoriasis, if you have joint pains and the medical conditions you have.

However, the doctor may also ask for a skin biopsy wherein a small sample of the skin will be examined under a microscope. This will identify the type of psoriasis.

Psoriasis Triggers:

  • Common infections of the skin and throat (strep infections)
  • Injury to the skin – severe sunburn or lacerations
  • Smoking
  • Stress
  • Alcohol consumption
  • Some medications like lithium, beta-blockers, antimalarial and iodides
  • Vitamin D deficiency

5Treatment

There is no cure for psoriasis but the treatment options today aim to reduce the inflammation and skin irritations. The treatments are also determined by the type and severity of the condition and the area of the skin affected. These treatment options, however, need to be prescribed by a licensed doctor or dermatologist.

Topical Treatments

These topical treatments may reduce the lesions and clear the skin. These are usually the first treatments for mild to moderate psoriasis.

Topical Corticosteroids – These are the most frequently prescribed medications for mild to moderate psoriasis. They aim to reduce inflammation and relieve itching.

Emollients – Emollients are moisturizing treatments applied to the skin. These products aim to reduce water loss and cover the skin with a protective film. They will also reduce itching and scaling.

Vitamin D analogues – These are creams commonly used along with steroid creams. They work by slowing the production of skin cells and reduce inflammation.

Coal Tar – Coal tar is derived from coal, and this product helps reduce itching, scaling and inflammation.

Calcineurin inhibitors ­– These are ointments and creams that reduce the activity of the immune system and reduce inflammation.

Salicylic acid – This skin product promotes the sloughing of dead skin cells and decreases scaling.

Dithranol – Used for over five decades to treat psoriasis, Dithranol help suppresses the production of skin cells.

Phototherapy (Light Therapy)

A phototherapy is a treatment option that uses natural and artificial light to treat psoriasis.

Systemic Treatments

Systemic treatments come in two forms – tablets or pills and injections. The common drugs used are retinoids, methotrexate, cyclosporine, biologics or those that alter the immune system and other medications.

6Complications

The skin plays an important role in the regulation of body temperature, serving as a barrier against infection and maintaining body fluids. Dehydration increased body temperature, and infection is factors that could negatively affect the kidneys and the heart.

Here are other complications associated with psoriasis:

Psoriatic arthritis

This is a complication of psoriasis wherein the joints become inflamed. In time, this could lead to joint damage and loss of function of some joints. This could take a toll on one’s life.

Obesity

People with psoriasis are at a greater risk of becoming obese. The link between obesity and psoriasis is still not clear, but the inflammation associated with obesity may play a role in psoriasis.

Eye Problems

People with psoriasis have a higher risk of developing certain eye problems like conjunctivitis, uveitis, and blepharitis, which all involves inflammation.

High Blood Pressure

Individuals with psoriasis have a greater risk of having high blood pressure.

Cancer

People with psoriasis and psoriatic arthritis have a heightened risk of developing cancers like lymphoma, lung cancer, and non-melanoma skin cancer.

Type 2 Diabetes

The risk of type 2 diabetes in people with psoriasis increases depending on the severity of the skin condition.

Cardiovascular Disease

Heart problems and other types of cardiovascular disease are twice as high for those with psoriasis. The skin condition increases the risk of stroke, high cholesterol levels, atherosclerosis and irregular heartbeat.

Celiac Disease

People with psoriasis have increased antibodies to gliadin, the protein in wheat that people with celiac disease can’t properly digest. Hence, psoriasis may increase the risk of the autoimmune disorder that damages the small intestine when the diet consists of gluten.

Kidney Disease

People with psoriasis also have a higher risk of developing kidney disease.

Depression and other emotional problems

Psoriasis can take a toll on the lives of those who have it. It has been linked to various emotional problems such as low self-esteem and depression.

7Prevent Psoriasis

There are ways to prevent psoriasis and its flare-ups:

  • Moisturize your skin
  • Take care of your skin and scalp, avoid harsh chemicals
  • Avoid dry and cold weather
  • Use a humidifier at home
  • Avoid the medications that could lead to flare-ups

8How To Live With Psoriasis?

Living with psoriasis is not easy. You need to face the discomforts every day. There are ways to cope with the illness and live a normal life.

  • Identify and avoid triggers
  • Avoid stress and find ways to deal with it
  • Manage the dry and itchy skin
  • Live a healthy life through proper diet and regular exercise
  • Take time to relax
  • Deal with depression
  • Join a psoriasis support group
  • Find a psoriasis specialist
  • Be aware of other diseases
  • Take note of possible complications