WHAT IS PSORIASIS: SYMPTOMS, CAUSES, DIAGNOSIS, AND MORE

Psoriasis is a skin condition that creates an itchy, scaly rash on the knees, elbows, trunk, and scalp.

Psoriasis is a prevalent, chronic (ongoing) condition with no treatment. It can be uncomfortable, disrupt sleep, and make it difficult to focus. The problem tends to flare up for a few weeks or months, then subside for a time. Infections, scrapes or burns, and certain drugs are common triggers in persons who have a hereditary susceptibility to psoriasis.

There are treatments available to assist you manage your symptoms. You can also experiment with different lifestyle habits and coping skills to help you live a better life with psoriasis.

WHAT ARE THE SYMPTOMS OF PSORIASIS?

The following are common psoriasis signs and symptoms:

A patchy rash that varies greatly in appearance from person to person, ranging from dandruff-like scaling areas to massive eruptions covering most of the body.

Skin that is dry and damaged and may bleed

Itching, burning, or pain

Colorful rashes that tend to be purple with a gray scale on brown or black skin and pink or red with a silver scale on white skin.

Small scaling patches (commonly seen in children)

Cyclic rashes that appear and then disappear for a few weeks or months

There are several forms of psoriasis, each with its own set of signs and symptoms:

Plaque psoriasis: Plaque psoriasis, the most common kind of psoriasis, involves dry, itchy, raised skin patches (plaques) coated in scales. There might be a few or many. They are most commonly found on the elbows, knees, lower back, and scalp. The hue of the patches varies based on the skin tone. On dark or black skin, the afflicted skin may recover with transitory color changes (post-inflammatory hyperpigmentation).

Nail psoriasis: Psoriasis can cause pitting, irregular nail development, and discolouration of the fingernails and toes. Psoriatic nails may become loose and detached from the nail bed (onycholysis). The nail may collapse if the illness is severe.

Guttate psoriasis: Guttate psoriasis is more common in young people and children. It is typically caused by a bacterial infection, such as strep throat. Small, drop-shaped, scaling patches on the trunk, limbs, or legs indicate it.

Pustular psoriasis: A uncommon form of psoriasis known as pustular psoriasis generates clearly defined pus-filled blisters. It can appear in large patches or in little spots on the palms or soles.

Erythrodermic psoriasis: Erythrodermic psoriasis, the least frequent variety of psoriasis, can cover the entire body with a peeling rash that can itch or burn fiercely. It can be either acute or chronic (chronic).

Inverse psoriasis: The skin folds of the groin, buttocks, and breasts are the most commonly affected by inverse psoriasis. It generates smooth, inflammatory patches of skin that increase with friction and perspiration. This kind of psoriasis can be caused by fungal infections.

WHAT ARE THE CAUSES OF PSORIASIS?

Psoriasis is assumed to be an immune system disorder that causes skin cells to develop at an abnormally rapid rate. This fast turnover of cells leads in dry, scaly patches in the most common kind of psoriasis, known as plaque psoriasis.

The exact etiology of psoriasis is unknown. It's assumed to be an immune system issue in which infection-fighting cells mistakenly destroy healthy skin cells. Both genetics and environmental variables, according to researchers, have a role. The illness is not communicable.

Psoriasis triggers

Many people who are prone to psoriasis may go years without symptoms before the condition is triggered by an environmental event. The following are common psoriasis triggers:

Infections include strep throat and skin infections

Weather, particularly cold and dry conditions

Skin injury, such as a cut or scrape, an insect bite, or severe sunburn

Certain medicines, such as lithium, blood pressure meds, and antimalarial drugs

Rapid discontinuation of oral or injectable corticosteroids

Smoking and secondhand smoke exposure

Excessive alcohol consumption

WHAT ARE THE RISK FACTORS FOR PSORIASIS?

Psoriasis may affect everyone. A third of all cases begin in childhood. These variables can raise your chances of getting the disease:

Family history: The disease runs in families. Having one parent who has psoriasis raises your chances of developing the condition. Having two parents who have psoriasis raises your risk even more.

Smoking: Tobacco use not only raises the risk of psoriasis, but it may also worsen the condition.

WHAT ARE THE COMPLICATIONS OF PSORIASIS?

If you have psoriasis, you are more likely to get the following conditions:

Psoriatic arthritis is characterized by joint pain, stiffness, and edema.

Temporary changes in skin color (post-inflammatory hypopigmentation or hyperpigmentation) in areas where plaques have healed

Obesity

Diabetes type 2

Other autoimmune disorders, which includes celiac disease, sclerosis, and Crohn's disease, an inflammatory bowel disease.

Conjunctivitis, blepharitis, and uveitis, which are examples of eye ailments.

Hypertension (high blood pressure)

Cardiovascular illness

Mental health issues, like depression and low self-esteem

HOW IS PSORIASIS DIAGNOSED?

Your doctor will ask you questions about your health and inspect your skin, scalp, and nails. Your doctor may then take a tiny sample of skin (biopsy) for examination under a microscope. This aids in determining the kind of psoriasis and ruling out other conditions.

WHAT ARE THE TREATMENTS FOR PSORIASIS?

Psoriasis therapies try to slow the growth of skin cells and eliminate scales. Creams and ointments (topical treatment), light therapy (phototherapy), and oral or injectable drugs are all options.

The therapies you employ are determined by the severity of your psoriasis and how responsive it has been to previous treatment and self-care methods. Before you discover a therapy that works for you, you may need to try multiple medicines or a combination of therapies. Even after effective therapy, the condition frequently returns.

Topical therapy

Corticosteroids: These are the most often recommended medicines for the treatment of mild to moderate psoriasis. Oils, ointments, creams, lotions, gels, foams, sprays, and shampoos are all available. Mild corticosteroid ointments (hydrocortisone) are often indicated for treating sensitive regions such as the face or skin folds, as well as addressing extensive patches. During flares, topical corticosteroids may be administered once daily, and on alternate days or weekends during remission.

For smaller, less-sensitive, or more difficult-to-treat regions, your doctor may prescribe a stronger corticosteroid cream or ointment, such as triamcinolone (Trianex) or clobetasol (Cormax, Temovate, and others).

Long-term or excessive usage of corticosteroids can cause skin thinning. Topical corticosteroids may lose their effectiveness over time.

Calcineurin inhibitors: Calcineurin inhibitors, such as tacrolimus (Protopic) and pimecrolimus (Elidel), minimize scaly accumulation and soothe the rash. They are particularly useful in regions of thin skin, such as around the eyes, where steroid creams or retinoids can be unpleasant or hazardous.

Calcineurin inhibitors are not advised if you are pregnant, nursing, or want to become pregnant. This medication is also not indicated for long-term usage due to an elevated risk of skin cancer and lymphoma.

Salicylic acid: Salicylic acid shampoos and scalp treatments help to minimize scalp psoriasis scaling. They come in nonprescription and prescription strengths. This sort of lotion can be used alone or in conjunction with other topical treatments since it prepares the scalp to absorb medicine more easily.

Vitamin D analogues: Skin cell proliferation is slowed by synthetic versions of vitamin D, such as calcipotriene (Dovonex, Sorilux) and calcitriol (Vectical). This medication can be used alone or in conjunction with topical corticosteroids. In sensitive locations, calcitriol may produce less discomfort. Topical corticosteroids are frequently less costly than calcipotriene and calcitriol.

Retinoids: Tazarotene (Tazorac, Avage, and others) comes as a gel or cream. It is used once or twice a day. Skin discomfort and increased sensitivity to light are the most typical adverse effects.

Tazarotene is not suggested if you are pregnant, nursing, or plan to become pregnant.

Coal tar: Scaling, irritation, and inflammation are all reduced by coal tar. It comes in both nonprescription and prescription strengths. It is available in a variety of forms, including shampoo, cream, and oil. These items may cause skin irritation. They are also unsightly, stain clothing and bedding, and have a strong stink.

Coal tar treatment is not advised if you are pregnant or nursing.

Anthralin: Anthralin is a tar cream that suppresses the proliferation of skin cells. It can help eliminate scales and smooth the skin. It should not be used on the face or genitals. Anthralin irritates the skin and stains practically everything it comes into contact with. It is normally administered for a brief period of time and then wiped away.

Light therapy

Light therapy, either alone or in conjunction with pharmaceuticals, is a first-line treatment for moderate to severe psoriasis. It entails exposing the skin to varying degrees of natural or artificial light. Treatments must be repeated. Consult your doctor about if home phototherapy is a possibility for you.

Sunlight: Heliotherapy (brief daily exposure to sunshine) may help with psoriasis. Before starting a sunshine program, consult with your doctor about the healthiest approach to utilize natural light for psoriasis therapy.

Goeckerman therapy: The Goeckerman therapy is a method that combines coal tar treatment with light therapy. Because coal tar renders skin more sensitive to ultraviolet B (UVB) radiation, this method may be more successful.

Excimer laser: A powerful UVB light is used to target just the afflicted skin in this type of light treatment. Because more strong UVB radiation is utilized in excimer laser treatment, it requires fewer sessions than regular phototherapy. Inflammation and blistering are possible side effects.

UVB broadband: Single psoriasis patches, extensive psoriasis, and psoriasis that does not improve with topical therapies can all be treated with controlled doses of UVB broadband radiation from an artificial light source. Inflammation, itching, and dry skin are possible short-term adverse effects.

UVB narrowband: UVB narrowband light therapy may be more successful than UVB wideband light therapy. It has largely supplanted broadband treatment in many regions. It is often given twice or three times each week until the skin recovers, then less frequently for maintenance therapy. However, narrowband UVB phototherapy may have more severe adverse effects than UVB broadband phototherapy.

Psoralen plus ultraviolet A (PUVA): Before exposing the afflicted area to UVA rays, a light-sensitizing drug (psoralen) is taken. UVA radiation penetrates the skin deeper than UVB light, and psoralen makes the skin more sensitive to UVA exposure.

This more rigorous therapy improves skin regularly and is frequently used for more severe psoriasis. Nausea, headache, burning, and itching are possible short-term adverse effects. Dry and wrinkled skin, freckles, increased sun sensitivity, and an increased risk of skin cancer, including melanoma, are all possible long-term adverse effects.

Oral or injected medications

If you have moderate to severe psoriasis and previous therapies have failed, your doctor may prescribe oral or injectable (systemic) medications. Because of the potential for significant adverse effects, several of these medications are only administered for short periods of time and may be alternated with other therapies.

Steroids: If you have a few tiny, persistent psoriasis spots, your doctor may recommend injecting triamcinolone directly into them.

Retinoids: Acitretin and other retinoids are medications that are used to decrease the creation of skin cells. Dry skin and muscular aches are possible side effects. These medications are not advised if you are pregnant, nursing, or want to become pregnant.

Biologics: These medications, which are often provided by injection, modify the immune system in such a manner that the disease cycle is disrupted and symptoms and indications of disease improve within weeks. Several of these medications have been authorized for the treatment of moderate to severe psoriasis in patients who have not responded to first-line therapy. There are other options, including apremilast (Otezla), etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), ustekinumab (Stelara), secukinumab (Cosentyx), ixekizumab (Taltz), guselkumab (Tremfya), tildrakizumab (Cimzia). Three of them are authorized for children: etanercept, ixekizumab, and ustekinumab. These medications are costly and may or may not be covered by health insurance companies.

Biologics must be administered with caution since they have the potential to depress the immune system, increasing the risk of severe infections. Patients receiving these medicines must be tested for TB.

Methotrexate: Methotrexate (Trexall), which is usually given once a week as a single oral dosage, reduces skin cell formation and inhibits inflammation. It is not as effective as adalimumab or infliximab. It may induce stomach trouble, lack of appetite, and weariness. Long-term methotrexate users require continuous testing to evaluate their blood counts and liver function.

Methotrexate should be discontinued at least three months before attempting to conceive. Breastfeeding mothers should avoid taking this medication.

Cyclosporine: Cyclosporine (Gengraf, Neoral, Sandimmune) inhibits the immune system when used orally for severe psoriasis. Its efficacy is comparable to methotrexate, although it cannot be administered constantly for more than a year. Cyclosporine, like other immunosuppressant medicines, raises the risk of infection and other health concerns, including cancer. Long-term cyclosporine users require continuous testing to check their blood pressure and renal function.

These medications are not advised if you are pregnant, nursing, or want to become pregnant.

Other medicines: Thioguanine (Tabloid) and hydroxyurea (Droxia, Hydrea) are pharmaceuticals that can be utilized when other treatments are not an option. Consult your doctor about the potential negative effects of these medications.

Treatment considerations

You and your doctor will decide on a treatment plan based on your needs as well as the kind and severity of your psoriasis. You'll most likely begin with the gentlest therapies, such as topical creams and UV light therapy (phototherapy). If your condition does not improve, you may go to more aggressive therapies.

People with pustular or erythrodermic psoriasis typically require stronger (systemic) drugs to begin treatment.

In any case, the objective is to identify the most efficient strategy to limit cell turnover while causing the fewest negative effects.

Alternative medicine

According to certain research, alternative treatments (integrative medicine) – items and methods not included in standard medical care or created outside of traditional Western practice — alleviate psoriasis symptoms. People with psoriasis may employ alternative remedies such as specific diets, vitamins, acupuncture, and herbal items applied to the skin. None of these techniques is supported by good evidence, although they are typically safe and may help persons with mild to severe psoriasis reduce itching and scaling.

Aloe extract cream: Aloe extract cream, derived from the leaves of the aloe vera plant, may help to decrease scaling, irritation, and inflammation. To observe any change in your skin, you may need to apply the cream multiple times each day for a month or longer.

Fish oil supplements: Oral fish oil therapy combined with UVB radiation may help to lessen the severity of the rash. Scaling may be improved by applying fish oil to the afflicted area and covering it with a dressing for six hours a day for four weeks.

Oregon grape: When Oregon grape, commonly known as barberry, is applied to the skin, it has been shown to diminish the severity of psoriasis.

If you're thinking about using alternative medicine to treat your psoriasis, talk to your doctor about the benefits and drawbacks of various treatments.