Psoriasis is a common non-communicable skin disease caused by the rapid reproduction of skin cells leading to a red, dry spot on thinned skin. Dry flakes and flakes that appear on the skin are the result of the rapid production of skin cells. Psoriasis usually affects the skin of the elbows, knees, scalp and ears.
Some people have very little involvement with small red spots on their elbows, knees, or scalp and are not even aware that they are sick because the symptoms are so mild. Others have a very serious illness where the whole body is completely covered with psoriasis.
Psoriasis is a long-term (chronic) skin disease, it has a variable course with periodic improvements and exacerbations. Sometimes it can rest for years and remain in remission. In most patients, the symptoms worsen in the cold winter months. On the contrary, most patients report improvement in warmer months, warmer climates, or with increased sun exposure.
Psoriasis is a disease seen worldwide in all races and both sexes. Although psoriasis can be seen in people of all ages from children to adults it is most commonly diagnosed in younger people.
Patients with psoriasis can be socially vulnerable, may experience emotional stress and have other problems due to the appearance of their skin.
What causes psoriasis?
The real reasons are unknown for now. They can be a combination of factors that include genetic predisposition and environmental factors. The immune system is thought to play an important role in the development of psoriasis. Despite research over the past 30 years, many triggers (triggers) that can trigger psoriasis seem to be still a mystery.
What does psoriasis look like? What are the symptoms?
Characteristics of psoriasis are typical red or pink areas of thinned, raised and dry skin. It mainly affects the area above the elbows, knees and scalp. Essentially any body surface can be involved especially in the area of trauma, rubbing or abrasion.
Psoriasis comes in a lot of different forms such as a small flattened swelling, a large thin plaque of raised skin, a red spot or pink colored dry skin with large flakes of dry skin falling off.
There are several different types of psoriasis including vulgar psoriasis (common type), gutta-percha psoriasis (small, spot-like drops), inverse psoriasis (in folds such as lower limbs, navel and thighs), and pustular psoriasis (fluid-filled yellow small blisters).
Sometimes removing these small dry white flakes of skin causes tiny blood spots on the skin.
Genital lesions especially on the glans penis are common. Psoriasis in moist areas like the navel or the area between the thighs (intergluteal fold) can look like a flat red spot. This atypical appearance may be confused with other skin conditions such as fungal yeast infections, skin irritations, or bacterial staphylococcal infections.
On the nails, psoriasis can look like very small indentations (pinpoint depression or white depression on the nails) or as long yellow-brown separations on the nail bed called “oil stains”. Nail psoriasis can be mistaken for an incorrect diagnosis such as a fungal infection.
On the scalp it can look like numerous dandruff with dry scalp and red areas of skin. It is sometimes difficult to distinguish it from seborrhea of the scalp. However, the treatment is often very similar for both diseases.
Can psoriasis affect my joints?
Yes, psoriasis is associated with joint problems in about 10% – 35% of patients. In fact, sometimes joint pain can be the only sign of damage, even though the skin is completely clean. A joint disease associated with psoriasis has been identified as psoriatic arthritis. Patients may have arthritis, although the joints of the hand, knee, and ankle may be the most commonly affected.
The average age for the onset of psoriatic arthritis is 30-40 years. In most cases, skin symptoms appear before the onset of arthritis.
The diagnosis of psoriatic arthritis is made with a medical examination, medical history and a specific family history. Sometimes laboratory tests and X-rays can be used to identify several diseases and to rule out other diagnoses such as rheumatoid arthritis or osteoarthritis.
Can psoriasis only affect my nails?
Yes, psoriasis can only affect the nails in a certain number of patients. Usually the symptoms on the nail go together with the skin and the symptoms of arthritis. Nails can have small pointed depressions or large yellow separations of the nail plate called “oil stains”. Nail psoriasis is very difficult to treat. Treatment options are sometimes limited and include potent topical steroids applied to the nail base called the cuticle, injections or steroids to the nail base of the cuticle, and oral or systemic medications (described below) to treat psoriasis.
Is psoriasis curable?
No, psoriasis is not currently curable however, it can go into remission and show no signs of disease. In the course of research, progress needs to be made towards seeking better treatment in the future.
Is psoriasis contagious?
No, research studies do not show that it is transmissible from person to person. You cannot get it or pass it on to people who come in contact with your skin. You can directly touch psoriasis sufferers every day and never get skin disease.
Can I pass the disease on to my children?
Yes it is possible. Although psoriasis is not transmitted from person to person, the genetic predisposition to transmission is known and can be transmitted from parents to their children. It occurs in some families and a family history is a great help in making a diagnosis.
What type of doctor treats psoriasis?
A large number of physicians can treat psoriasis, including dermatologists, family physicians, internists, rheumatologists, physiatrists, and other physicians. Some patients turn to other health professionals such as acupuncturists, holistic practitioners, chiropractors, and nutritionists. Dermatologists specialize in diagnosing and treating psoriasis while rheumatologists specialize in treating joint disease and psoriatic arthritis.
How is psoriasis treated?
There are many effective treatment choices for psoriasis and it depends on whether the disease is localized and affects only parts of the body or affects the whole body.
For a milder form of the disease that affects only small areas of the body (less than 10% of the skin surface), topical agents are applied to the skin. Such are creams, lotions and sprays that are very effective and safe to use. Occasionally small local injections of steroids directly into the focus or resistant isolated psoriatic plaque may be helpful.
To treat a generalized disease that affects many large areas of the body (20% or more of the total skin surface) topical medications may not be effective and practical to apply. In this case, tablets, light therapy or injections are used.
For psoriatic arthritis, systemic medications are necessary because topical therapy is not effective.
Some patients do not bother with all their skin symptoms, while on the contrary, some are burdened with small plaques of psoriasis and want to keep the skin clean. Patients are different and therefore the chances of treatment also vary depending on the patient’s goals and expressed desires.
What creams or lotions are available?
Topical (skin-applied) drugs include topical corticosteroids, vitramine D analog creams (Dovonex), topical retinoids (Tazorac), moisturizing topical immunomodulators (tacrolimus and pimecrolimus), carbon tar, anthralin, and more.
Topical corticosteroids (steroids such as hydrocortisone) are very useful and often the first line of treatment for limited or small area psoriasis. They come in several preparations including sprays, liquid creams, gels, ointments and foams. Steroids come in a variety of strengths including strong ones used for elbows, knees and hard areas of the skin and weak ones for areas like the face of the forearm and groin.
- Strong steroid preparations may be limited in use. Excessive or prolonged use can cause a problem including permanent thinning of the skin and damage called atrophy. Also, after stopping steroid use, there is a sudden deterioration in the skin so called. rebund phenomenon.
- A vitamin D analog cream called calcipotriene (Dovonex) is also useful in psoriasis. The advantage of calcipotriene is that it is not known to thin the skin excessively like topical steroids. Particular caution with calcipotriene is that it cannot be used on more than 20% of a person’s skin. Excessive use can cause drug absorption and abnormal calcium levels.
- Keratolytics with therapeutic concentrations of salicylic acid, lactic acid, urea and glycolic acid may be useful in psoriasis. They help moisturize the skin and reduce the appearance of psoriatic scales. Some available preparations include Salex (salicylic acid), AmLactin (lactic acid) or LacHydrin (lactic acid) lotion.
- Immunomodulators (tacrolimus and pimecrolimus) can also be used in a limited type of psoriasis. Their advantage is that they do not cause thinning of the skin. They can have other potential side effects including skin infection and possible malignancy (tumor). The actual association between these immunomodulatory creams and tumors is controversial.
- Bathing salts or bathing in highly concentrated waters like the Dead Sea in the Middle East can help some psoriatic patients. A new generation of absorbent salt (available via computer) can also be helpful for many patients. Overall they are fairly safe with very few possible side effects.
- Coal tar is available in many preparations including shampoos, bath solutions and creams. Coal tar can help reduce the appearance and shrink scales in psoriasis. The stench, color, and excessively uncontrolled use with Coal Tar can make it harder to use and less desirable than other therapies. A big advantage with tar is the lack of skin thinning.
- Anthralin is available for topical use as a cream, ointment or paste. Pain, possible skin irritation and discoloration may make it less acceptable for use. Anthralin can be applied to psoriatic skin for 10-30 minutes.
- Naphthalene is available for topical use as a naphthalene bath, cream or oil. The cream and oil are available in combination with salicylic acid and contribute to the removal of scales from psoriatic plaques as well as calming inflammation and reducing plaque. Its advantage is that they do not cause thinning of the skin and there are no serious side effects.
What oral medications are available?
Oral medications include acitretin, cyclosporine, methotrexate, mycophenolate mofetil and others. Oral prednisone (a corticosteroid) is generally not used in psoriasis and can cause increased erythema and redness due to a vasomotor reaction.
- Acitretin (Soritaine) is an oral medication used for a specific type of psoriasis. It is not effective in all types of diseases. It can be used in men and women who are not pregnant and do not plan to become pregnant in at least three years. The biggest side effects include dry skin and eyes and temporarily raise the level of triglycerides and cholesterol (fat substances) in the blood. Blood tests are generally indicated before starting such therapy and periodic review of triglyceride levels. Patients should not become pregnant while taking this medication and usually for at least three years after stopping taking this medication.
- Cyclosporine is a potent immunosuppressive drug used for other medical problems including organ transplantation of patients. It can be used for serious, difficult-to-treat cases of extended psoriasis. Involvement and results can be very quick at first. Due to potential cumulative toxicity, cyclosporine could not be used for more than a year to two years for the most psoriatic patients. Major possible side effects include kidney and problems with high blood pressure.
- Methotrexate is a common drug used in rheumatology for rheumatoid arthritis and oncology for tumor treatment. For psoriasis it can be used effectively for years. It is usually given in small doses (5mg – 15mg). Blood tests are indicated before using therapy. The drug can cause liver damage or if given for a long period of time, kidney damage. Regular monthly or quarterly medical examinations and laboratory tests are required.
What injections and infusions are available?
The latest category of injectable and infusion drugs for psoriasis is called biology. All biologists modulate and sometimes inhibit (calm) the immune system. These currently available drugs include Amevive, Humira, Remicade, Enbrel, Raptiva and Ustekinumab. Some biologists are self-injecting for home use while others are intramuscular drugs or intravenous infusions for administration in medical offices.
As with other drugs, side effects are possible with all biologics. Common potential side effects include moderate local reaction (redness and increased sensitivity) and decreased immunity. This refers to frequent infections and potential malignancy in the use of biological drugs.
The association of lymphomas may be partially increased in patients taking biologics.
Biologists are expensive drugs ranging in price from a few to tens of thousands of dollars per year per person.
Currently, the four main types of biologics for psoriasis are:
- TNF-alpha blocker (tumor necrosis factor)
- drugs that block T-cell activation and T cell movement
- drugs that lower the number of activated T cells
- drugs that interfere with interleukin mechanisms
What is light therapy?
Light therapy is also called phototherapy. There are several types of traditional medical light therapy called PUVA, UVB and narrow band UVB. These artificial light sources have been used for decades and are generally available in medical practices.
Natural sunlight is also used in the treatment of psoriasis. Daily short-term controlled exposure to natural sunlight may help or clear psoriasis in some patients.
There are also multiple light sources such as lasers and photodynamic therapy (use of light-activated drugs and special light sources) that are used to treat psoriasis but they are a matter of the future.
What is PUVA therapy?
PUVA is a special treatment using photosensitized drugs and time-artificial exposure to light. The photosensitive drug in PUVA therapy is called psoralen. These treatments are usually administered in dermatological surgeries two to three times a week. A few weeks of PUVA therapy is usually required before obtaining significant results. Light exposure time is slow and gradually increases with each subsequent treatment.
Psoralen can be given orally as a pill or topically as a cream, bath or lotion. After a short incubation, the skin is exposed to special wavelengths called UVA rays. Patients using PUVA therapy are generally sensitive to the sun and must avoid sun exposure for a period of time after PUVA. PUVA treatment should be carefully monitored and dosed by a physician.
What is UVB therapy?
UVB phototherapy is an artificial light treatment using special wavelengths of light, given two to three times a week. UVB is also a component of natural sunlight. UVB dosing is time-based and exposure is quite increased by 15-60 seconds per treatment or over the week. Sometimes UVB is combined with other treatments such as tar application.
What is the long-term prognosis of psoriasis?
The overall prognosis for most patients with psoriasis is good. It is not curable, but it is controllable.
What will the future bring?
The causes of psoriasis are slowly being found and make great promises for the future. It is in the last 10 years that great progress has been made in treatment with self-injecting drugs called biologics.
Psoriasis in short
Psoriasis is a chronic inflammatory skin disease
- Psoriasis has no known cause
- The tendency to develop psoriasis is genetic inheritance
- Psoriasis is not contagious
- Psoriasis improves and worsens spontaneously and may have periodic remissions (clear skin)
- Psoriasis can be controlled with medication
- Psoriasis is not currently curable
- There are many promising therapies including some biologics
- The future of psoriasis research is promising.
Keywords: Psoriasis, Psoriatic arthritis, Nail psoriasis, topical corticosteroids, oral medications, biologists, light therapy,
Interesting facts:
Psoriasis is a common disease found to affect approximately 1% -3% of the world’s population. It currently affects 7.5 to 8.5 million people in the United States. It is seen worldwide in about 125 million people. Interestingly, African Americans have about half the rate of psoriasis than whites.
