Psoriasis is an autoimmune disease that has no cure. However, the disease could be managed so that lifestyle is not affected. The symptoms may vary depending on the type of psoriasis. It is usually characterised by patches of abnormal skin. The skin cells begin to multiply about ten times faster and the volume of the cells thus formed
leads to skin patches that are typically red, itchy, and scaly. The affected areas may vary in severity but they usually affect the knees,elbows, palms, feet and at times the torso. There are five main types of psoriasis: plaque, guttate, inverse, pustular, and erythrodermic. Most of the cases are of Plaque psoriasis. The typical symptoms are red patches with white scales on the top. The parts of the body generally affected are forearms, shins, and the scalp.
Guttate psoriasis is the type that has lesions while Pustular psoriasis occur as small non-infectious blisters filled with pus. Inverse psoriasis presents as red patches in skin folds. Erythrodermic psoriasis is very widespread, and can develop from any of the other types. At some point of the time during the course of the disease, fingernails and toenails get affected. There may be discoloration of the nails or pit-like appearance on the nail surface.
Even though Psoriasis is triggered by external factors such as weather, it is suspected to have some genetic basis based on twin studies. Infections and psychological stress may also play a role. Psoriasis is not a contagious disease. The disease occurs when body’s immune system fails to recognise its own skin cells and thus reacts.
Diagnosis is only based on the signs, symptoms, and presentation of the disease.Treatment options are highly individualised depending on the needs of the patient & response to a line of therapy. Treatments cannot cure the disease completely but can only help in reducing the symptoms and keep the skin clear. It is very important to avoid sunburn which worsens the symptoms.
This is the first choice of treatment if the symptoms are mild.They work in different ways such as slowing down the growth of skin cells or reducing itchiness, scaling, redness of the skin or inflammation. These could be steroids or vitamin D3 creams. Corticosteroids are used in these topicals but the risks include thinning of the skin, secondary infections, changes in the color of the skin, abnormal hair growth, irritation or rash.
When the symptoms are moderate to severe then Phototherapy becomes the best choice. It also works best on Plaque Psoriasis. Symptoms improve with both natural sunlight and artificial ultraviolet (UV) light which penetrates the upper layer of skin. Both UVA and UVB light works well and certain creams can be used along with phototherapy to increase the skin’s light receptivity. The amount or dose of light used for therapy depends on the person’s skin color and the exposure needs to be carefully monitored to avoid blistering, erythema or even carcinogenesis where normal cells turn cancerous.
It is very common to combine two or more types of treatments to balance the risks and benefits of each form of therapy. It is most important for the healthcare provider to follow up and manage the symptoms. A step-by-step approach works best as there are many options available with the researchers testing the drugs and making them more effective.
These include drugs that suppress the immune system functions or reduce the activity of certain enzymes involved in the immune reaction. If the severity of the symptoms is high and other methods such as lotions, creams, phototherapy is inadequate to control then the choice of treatment would be using these drugs. It is of profound importance to discuss other medications including multivitamin supplements that the patient is taking so that the drugs do not interact. Pregnancy must be ruled out before such drugs are prescribed.
There may be side effects such as diarrhea, nausea, vomiting, fatigue and headaches to lowering the level of white blood cells that can decrease the ability to fight infection depending on the drugs prescribed.
- Biologics: Biologics are drugs that are administered by injection. They react by blocking the action of different proteins in the immune system that cause the inflammation.The risks are susceptibility to serious bacterial, viral & fungal infections. As proteins are targeted, myelin sheath surrounding the nerve fibres could be damaged leading to neurological problems. Blood, liver issues, or malignancies such as lymphomas could develop.It cannot be a choice of treatment if there is an active or serious infection in the patient. Mild or moderate side effects such as injection site reactions, upper respiratory tract infections, headaches, rashes, or difficulty breathing or swallowing.
About 2-4% of the population is affected by the disease. Men and women are equally affected. Usually the onset of the disease occurs in adulthood.Psoriasis is associated with an increased risk of psoriatic arthritis, lymphomas, cardiovascular disease, Crohn’s disease, and depression.About 30% of population that is affected with psoriasis develop Psoriatic arthritis. There is a hope to predict which medication is more suitable to an individual through genetic studies. Prognosis of the disease can be improved with such targeted treatment with greater efficiency and fewer side effects.