Psoriasis

Psoriasis is a chronic autoimmune condition that causes rapid buildup of skin cells, resulting in scaling on the skin's surface. Normally, skin cells grow deep in the skin and slowly rise to the surface, eventually falling off. The normal life cycle of a skin cell is one month. In people with psoriasis, this production process may occur in just a few days, causing cells to build up rapidly, forming thick, silvery scales and itchy, dry, red patches that are sometimes painful. Psoriasis is not contagious but is a lifelong condition that tends to cycle through flare-ups and periods of remission. While there is no cure, various treatments can help control symptoms.

Psoriasis

Causes

  • Immune system dysfunction - Psoriasis is an autoimmune condition where T cells (a type of white blood cell) mistakenly attack healthy skin cells, triggering increased production of new skin cells, white blood cells, and blood vessels in the skin.
  • Genetic factors - Specific genetic mutations that affect the immune system can increase susceptibility. Having one parent with psoriasis increases your risk, and having both parents with it increases it further.
  • Environmental triggers - These can initiate psoriasis in genetically predisposed individuals or cause flare-ups in those who already have the condition.
  • Infections - Strep throat and other infections can trigger the onset of certain types of psoriasis, particularly guttate psoriasis, or worsen existing symptoms.
  • Stress - Psychological stress can trigger initial flare-ups or exacerbate current symptoms through effects on the immune system.
  • Injury to the skin - Cuts, scrapes, bug bites, or severe sunburns can trigger psoriasis at the site of injury (known as the Koebner phenomenon).
  • Medications - Certain drugs, including lithium, antimalarials, beta-blockers, and NSAIDs, can trigger or worsen psoriasis symptoms.
  • Obesity - Being overweight increases the risk of developing psoriasis and may make existing psoriasis more severe due to increased inflammation.
  • Smoking - Tobacco use increases the risk and severity of psoriasis, with the risk particularly high for pustular psoriasis.
  • Alcohol consumption - Heavy drinking may trigger or worsen psoriasis and can make treatments less effective.

Signs and Symptoms

  • Red patches of skin covered with thick, silvery scales
  • Small scaling spots (commonly seen in children)
  • Dry, cracked skin that may bleed or itch
  • Itching, burning, or soreness
  • Thickened, pitted, or ridged nails
  • Swollen and stiff joints
  • Patches anywhere on the body, most commonly on the scalp, elbows, knees, and lower back
  • Severity ranging from a few spots of dandruff-like scaling to major eruptions covering large areas
  • Cycles of flare-ups lasting weeks or months, alternating with periods of remission
  • Varying symptoms depending on the type of psoriasis: plaque (most common), guttate, inverse, pustular, erythrodermic, and psoriatic arthritis

Diagnosis

Physical Examination

Your dermatologist will examine your skin, scalp, and nails for characteristic signs of psoriasis, including red patches with silvery scales, nail pitting, and specific distribution patterns on the body. They'll also ask about your medical history and any family history of psoriasis.

Skin Biopsy

In some cases, a small sample of skin may be removed (biopsied) and examined under a microscope to determine the exact type of psoriasis and to rule out other skin disorders. The microscopic appearance of psoriatic skin is quite distinctive, showing thickened skin, inflammation, and abnormal cell maturation.

Medical History Assessment

Your doctor will ask about symptom onset, pattern of flare-ups, family history, recent illnesses or infections, medications, and potential triggers like stress or skin injuries to help confirm the diagnosis and identify potential triggers.

Joint Evaluation

If you have joint pain, your doctor may examine your joints for signs of psoriatic arthritis, which affects up to 30% of people with psoriasis. X-rays or other imaging may be ordered to check for joint damage.

Differential Diagnosis

Your doctor will rule out other conditions that may look similar to psoriasis, such as eczema, seborrheic dermatitis, lichen planus, and certain fungal infections, each of which requires different treatment approaches.

Treatment Options

Topical Treatments

Applied directly to the skin, these are typically the first line of treatment. Options include corticosteroids to reduce inflammation and slow cell turnover, vitamin D analogues to slow skin cell growth, retinoids to normalize DNA activity, calcineurin inhibitors to reduce inflammation and plaque buildup, salicylic acid to promote shedding of dead skin cells, coal tar to reduce scaling, itching, and inflammation, and moisturizers to reduce dryness and scaling.

Light Therapy (Phototherapy)

This involves exposing the skin to controlled amounts of natural or artificial ultraviolet light. Options include narrowband UVB therapy, broadband UVB therapy, psoralen plus ultraviolet A (PUVA), and excimer laser. Light therapy can be administered alone or in combination with medications. Regular treatments are necessary for optimal results.

Systemic Medications

For moderate to severe psoriasis or psoriasis that doesn't respond to other treatments, oral or injected medications that work throughout the body may be prescribed. These include retinoids, methotrexate, cyclosporine, and other immunosuppressants. These medications can have significant side effects and require careful monitoring.

Biologics

These newer drugs target specific parts of the immune system that trigger psoriasis. They include TNF-alpha inhibitors (adalimumab, etanercept, infliximab), interleukin 12/23 inhibitors (ustekinumab), interleukin 17 inhibitors (secukinumab, ixekizumab), and interleukin 23 inhibitors (guselkumab, risankizumab). Typically administered by injection or infusion, these can be highly effective for moderate to severe cases.

Home Remedies

Daily Bathing

Taking daily baths with lukewarm water and mild soaps can help remove scales and calm inflamed skin. Adding bath oil, colloidal oatmeal, Epsom salts, or Dead Sea salts to the water can enhance the effect. Limit bathing time to 15 minutes and pat skin dry gently rather than rubbing.

Moisturizing

Apply a heavy, ointment-based moisturizer while your skin is still damp after bathing to lock in moisture. Reapply moisturizers throughout the day, focusing on thick, fragrance-free products. For very dry skin, oils can be more effective than creams or lotions.

Diet Modifications

Some people find that eliminating certain foods helps reduce inflammation and flare-ups. Consider an anti-inflammatory diet rich in fruits, vegetables, whole grains, fatty fish, and plant-based proteins. Omega-3 fatty acids, found in fish oil supplements, may also help reduce inflammation.

Stress Management

Since stress can trigger or worsen psoriasis flares, practicing stress-reduction techniques like meditation, yoga, deep breathing exercises, or guided imagery may help manage symptoms. Regular physical activity and adequate sleep also help reduce stress levels.

Aloe Vera

Applied topically, pure aloe vera gel may reduce redness, scaling, itching, and inflammation. Use it up to three times daily on affected areas. Choose a product with a high concentration of aloe vera and minimal added ingredients that could irritate the skin.

Preventive Care

  • Identify and avoid personal triggers that worsen your psoriasis, such as stress, specific foods, alcohol, or tobacco.
  • Moisturize daily to prevent dry skin that can worsen psoriasis symptoms and trigger flare-ups.
  • Take care of your skin by avoiding injuries, sunburns, and harsh products that can trigger the Koebner phenomenon.
  • Use a humidifier in dry or cold weather to add moisture to the air and prevent skin dryness.
  • Manage stress through regular exercise, adequate sleep, and relaxation techniques like meditation or deep breathing.
  • Follow a healthy lifestyle with a balanced diet, regular exercise, and limited alcohol consumption.
  • Get some natural sunlight, as moderate sun exposure can improve psoriasis (but avoid sunburn).
  • Take medications as prescribed and attend regular follow-up appointments with your dermatologist.
  • Join a support group or connect with others who have psoriasis to share coping strategies and emotional support.
  • Stay up to date on vaccinations, as certain infections can trigger psoriasis flares.
  • Consider genetic counseling if planning a family, as psoriasis has a hereditary component.

Surgical Options

No Surgical Options

Psoriasis is primarily managed with non-surgical approaches including topical treatments, light therapy, and oral or injectable medications. While there are no surgical treatments specifically for psoriasis itself, related conditions might occasionally require procedural intervention.

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Excimer Laser Treatment

While not traditional surgery, excimer laser treatment is a procedural approach that delivers a controlled beam of ultraviolet light directly to psoriasis plaques, sparing surrounding healthy skin. This targeted therapy can be effective for stubborn, localized patches of psoriasis that haven't responded to other treatments.

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Joint Surgery for Psoriatic Arthritis

In severe cases of psoriatic arthritis where joint damage has occurred, orthopedic surgical procedures might be necessary to repair or replace damaged joints. This is not a treatment for the skin symptoms of psoriasis but addresses the joint complications that can accompany the disease.

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