A colleague, who is usually seen in casual wear, had been wearing full sleeves shirts for a month. Surprised, his friends asked him if he has changed his workplace attire. The answer was very much unexpected…he had a reddish patch on his elbows; the full sleeves shirt was meant to hide it. The physician said it was psoriasis, a skin disease.
What is psoriasis?
Psoriasis is a non-contagious, persistent autoimmune (overactive immune response attacking body’s own cells and tissues) disease. Psoriasis is manifested on the skin as thick, pink to red patches causing the skin to slit, rupture, itch, bleed, flake and to appear as silvery white scales.
Causes of Psoriasis
Usually the skin cells in the deeper layer grow and replace the surface cells. This process usually takes a month. But in psoriasis, this happens more rapidly. When the white blood cells (T-Cells) of the immune system mistake the skin cells for a foreign body, and launch attack, it results in psoriasis. It is not known why the immune system attacks the skin cells. There may be periods of absence of psoriasis or periods of remission during which no symptoms of psoriasis are exhibited.
The exact cause of psoriasis is not known. But some of the following that cause psoriasis include the following. Most of these trigger psoriasis as they may weaken or affect immune system or may expose to the factors that trigger psoriasis.
- Streptococcal infections such as strep-throat or common cold
- Diseases that weaken immune system like HIV/AIDS
- Stress
- Medications such as beta-blockers (medicines that reduce stress hormones) and anti-malarial drugs such as chloroquine, amodiaquine or primaquine).
- Injury or irritation to the skin such as burns, cuts or surgery
- Less sun light and less exposure to UVB rays increases risk of flare up of psoriasis. In addition, cold weather is dry and central heating can deprive the skin of moisture, increasing the risk of psoriasis
- Tobacco Smoking
Identifying Psoriasis
Though it is possible for psoriasis to appear anywhere on the body including scalp, palms, soles and the skin on the joints, psoriasis often affects the skin on the knees and elbows.
Psoriasis begins as small red elevations or swellings or bumps. These red bumps enlarge in size and form scales (surface scales) on the top, which are shed easily. But scales below them stick together and cannot be shed easily. When these bumps are scratched, the lower scales are also scratched away from the skin, making the skin split open and crack, causing bleeding. As the rash progresses, large lesions can form. The dried silvery white scales on top of these lesions are sometimes called plaques or flakes. The rash can produce severe itching, dry and scratching skin, swelling, pain, uneven, cracked, or flaky loose nails.
There are other less common forms of psoriasis. Inverse psoriasis manifests under the arm pits, beneath breasts and around the groin, buttocks and genitals. Another form called Guttae psoriasis involves small, red and flaky spots in children and young adults that appear after strep throat infections. Pustular psoriasis is characterized by pus filled red bumps on the patches or flakes.
Treating Psoriasis
Though Psoriasis is incurable, most of the symptoms can be treated with proper medications. These treatments are aimed to reduce new formation of scales, relieve itching and decrease inflammation. Your doctor may recommend various treatments depending on your sex, age, severity and other health conditions.
Common recommended medications include:
- Steroid creams to reduce the inflammation
- Moisturizers to keep the skin moist and relieve dry skin
- Coal-tar in lotions, shampoos and bathing soaps mainly for scalp psoriasis to relieve itching, swelling and flaking
- Topical vitamin D3 ointment for reducing the inflammation associated with psoriasis.
Severe cases of psoriasis need treatment approaches other than medications.
- Long wave ultraviolet radiation (UVA): Ultraviolet light at specific wavelengths decreases the inflammation of the skin and reduces the development of skin cells
- Photochemotherapy (PUVA): It is the treatment that combines a medicine called “psoralen” with exposure to a special form of ultraviolet light. PUVA treatment is generally administered to older psoriasis patients or patients with severe psoriasis or to patients who do not respond adequately to conventional treatments of psoriasis.
- Retinoid gel or pills: Given together with UVA and PUVA to slow down the growth and shedding of the skin cells
- Cyclosporine: Cyclosporine suppresses the immune system and slows down the growth of certain immune cells responsible for psoriasis.
- Biological therapies: Newer biological drugs (drugs created in the living cells) used for treating psoriasis include Amevive, Raptiva, and Enbrel. These are given by injection. They block the body’s immune system to kick start the autoimmune disease psoriasis.
Coping with psoriasis
Psoriasis is a genetic disorder. It cannot be cured. But psoriasis can be managed and treated. Symptoms such as itching, scaling and flaking can be reduced effectively. Remissions are obtained through proper medications. It is better to discuss with your doctor regarding various treatment options and medications or their dosages available.
