Psoriasis

Psoriasis facts

• Psoriasis is a chronic inflammatory skin disease.
• Psoriasis has no known cause.
• The tendency toward developing psoriasis is inherited in genes.
• Psoriasis is not contagious.
• Psoriasis gets better and worse spontaneously and can have periodic remissions (clear skin).
• Psoriasis is controllable with medication.
• Psoriasis is currently not curable.
• There are many promising therapies, including newer biologic drugs.
• Future research for psoriasis is promising.

What is psoriasis?
Psoriasis is a noncontagious skin condition that produces red, dry plaques of thickened skin. The dry flakes and skin scales are thought to result from the rapid proliferation of skin cells that is triggered by abnormal lymphocytes from the blood . Psoriasis commonly affects the skin of the elbows, knees, and scalp.

Some people have such mild psoriasis (small, faint dry skin patches) that they may not even suspect that they have a medical skin condition. Others have very severe psoriasis where virtually their entire body is fully covered with thick, red, scaly skin.

Psoriasis is considered a non-curable, long-term (chronic) skin condition. It has a variable course, periodically improving and worsening. It is not unusual for psoriasis to spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms in the colder winter months.

Psoriasis is seen worldwide, in all races, and both sexes. Although psoriasis can be seen in people of any age, from babies to seniors, most commonly patients are first diagnosed in their early adult years.

Patients with more severe psoriasis may have social embarrassment, job stress, emotional distress, and other personal issues because of the appearance of their skin.

There are five types of psoriasis:
plaque, guttate, lnverse, pustular, and  erythrodermic. Plague psoriasis is the most common form, appears as red patches, raised or lesions covered with a silvery white buildup of dead skin cells, it is called scale. Psoriasis can occur on any part of the body and is associated with other serious health conditions, such as diabetes, heart disease and depression

Plague Psoriasis
is the typical form with scaly, red, raised patches – the plaques – which vary in size from a few millimeters to many centimeters. They tend to be symmetrical and prefer the extensor surfaces such as the backs of the elbows and the fronts of the knees. The lower back and sacral area (top of the buttocks) is another common site for large plaques. Although the plaques can be very large and widespread, they generally cover 5% or less of a person’s body surface.

Guttate Psoriasis
is also known as teardrop or raindrop psoriasis. It tends to occur in children, adolescents and younger adults., and is a generalized rash of small spots up to 1 centimetre in diameter. It tends to follow an infection, often of the throat, when it appears very suddenly a week after the infection. It is widespread but does spare the palms and soles, and clears up after several weeks or months depending on how quickly treatment is started. Up to 50% of people affected will not have a further attack, but it may become chronic or evolve into one of the other types of psoriasis.

lnverse Psoriasis
develops in the natural folds of the skin, such as the armpit, the breast folds, the pubis, the genital area, the groin, and the buttock crease. The area affected appears highly inflamed but lacks scales because of the body’s natural lubrication. It can cause troublesome nappy rash in infants but is mainly found in older people. The reason for the lack of scale is the decreased water loss from two surfaces of skin lying against each other.

Pustular Psoriasis
Can affect just the hands and feet, with round yellow pustules (raised areas of skin containing pus) appearing under the skin surface of the palms or soles, or both. They gradually turn brown as they reach the surface and are shed as scales. The pustules are sterile and not due to infection. This pattern is most often seen in middle-aged people who are smokers. Generalised pustular psoriasis, with sheets of very small pustules on a background of very red, hot skin, is a medical emergency. A person can become very ill from loss of heat, and fluid, and feel very feverish. It is sometimes triggered if large amounts of strong steroid creams have been used to treat widespread plaques or after oral steroids

Erythrodermic Psoriasis
Also is an emergency. Like many medical terms, erythroderma is from the Greek – for red or inflamed and skin. The whole of the skin turns red and leads to loss of fluid and heat, as with pustular psoriasis. There are no pustules but urgent admission to hospital is needed to replace lost fluid and to prevent hypothermia (low body temperature). The underlying psoriasis also needs to be treated once the person has been stabilized. Erythroderma can occur with other skin diseases such as eczema but is, thankfully, quite rare. It can occur slowly but, as with pustular psoriasis, often develops suddenly after incorrect use of sudden withdrawal of steroid treatment.

What causes psoriasis?
The exact cause remains unknown. There may be a combination of factors, including genetic predisposition and environmental factors. It is common for psoriasis to be found in members of the same family. The immune system is thought to play a major role. Despite research over the past 30 years looking at many triggers, the "master switch" that turns on psoriasis is still a mystery.

Is psoriasis curable?
No, psoriasis is not currently curable. However, it can go into remission and show no signs of disease. Ongoing research is actively making progress on finding better treatments and a possible cure in the future.

Is psoriasis contagious?
No. Research studies have not shown it to be contagious from person to person. You cannot catch it from anyone, and you cannot pass it to anyone else by skin-to-skin contact. You can directly touch someone with psoriasis every day and never catch the skin condition.


What is the treatment for psoriasis?
There are many effective treatment choices for psoriasis. The best treatment is individually determined by the treating physician and depends, in part, on the type of disease, the severity, and the total body area involved.

For mild disease that involves only small areas of the body (like less than 10% of the total skin surface), topical (skin applied) creams, lotions, and sprays may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriasis plaque may be helpful.

For moderate to severe disease that involves much larger areas of the body (like 20% or more of the total skin surface), topical products may not be effective or practical to apply. These cases may require ultra-violet light treatments or systemic (total body treatments such as pills or injections) medications. Internal medications usually have greater risks.

For psoriatic arthritis, systemic medications are generally required to stop the progression of permanent joint destruction. Topical therapies are not effective.

It is important to keep in mind that as with any medical condition, all medications carry possible side effects. No medication is 100% effective for everyone, and no medication is 100% safe. The decision to use any medication requires thorough consideration and discussion with your physician. The risks and potential benefit of medications have to be considered for each type of psoriasis and the individual patient. Some patients are not bothered at all by their skin symptoms and may not want any treatment. Other patients are bothered by even small patches of psoriasis and want to keep their skin clear. Everyone is different and, therefore, treatment choices also vary depending on the patient's goals and expressed wishes.

An approach to minimize the toxicity of some of these medicines has been commonly called "rotational" therapy. The idea is to change the antipsoriasis drug every six to 24 months in order to minimize the possible side effects from any one type of therapy or medication.

In another example, a patient who has been using strong topical steroids over large areas of their body for prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy like calcitriol (Vectical), light therapy, or an injectable biologic.