Psoriasis is a complex, inflammatory disease which mostly affects the skin and joints. It is however not a contagious disease.

The disease affects both males and females of all age groups. Nevertheless it mostly makes its mark for the first time in young individuals between the ages of 15-20 years. It is quite unusual for the disease to manifest before the age of 5 years.

This disease is common, chronic, and costly, both in monetary terms and in quality of life. According to a study in India, 60% of the patients had the disease onset before the age of 30 years, with a positive family hi   story in almost 14% of the cases. Skin and scalp was the most commonly affected site.

How is it caused?

The pathogenesis of psoriasis is yet unknown but it is believed to be immune-mediated. Genes also play a role in its development.

The inheritance of psoriasis does not fit into the Mendelian pattern. When one parent has the disease the chances of the child to develop the disease is 15-20%; if both parents have the disease, the chances of the child getting the disease is 50 percent.

Plaque psoriasis or psoriasis vulgaris is the most common form of the disease. There are typically, red scaly patches – called psoriatic plaques that appear on the skin of affected persons. These plaques are inflammatory sites where the skin rapidly accumulates, thereby, taking on a silvery white appearance. When the scales are removed, the skin underneath is tender and tends to bleed and results in the inflamed patches.

In the case of a normal skin, the production and proliferation of the epidermal layer of the skin takes about 28 days to complete, while in the case of psoriasis, it is restricted to just 4 days. This results in the pile up of immature skin cells – a special feature characteristic to psoriatic lesion.

The severity with which psoriasis occurs varies. The plaques may occur as local patches or they may be distributed all over the body. They frequently affect the skin covering the elbows and knees but may also occur on the scalp, finger or toenails or on the genital area. In some cases, it may cause psoriatic arthritis or inflammation of the joints. This condition is observed in 10-15% of psoriasis patients.

The psychological impact of the disease is inevitable because of the unattractive skin manifestations. Most often the patients are depressed and suffer from very low self-esteem. As such, their lifestyle becomes compromised.

Management

Psoriasis treatment continues to be a challenge due to the recurrent nature of the disease. There is no cure for the disease.

Disease management will be dependent on its severity, its impact on the patient and also on the patient’s lifestyle. Those involved in the care of psoriatic patients must be skilled in the art of disease management and must also be capable of motivating the patient. Although varied treatments options are available, the treatments that work well may vary from person to person.

Treating doctor would test the nature of your skin and decide on the best treatment approach for you. I is important to discuss the treatment plan with your doctor. The most common methods would be the usage of topical applicants. These ointments can be a combination of salicylic acid, coal tar, anthralin, etc.

Light therapy can also work against the exploit of the skin cells. These treatments use natural or artificial UV light over the skin to control the cell expansion which occurs. Treating doctor can guide you on the type of light to use and the amount of exposure you would require.

In some cases, you might be undertaking oral medications or injected medications to prevent the flare up. It should be noted that not all these drugs work on everyone. Hence care should be taken to first identify the skin type you have and your health condition before getting these drugs. You can discuss and consult with your doctor about these medications in detail.

-Dr.Bhavani Sagar Surampally

REFERENCES:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550454/

https://www.nejm.org/medical-research/psoriasis

https://www.mdedge.com/cutis/psoriasis/latest

 

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