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Psoriasis

Psoriasis is a chronic inflammatory skin disease characterized by itchy or sore patches of thick, red skin with silvery scales. It is not contagious and can occur in people of any age. It may begin in late childhood or young adulthood and usually continues throughout life.

Types of psoriasis

Psoriasis appears in different forms with distinct features.

Plaque psoriasis - It is the most common form of psoriasis and typically seen on the elbows, knees, scalp, and lower back. Lesions appear red, inflamed and covered by a silvery white scale.

Guttate Psoriasis - It appears as small red scaly dots and is more prevalent in children and young adults. These lesions appear on the trunk and limbs.

Inverse psoriasis - It is characterized by bright red lesions that are smooth and shiny. It is found in the groin, armpits and deep skin fold.

Pustular psoriasis - It is characterized by small inflamed elevated areas filled with pus and is commonly seen on the palms of the hands, feet, fingers and nails.

Erythrodermic psoriasis - It can affect most of the body’s surface; characterized by widespread and fiery redness of the skin with scaly patches.

Psoriasis arthritis - It is an inflammatory condition where joint pain, stiffness, and swelling is associated with psoriasis.

Causes

Immune system plays a major role in the development of psoriasis. It begins with T-cells (type of white blood cells), which protect the body against infections and diseases. In patients with psoriasis, T cells will be more active leading to a cascade of events that finally result in inflammation and fast turnover of skin cells. The normal turnover time for skin cells is 28-30 days; however in patients with psoriasis the turnover time will be 3-4 days. These layers of cells pile up on the skin forming psoriatic lesions. There may be a combination of other factors including autoimmune disorder, hereditary factors, trauma to skin and emotional stress. It tends to occur more commonly in areas where trauma has occurred.

Clinical features

Psoriasis occurs on the elbows, knees, scalp, lower back, palms and soles of the feet. It may also affect the fingernails and the soft tissues inside the mouth. The most typical areas affected are the knees and elbows. Men and women are equally affected. The entire skin becomes red, inflamed and scaly with silvery patches.

Treatment

Psoriasis is diagnosed by physical examination and your doctor may order a skin biopsy to exclude other conditions resembling psoriasis as well as to identify the type of psoriasis. In this process, a small sample of skin is taken from the affected area and examined under the microscope.

Psoriasis can usually be controlled, but not cured. The treatment options include the following:

Topical therapy - Two main ingredients salicylic acid and coal tar are used for the treatment of psoriasis. The topical non steroidal medications used in management of psoriasis include calcipotriene, calcipotriene and betamethasone dipropionate, tazarotene, calcitriol, and anthralin. Topical medications routinely used are corticosteroids, vitamin D3 and retinoid. These topical medications control inflammation and provide relief from the symptoms of psoriasis. Cream, lotions and sprays may be effective and safe to use. Topical therapy is used in the treatment of mild to moderate psoriasis. Tar is another topical medicine used to treat psoriasis. Tars are used in shampoos for scalp psoriasis and tar oil can be added to a bath for soaking the whole skin area. Tar preparations applied directly to the infected area at bedtime is most effective.

Phototherapy - As the name implies it uses ultraviolet light to treat psoriasis. It slows the production of skin cells and reduces inflammation. It can be used alone or in combination with topical steroids. Light therapy is indicated in moderate to severe case of psoriasis.

Systemic therapy - It is recommended when both topical and light therapies fail. This therapy is indicated in moderate, severe or disabling psoriasis. Common systemic medications used are cyclosporine, methotrexate, and actretin.

Combination therapy - In certain cases, dermatologists may recommend a combination of topical, light, and systemic therapies which may yield better results.

Biologics - Biologics are also known as disease modifying agents. These drugs are a relatively new class of drugs used in the management of psoriasis. Biologics are derived from human or animal protein. They are designed to work by targeting specific parts of the immune system resulting in reduction of skin inflammation. Biologics are administered either directly into the skin (subcutaneously), into the muscle (intramuscular), or by intravenous infusion (IV). Biologics approved for psoriasis include etanercept, adalimumab, alefacept, efalizumab, and ustekinumab.

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