Psoriasis

Psoriasis is a common, chronic skin disorder that affects between 2-3% of the population. In psoriasis, T-cells (white blood cells that regulate the body’s immune system) become over-activated, which triggers an inflammatory response that leads to the accelerated production of skin cells. Normally, the time between the production and shedding of skin cells is about 28 days, however, in psoriasis, the process accelerates and results in poorly formed outer cells that do not shed properly. Instead, the accumulated dead skin cells pile up and produce scales. Although the exact cause is unknown, current evidence suggests that autoimmunity and genetics are contributing factors. Individuals with moderate-to-severe psoriasis may be impacted by symptoms of the skin disorder as well as quality of life. Frequently, joint involvement develops years later and this associated disabling condition is known as psoriatic arthritis. Medical intervention under the supervision of a qualified physician can slow or prevent disease progression and improve the quality of life.

Common features of psoriasis include:

Plaque Psoriasis (also known as psoriasis vulgaris) is the most common type and is characterized by well-defined red patches with dry, silvery scales on the scalp, elbows, knees, lower back and around the belly-button. The face is not usually involved.

Inverse Psoriasis (also known as flexural psoriasis) occurs in the creases and folds of the skin, such as the armpits, groin and under the breasts. The lesions are characterized by smooth, well defined red patches, but scaling is generally minimal or absent. Inverse psoriasis is commonly seen in people who are overweight, as the condition is aggravated by the friction of rubbing skin and trapped perspiration in skin fold areas.

Guttate Psoriasis Usually occurs as a shower of small spots usually after a strep infection.

Psoriatic Arthritis: 30% of people who have psoriasis will experience psoriatic arthritis. It’s important to note that severe Psoriasis may increase the risk of cardiovascular disease.

 

Although the exact cause of psoriasis remains a mystery, factors such as stress, smoking and cold weather can contribute to the frequency of flare-ups.

Choosing skin care products carefully. For example, avoid soaps, especially bar soaps, as they will dry your skin and may damage the skin barrier. Instead, opt for mild soap-free cleansers, preferably in liquid form. These cleansers will gently remove dirt, excess oil, bacteria and cosmetics without damaging the skin barrier. Hot water can actually dry out the skin further, so choose cool water when cleansing. Look for moisturizers specially designed for sensitive skin that are free of fragrance, dye or other allergens that may irritate the skin. Frequent application of moisturizer can help soothe dry and itchy spots.If you are experiencing severe itching, do not scratch the affected area as it can lead to scarring, increased pigmentation (darkening of the skin), thickening of the skin, or infection. Instead, gently pat the skin, or apply a damp compress for relief.

Although there is no sure-fire method to prevent psoriasis, you can reduce the chances of a flare-up by avoiding factors such as stress, smoking and extreme weather.

OTC
Psoriasis can be treated at home with over-the-counter products such as moisturizers, which can help control scaling and dryness and may relieve itching. Apply a moisturizer immediately after bathing and at other times during the day to help maintain skin hydration levels. Moisturizer should be applied in the direction of the hairs to minimize the risk of pimple-like eruptions. Salicylic acid helps to remove or reduce the thickness of psoriatic scales. Salicylic acid may be combined with tar. Topical hydrocortisone creams are effective at reducing the body’s inflammatory and immune reactions.

Prescription
A doctor may prescribe Anthralin, which is effective at slowing down the growth of skin cells and has anti-inflammatory properties. Topical steroids (corticosteroids or glucocorticoids) are the most commonly prescribed psoriasis medications, available as creams, ointments, gels, lotions, oils, solutions, sprays and shampoos. They can be used anywhere on the body and work within 1-2 weeks. However, with long-term use, steroids often lose their effectiveness and can cause systemic adverse effects, as well as irreversible skin changes. Topical vitamin D is useful is often used in combination with topical corticosteroids. Tazarotene (Tazorac®) is a retinoid that is related to vitamin A, and is believed to normalize cell differentiation, suppress the growth of skin cells and inhibit inflammatory responses. However, it can be irritating so is best used on the scalp and hands. A doctor may also prescribe oral treatments such as Acitretin (Soriatane®), Cyclosporine (Neoral®) and Methotrexate.

Biologicals
There are now a new generation of drugs called “biologicals” that have been developed for arthritis and psoriasis which are very effective. They include the TNF blockers which are entaneracrpt, adalumimab and infliximab as well as blockers of IL12/23 called ustekinumab. These are injectable drugs that have provided a huge step forward in the therapy of moderate to severe proriasis.