Psoriasis is a common chronic skin disorder that has no cure at this time, but there are many treatment options to help relieve symptoms and control this condition. All individuals with psoriasis should be treated because untreated psoriasis can affect the quality of life and lead to many complications.
What is psoriasis?
Psoriasis is a common skin condition that changes the life cycle of skin cells. Psoriasis causes cells to build up rapidly on the surface of the skin. The extra skin cells form thick, silvery scales and itchy, dry, red patches that are sometimes painful. Psoriasis can be very persistent and symptoms can become very severe at times and then disappear for some time as well. Symptoms especially on the face, hands and arms can be very embarrassing for some and can affect the quality of life for many.
Who gets psoriasis?
Anyone can develop psoriasis, but certain factors can increase your risk of developing the disease. These factors include the following:
• Family history. Perhaps the most significant risk factor for psoriasis is having a family history of the disease. Having one parent with psoriasis increases your risk of getting the disease, and having two parents with psoriasis increases your risk even more.
• Viral and bacterial infections. People with HIV are more likely to develop psoriasis than people with healthy immune systems. Children and young adults with recurring infections, particularly strep throat, also may be at increased risk.
• Stress. Because stress can impact your immune system, high stress levels may increase your risk of psoriasis.
• Obesity. Excess weight increases the risk of psoriasis.
• Smoking. Smoking tobacco not only increases your risk of psoriasis but may also increase the severity of the disease.
Types of psoriasis
There are several types of psoriasis:
• Plaque psoriasis. The most common form, plaque psoriasis causes dry, raised, red skin lesions (plaques) covered with silvery scales. The plaques itch or may be painful and can occur anywhere on your body, including your genitals and the soft tissue inside your mouth.
• Nail psoriasis. Psoriasis can affect fingernails and toenails causing pitting, abnormal nail growth and discolouration. Psoriatic nails may become loose and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.
• Scalp psoriasis. Psoriasis on the scalp appears as red, itchy areas with silvery-white scales. The red or scaly areas often extend beyond the hairline.
• Guttate psoriasis. This primarily affects young adults and cases usually triggered by a bacterial infection. It is marked by small, water-drop-shaped sores on your trunk, arms, legs and scalp. The sores are covered by a fine scale and are not as thick as typical plaques are.
• Inverse psoriasis. Mainly affecting the skin in the armpits, in the groin, under the breasts and around the genitals, inverse psoriasis causes smooth patches of red, inflamed skin. It is worsened by friction and sweating. Fungal infections may trigger this type of psoriasis.
• Pustular psoriasis. This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips. It generally develops quickly, with puss-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.
• Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic psoriasis, can cover your entire body with a red, peeling rash that can itch or burn intensely.
• Psoriatic arthritis. In addition to inflamed, scaly skin, psoriatic arthritis causes pitted, discoloured nails and the swollen, painful joints that are typical of arthritis. Symptoms range from mild to severe, and psoriatic arthritis can affect any joint. Although the disease is usually not as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity.
What causes psoriasis?
At this time, we do not what exactly causes this chronic skin disorder. Many experts in this area believe that the cause has to do with an altered immune system resulting in a problem with cells production in the body. Certain things can trigger an outbreak of symptoms. They include the following:
• Infections, such as strep throat or skin infections
• Injury to the skin, such as a cut or scrape, bug bite, or a severe sunburn
• Stress
• Cold weather
• Smoking
• Heavy alcohol intake
• Certain medications — including lithium, which is prescribed for bipolar disorder; high blood pressure medications such as beta blockers; antimalarial drugs; and iodides.
Making the diagnosis
If you have symptoms suggestive of psoriasis you should see your doctor. In most cases, diagnosis of psoriasis is fairly straightforward. An experienced and qualified doctor usually can diagnose psoriasis by taking your medical history and examining your skin, scalp and nails. In a few cases a skin biopsy might be done to make the diagnosis or to rule out other skin disorders.
How is psoriasis treated?
Psoriasis cannot be cured, so the main aim of therapy is to stop the skin cells from growing so quickly, which reduces inflammation and plaque formation and to remove scales and smooth the skin, which is particularly true of topical treatments that you apply to your skin.
Psoriasis treatments can be divided into three main types: topical treatments, light therapy and systemic medications. Your doctor and you will decide on the most appropriate form of therapy. In spite of a range of treatment options, effective treatment of psoriasis can be challenging. The disease is unpredictable, going through cycles of improvement and worsening, seemingly at random. Some forms of treatment work in one individual and does not work in others for no apparent reason.
Conclusion
Psoriasis is a common chronic skin disorder that has no cure at this time. There are many treatment options but in some cases controlling symptoms can be very difficult. Coping with psoriasis can be a challenge, especially if the disease covers large areas of your body or is in places readily seen by other people, such as your face or hands. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden. This condition is not contagious or infectious and individuals should not avoid persons with this disorder or discriminate against theme.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).