Psoriasis is a noncontagious, chronic skin condition that produces plaques of thickened, scaling skin. The dry flakes of skin scales result from the excessively rapid proliferation of skin cells. It typically affects the outside of the elbows, knees or scalp, though it can appear in any location. Some people report that it is itchy, burns and stings. Scales typically develop on joints, such elbows, and knees. They may develop anywhere on the body, including the: hands, feet, neck, scalp, and face. Less common types of it affect the nails, the mouth, and the area around genitals.
Pathophysiology of Psoriasis
Psoriatic skin lesions are the result of inflammation of the dermis and hyperproliferation with abnormal differentiation of the epidermis. The primary pathologic process is most likely dysregulation of activated T cell interactions with antigen-presenting cells and overproduction of pro-inflammatory cytokines such as interferon-α and tumor necrosis factor-α (TNF-α ).
Evidence for this theory derives from the dramatic improvement of severe psoriasis in patients treated with immunosuppressive therapies such as cyclosporine (a potent T cell inhibitor used to prevent transplant rejection) or with TNF-α inhibitors (used in other inflammatory diseases such as inflammatory bowel disease, rheumatoid arthritis, and ankylosing spondylitis).
Recently, additional cytokine mediators, IL-12 and IL-23, have been linked to psoriasis as they promote differentiation of naïve CD4+ lymphocytes into Th1 and Th17 cells respectively.
Types of psoriasis
Plaque psoriasis: It appears as raised, inflamed, red lesions, covered by a silvery, white scales, usually on the elbows, knees, scalp, and lower back.
Inverse psoriasis: Inverse psoriasis appears in the armpits, the groin, under the breasts, and in other skin folds such as around the genitals, and the buttocks. It first appears as red lesions, usually without the scale associated with plaque psoriasis. It may appear smooth and shiny.
Erythrodermic psoriasis: Erythema means reddening. It generally appears on people with unstable plaque psoriasis, where lesions are not clearly defined. There may also be exfoliation, or shedding of the skin, severe itching, and pain.
Guttate psoriasis: Guttate psoriasis often starts in childhood or young adulthood. It appears as small, red, individual spots on the skin that are not normally as thick or as crusty as the lesions in plaque psoriasis.
Pustular psoriasis: It appears as white pustules, or blisters, or non-infectious pus, surrounded by red skin. It can affect certain areas of the body, for example, the hands and feet, or most of the body.
- Cold Weather
- Dry Skin
- Vaccinations: As with dry skin, puncturing the skin during a vaccination may cause a psoriasis flare
- Beta-Blockers and Lithium: Beta-blockers to treat high blood pressure, and lithium for a mental disorder, can make psoriasis worse.
- Upper-Respiratory Infections: Colds and other infections, especially strep throat, activate the immune system and can cause psoriasis to flare.
- Smoking: There’s some evidence that smoking can make psoriasis worse.
- Diet: psoriasis may also have gluten sensitivity, and eating a gluten-free diet can help reduce psoriasis symptoms.
- Alcohol: For some people with psoriasis, having more than one or two drinks a day has been shown to cause it flares.
Risk factor of Psoriasis
Some factors increase the likelihood of developing it include:
- Having cardiovascular disease and metabolic syndrome
- Trauma to the skin
- Family history
- Enlarged red bumps
- Scaly skin
- Blood spots caused by the removal of the dry, scaly areas
- Bleeding on the removal of scaly skin
- Dry flaky skin
- Oil spots near the nail bed
- Sensitive skin
Complications of Psoriasis
Psoriatic arthritis: This complication can cause joint damage and a loss of function in some joints, which can be debilitating.
Eye conditions: Certain eye disorders — such as conjunctivitis, blepharitis and uveitis — are more common in people with this disease.
Obesity: People with it, especially those with more severe disease, are more likely to be obese. It’s not clear how these diseases are linked, however. The inflammation linked to obesity may play a role in the development of psoriasis. Or it may be that people with psoriasis are more likely to gain weight, possibly because they’re less active because of their psoriasis.
Type 2 diabetes: The risk of type 2 diabetes rises in people with psoriasis. The more severe the psoriasis, the greater the likelihood of type 2 diabetes.
High blood pressure: The odds of having high blood pressure are higher for people with psoriasis.
Cardiovascular disease: For people with psoriasis, the risk of cardiovascular disease is twice as high as it is for those without the disease. Psoriasis and some treatments also increase the risk of irregular heartbeat, stroke, high cholesterol, and atherosclerosis.
Metabolic syndrome: This cluster of conditions including high blood pressure, elevated insulin levels and abnormal cholesterol levels increase your risk of heart disease.
Other autoimmune diseases: Celiac disease, sclerosis and the inflammatory bowel disease called Crohn’s disease are more likely to strike people with psoriasis.
Parkinson’s disease: This chronic neurological condition is more likely to occur in people with this disease.
Kidney disease: Moderate to severe psoriasis has been linked to a higher risk of kidney disease.
Emotional problems: It can also affect your quality of life. Psoriasis is associated with low self-esteem and depression. You may also withdraw socially.
Diagnosis and Test
In most cases, diagnosis is fairly straightforward.
- Physical exam and medical history. Your doctor usually can diagnose by taking your medical history and examining your skin, scalp, and nails.
- Skin biopsy. Rarely, your doctor may take a small sample of skin (biopsy). He or she will likely first apply a local anesthetic. The sample is examined under a microscope to determine the exact type of psoriasis and to rule out other disorders.
Treatment and Medications
There are three main kinds of treatments:
- Medicines can include creams, lotions, and ointments that are put directly on the skin. They also can include pills and injections (shots).
- Light therapy, or phototherapy, means exposing the skin to natural or artificial ultraviolet light. A doctor may recommend you go outside and get a little more sun, but too much sunlight can make it worse.
- Systemic therapy – these are immunosuppressive agents and immune modulators and are usually reserved for severe/refractory cases.
- Olive Oil: Apply the oil over the patches that develop on the skin as a result of it.
- Reapply the oil every few hours.
- Rosehip oil: Apply this oil on the affected area and leave it on. Apply a couple of times during the day.
- Flaxseed oil: Place a few drops of this oil on the affected area and massage it for a few minutes. Use this oil three to four times a day.
- Coconut oil: Apply coconut oil liberally on your body, preferably after taking a bath. Do this every day for healthy skin.
- Neem oil: Apply neem oil on the affected areas either using your finger or with a cotton ball. Reapply the oil twice a day.
- Fish oil capsules: Pierce the capsule to extract the oil present inside. Apply it directly to the skin to get momentary relief from the discomfort caused by psoriasis. Also, consume fish oil capsules on a daily basis.
- The Dead Sea Salt Treatment: Add the sea salt to the warm water and soak in its goodness for 15 to 30 minutes. Rinse your body with clean water after. Soak in this relaxing bath every other day.
- Epsom Salt: Mix the salt in the water. Soak in this water for 15 to 20 minutes and then, rinse your body with normal water.
- Eating fewer protein-rich foods—primarily meats and dairy products—may help alleviate flare-ups.
- Get fish oil in a pill. Researchers around the world have tested fish-oil supplements as a treatment, often with excellent results.
- Heal with beta-carotene. Vitamin A is essential for healthy skin. But in too-large doses, the vitamin can have serious side effects.
- Stop stress from affecting your skin by the following meditation