What is psoriasis?

Psoriasis is a chronic scaling disease of the skin, which typically consists of red patches covered by silvery white scales. The areas most commonly affected are the elbows, knees, lower back and the scalp; although not infrequently the nails may also be affected. When it involves the groins, armpits, genital areas and beneath the breasts it tends to be less scaly and have a glazed appearance. It does not cause scarring and rarely results in hair loss.

Psoriasis affects about 2% of adults; it occurs equally in both men and women. It results from an overproduction of the skin cells in the epidermis i.e the outer layer of the skin. Normally it takes about 13 days for the cells of the epidermis to mature and be shed from the surface. In psoriasis the maturation occurs in 2 days. It is thought to be partly due to an abnormal immune reaction against some component of the skin.

Heredity and genetic factors seems to play a role; about half of those affected know of someone else in the family with it.

What are the factors that aggravate or trigger psoriasis?

Psoriasis often seems to start after some trigger factor:

  1. Minor skin injuries – Psoriasis can develop for the first time in sites of cuts, burns or infections.
  2. Emotional stress – Stress and tension can make psoriasis worse.
  3. Infections – streptococcal sore throat and upper respiratory tract infections.
  4. Certain medications- Drugs like beta blockers (used for high blood pressure) , lithium(antidepressant).
  5. Sunburn
  6. Alcohol

Psoriasis may improve or get worse during pregnancy it does not have any harmful effect on the mother or the child.

Is psoriasis a contagious disease?

No, it is not a contagious disease.

Is psoriasis a serious disease?

Psoriasis causes a great deal of skin discomfort and emotional embarrassment. Most people have only a small amount of the disease and is just of a nuisance value and does not affect the lifestyle. Only a small percentage of people develop serious disease and a form of arthritis called as psoriatic arthritis.

Can psoriasis be completely cured?

There is no permanent cure for psoriasis. But in most cases psoriasis can be completely controlled and relieved for long periods of time with proper treatment. Psoriasis can come and go without any obvious reason. The extent of psoriasis varies and fluctuates even without treatment. It may even disappear completely. However, the predisposition to develop psoriasis remains, so the rash may recur later even if it has been absent for years.

When patients obtain temporary control of the disease, they stop using their medication. Then psoriasis may recur. The best thing is to keep up the treatment regimen your dermatologist has prescribed and maybe you may remain free from psoriasis for a longer time.

How is psoriasis treated?

There is no one way of treating psoriasis - the treatment is individualized according to the patient’s extent, severity and location of psoriasis.

The main objective is to slow down the more rapid than usual growth rate of the skin cells.

  1. Mild psoriasis: topical medications
  2. Moderate psoriasis: topical medications combined with ultraviolet light therapy (PUVA)
  3. Severe psoriasis: Oral medications that will slow down the growth rate of the skin. These  have  significant side effects and have to be used with caution.

General Measures

  1. Sunshine – It may help to clear psoriasis but one has to be careful as psoriasis can occur in areas of sunburn.
  2. Baths- Soaking in warm water with a bath oil or tar solution can soften the psoriasis and remove scales.
  3. Moisturizing creams- psoriasis must be kept soft with moisturizing creams to prevent cracking.
  4. Scalp care- Shampoos containing tar, salicylic acid can be used. In more severe cases, steroid lotions, creams with salicylic acid and coal tar would have to be used.

Topical drugs

  1. Corticosteroids – Steroid creams or ointments with or without salicylic acid
  2. Coaltar
  3. Anthralin
  4. Calcipotriol
  5. Ultraviolet light

Systemic drugs:

  1. Psoralens – a drug extracted from plants , when used in combination with artificial ultraviolet A light(PUVA)  can be very effective in providing control of psoriasis
  2. A vitamin A derivative – etretinate is very effective in widespread psoriasis
  3. Immunosuppressive drugs – methotrexate and cyclosporin

What precautions need to be taken so that psoriasis remains under control?

A daily 15-minute shower or bath can help reduce itching and soften scales.

  1. Do not scrub the skin or scalp.
  2. Apply emollient cream while your skin is still damp i.e. within 3-minutes of your bath.
  3. Avoid alcohol and fragrance based moisturizers.
  4. Keep your skin consistently moisturized with a heavy, greasy cream or ointment.
  5. Avoid undue friction from tight .clothing or shoes.
  6. Eat a healthy diet, indulge in some exercise and reduce stress levels.
  7. Do not depend on steroid creams.
  8. Avoid alcohol.