PSORIASIS

Psoriasis is a lifelong immune-mediated inflammatory skin disease, associated with morbidities such as psoriatic arthropathy, psychological, cardiovascular and hepatic diseases.

An estimated 60 million people have psoriasis worldwide.

Psoriasis affects 2–4% of males and females. It can start at any age including childhood, with onset peaks at 15–25 years and 50–60 years.

It tends to persist lifelong, fluctuating in extent and severity. It is particularly common in Caucasians but may affect people of any ethnicity. About one-third of patients with psoriasis have family members with psoriasis.

Causes and triggers

Psoriasis is an autoimmune condition that affects the immune system. However, in a person with psoriasis, triggers may cause the immune system to mistakenly target healthy cells. T cells respond to a trigger as if they are fighting an infection or healing a wound, producing chemicals that cause inflammation.  In psoriasis, this autoimmune activity leads to the excessive growth of skin cells, which build up and form plaques.

Common triggers of psoriasis include:

• stress and anxiety
• skin injuries such as scratches, sunburn, and bug bites
• cold, dry weather
• infections (Streptococcal tonsillitis (‘Strep throat’) and other infections)
• hormonal changes
• Sun exposure in ~10% of psoriasis patients (sun exposure is more often beneficial)
• Obesity, smoking, or excessive alcohol
• Medications such as lithium, beta-blockers, antimalarials, nonsteroidal anti-inflammatories, terbinafine and others
• Stopping oral steroidsor strong topical corticosteroids, often referred to as steroid withdrawal rebound

Symptoms

Psoriasis usually presents with symmetrically distributed, red, scaly plaques with well-defined edges. The scale is typically silvery white, except in skin folds where the plaques often appear shiny with a moist peeling surface

The most common sites are the scalp, elbows, and knees, but any part of the skin can be involved.

The plaques are usually very persistent without treatment.

Itch is mostly mild but may be severe in some patients, leading to scratching and lichenification characterised by thickened leathery skin and increased skin markings. Painful skin cracks or fissures may occur, particularly on the palms and soles.

Psoriasis can demonstrate the Koebner phenomenon. This involves the generation of new lesions on the skin that has been damaged or irritated such as by injury, burns etc.

Diagnosis

A doctor will diagnose psoriasis by assessing a person’s symptoms and asking about their personal and family history. Healthcare professionals may also use the following assessment methods Trusted Source to determine the severity of a person’s psoriasis symptoms:

Treatment

Psoriasis treatments aim to stop skin cells from growing so quickly and to remove scales.

Therapeutic options for psoriasis include topical therapy, phototherapy or systemic treatment

Options include creams and ointments (topical therapy), light therapy (phototherapy), and oral or injected medications.

Which treatments you use depends on how severe the psoriasis is and how responsive it has been to previous treatment and self-care measures. You might need to try different drugs or a combination of treatments before you find an approach that works. Even with successful treatment, usually the disease returns.