Psoriasis: Types, Symptoms, Causes, Complication & Treatment

 

Psoriasis is an autoimmune skin disorder that causes itching and discomfort. Psoriasis of the plaque variety is the most common. It results in skin patches that are thick and scaly. Psoriasis treatment can help control symptoms, but there is no cure. For psoriasis, your doctor might recommend unique creams or ointments.

A rash with itchy, scaly patches is the hallmark of psoriasis, a skin condition that typically affects the knees, elbows, trunk, and scalp.

There is no known cure for the common, chronic disease known as psoriasis. It can cause pain, disrupt sleep, and impair concentration. The illness typically flares up for a few weeks or months and then subsides for a period. For those who are genetically predisposed to psoriasis, infections, burns, and some medications are common triggers.

You can manage your symptoms with the help of treatments. To improve your quality of life with psoriasis, you can also experiment with different lifestyle choices and strategies for coping.

Also Read: Gout: Symptoms, Causes, Risk factors, Diagnosis, Treatment & Prevention

What is Psoriasis?

Skin inflammation is a symptom of the autoimmune disease psoriasis. Thick patches of discolored, scale-covered skin are a symptom of psoriasis. Plaques are these thick, scaly patches.
Since psoriasis is a chronic skin condition, there is no known cure and it can flare up unexpectedly.

What types of psoriasis are there?

Psoriasis comes in several types, such as:

• Plaque psoriasis: This is the most common type of psoriasis. Plaque psoriasis affects between 80% and 90% of psoriasis patients.

• Inverse psoriasis: The folds of your skin are where inverse psoriasis manifests. It results in thin, scale-free plaques.

• Guttata psoriasis: sore throat brought on by a streptococcal infection may be followed by guttate psoriasis. Children and young adults are frequently affected, and it resembles tiny, red, drop-shaped scaly spots.

• Pustular psoriasis: Small, pus-filled pimples on top of plaques are a defining feature of pustular psoriasis.

• Erythrodermic psoriasis: More than 90% of your skin may be affected by erythrodermic psoriasis, a severe form of the skin condition. It results in extensive skin shedding and discoloration.

• Sebopsoriasis: This type usually manifests as oily, yellow scaly pimples and plaques on your face and scalp. This condition is a hybrid of seborrheic dermatitis and psoriasis.

• Nail psoriasis: This condition results in changes to your fingernails and toenails as well as skin discoloration and pitting.

Symptoms:

The following are typical psoriasis symptoms:

• A patchy rash that differs greatly in appearance from person to person, from large eruptions over a large portion of the body to areas of scaling that resemble dandruff.

• Color-changing rashes that typically appear as pink or red with silver scale on white skin and purple with gray scale on brown or black skin

• Little patches of scaling that are frequently observed in kids

• Cracked, dry skin that could bleed

• Soreness, burning, or itching

• Rashes that flare up and then go away for a few weeks or months

• Skin flaky patches that develop into scales are a symptom of psoriasis.

The scales may appear white or silvery, and the patches may appear pink or red on brown, black, or white skin. The patches may appear dark brown or purple on brown or black skin, and the scales may look grey.

Causes:

It is believed that psoriasis is an immune system problem that results in abnormally rapid skin cell growth. This quick cell turnover causes dry, scaly patches in the most prevalent type of psoriasis, called plaque psoriasis.

The exact cause of psoriasis is unknown. It is believed to be an immune system issue in which healthy skin cells are mistakenly attacked by infection-fighting cells. Scientists think that both environmental and genetic factors are involved. The illness is not communicable.

Risk factors:

A person can get psoriasis. A third or so of cases start in childhood. The following variables may raise the chance of contracting the illness:

Family history. The illness is inherited. You are more likely to develop psoriasis if you have one parent who has it. And having two parents with psoriasis increases your risk even more.

Smoking. In addition to raising the chance of developing psoriasis, smoking tobacco may make the condition worse.

Complications:

You are more likely to get other illnesses if you have psoriasis, such as:

• Psoriatic arthritis, which results in joint pain, stiffness, and swelling

• Changes in skin color that occur temporarily after plaques have healed (post-inflammatory hypopigmentation or hyperpigmentation)

• Eye disorders like blepharitis, uveitis, and conjunctivitis

• Being overweight

•  Type 2 Diabetes

• High blood pressure

• Heart-related conditions

• Some autoimmune conditions include Crohn's disease, a bowel inflammatory condition, sclerosis, and celiac disease.

• Mental health issues like depression and low self-esteem

How is a diagnosis of psoriasis made?

 After examining your skin and reviewing your symptoms, a dermatologist or other healthcare professional will make the diagnosis of psoriasis. They may ask you the following questions:

•  Does anyone in your biological family have a history of skin conditions?

•  You noticed symptoms for the first time when?

•  Have you tried any skin care products at home?

•  Have you ever experienced a skin outbreak before?

•  What types of shampoos and soaps do you use?

Although psoriasis is diagnosed based on the appearance of a skin plaque, your doctor may recommend a skin biopsy test to confirm your diagnosis because symptoms can be confused with those of other similar skin conditions. A tiny sample of skin tissue from your skin plaque will be taken out for this test, and it will be examined under a microscope.

Treatment:

How does one treat psoriasis?

Topical treatment

 Corticosteroids.  The most common prescription medications for mild to moderate psoriasis are these.  Oils, ointments, lotions, gels, foams, sprays, and shampoos are among their forms.  For sensitive areas like the face or skin folds, as well as for treating large patches, mild corticosteroid ointments (hydrocortisone) are typically advised.  During flares, topical corticosteroids may be applied once daily; during remission, they may be applied every other day or on the weekends.

 For smaller, less sensitive, or more difficult-to-treat areas, your doctor might recommend a stronger corticosteroid cream or ointment, such as clobetasol (Cormax, Temovate, etc.) or triamcinolone (Trianex).

 Excessive or prolonged use of potent corticosteroids can cause skin thinning.  Topical corticosteroids may lose their effectiveness over time.

Vitamin D analogs. Skin cell growth is slowed by synthetic forms of vitamin D, such as calcitriol (Vectical) and calcipotriene (Dovonex, Sorilux). Topical corticosteroids or such types of drugs can be used together. In sensitive areas, calcitriol may cause less irritation. Compared to topical corticosteroids, calcitriol and calcipotriene are typically more costly.

Retinoids. Tazarotene comes in gel or cream form (Tazorac, Avage, etc.). One or two times daily, it is applied. Skin irritation and heightened light sensitivity are the most frequent adverse effects.

It is not advised to use tazarotene if you are nursing a baby, are pregnant, or plan to become pregnant.

Inhibitors of calcineurin. Calcineurin inhibitors, like pimecrolimus (Elidel) and tacrolimus (Protopic), soothe rashes and lessen scaly accumulation. They can be particularly useful in places with thin skin, like the area around the eyes, where retinoids or steroid creams can cause irritation or damage.

It is not advised to take calcineurin inhibitors if you are nursing a baby, are pregnant, or plan to get pregnant. Additionally, due to a possible increased risk of lymphoma and skin cancer, this drug is not recommended for long-term use.

Salicylic acid. Shampoos and scalp treatments containing salicylic acid lessen psoriasis scaling. They come in both prescription and over-the-counter forms. Because it primes the scalp for easier drug absorption, this kind of product can be used either by itself or in conjunction with other topical therapies.

Coal tar. Scaling, itching, and inflammation are lessened by coal tar. Both prescription and over-the-counter forms are available. It is available in different forms, including oil, cream, and shampoo. The skin may become irritated by these products. In addition to being untidy, they can smell strongly and leave stains on bedding and clothes.

It is not advised to use coal tar treatment while pregnant or nursing.

Anthralin. A tar cream called anthralin slows the growth of skin cells. Additionally, it can smooth out skin and get rid of scales. It is not meant to be applied to the face or genitalia. Anthralin stains nearly everything it comes into contact with and can irritate skin. Usually, it is applied briefly before being removed with water.

What happens if popular psoriasis treatments don't work?

Your healthcare provider might suggest the following treatments if your psoriasis symptoms don't go away after treatment or if you have significant areas of involvement (10% or more of your skin):

Light therapy: Certain wavelengths of LED lights can help reduce inflammation and slow the growth of new skin cells.

PUVA: This treatment involves both exposure to a particular type of ultraviolet light and a medication called psoralen.

Medications are administered orally or by injection

Your doctor may recommend oral or injectable (systemic) medications if you have moderate to severe psoriasis or if no other treatments have been effective. Due to the possibility of serious side effects, some of these medications are only used for short periods and may be used in combination with other treatments.

Steroids. Your doctor may recommend an injection of triamcinolone directly into a few small, persistent psoriasis patches on your body.

Retinoids. Pills containing acitrin and other retinoids are used to lower skin cell production. Muscle soreness and dry skin are possible side effects. It is not advised to take these medications if you have been breastfeeding a baby, are pregnant, or plan to get pregnant. 

These vitamin A-related medications can alleviate the symptoms of psoriasis, but they may also have adverse effects, such as birth defects.

Cyclosporine. This medication can treat severe psoriasis, but it can also harm the kidneys and raise blood pressure.

To avoid drug interactions, discuss the side effects with your doctor before beginning treatment. You should also mention any medications or supplements you are currently taking.

Biologicals. Small molecule inhibitors and biologics, two more recent immune therapy medications, function by preventing your body's immune system from triggering an autoimmune reaction.

These medications, which are typically given by injection, change the immune system in a way that interrupts the course of the illness and alleviates symptoms and indicators in a matter of weeks. A number of these medications are authorized to treat moderate to severe psoriasis in patients who have not responded to initial treatments. Apremilast (Otezla), bimekizumab-bkzx (Bimzelx), ixekizumab (Taltz), guselkumab (Tremfya), adalimumab (Humira), ustekinumab (Stelara), risankizumab-rzaa (Skyrizi), etanercept (Enbrel), and secukinumab (Cosentyx) are among the available options. Etanercept, ixekizumab, secukinumab, and ustekinumab are the four that are authorized for use in pediatric patients. These drugs are costly, and health insurance plans may or may not cover them.

Because biologics have the potential to suppress the immune system in ways that raise the risk of serious infections, they must be used carefully. TB screening is required for patients receiving these treatments.

Methotrexate. Methotrexate (Trexall), which is typically taken once a week as a single oral dose, reduces inflammation and skin cell production. Compared to infliximab and adalimumab, it is less effective. Fatigue, loss of appetite, and upset stomach are possible side effects. Long-term methotrexate users require regular testing to keep an eye on their liver function and blood counts.

Methotrexate must be stopped at least three months before trying to conceive. Breastfeeding women are not advised to take this drug.

For severe cases of psoriasis, doctors advise taking methotrexate. Liver disease could result from it. Your doctor will use blood tests to track your progress if you take it. To monitor the health of your liver, you might require liver biopsies regularly.

Other medications. When you are unable to take other medications, you can use hydroxyurea (Droxia, Hydrea) and thioguanine (Tabloid). Discuss the possible side effects of these drugs with your healthcare provider.

How can psoriasis be prevented?

Psoriasis cannot be entirely prevented. By adhering to your doctor's advice, maintaining a healthy lifestyle, taking good care of your skin, and avoiding situations that could set off a flare-up of symptoms, you can lower your risk.

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