Psoriasis: Symptoms and Treatment

Psoriasis is a widespread, incurable, chronic illness that lasts a long time. It can hurt, disrupt sleep, and make it difficult to focus. The illness usually flares up for a few weeks or months, then goes into remission for a time. For those who have a hereditary susceptibility to psoriasis, wounds, burns, and certain drugs are common triggers.

You can control your symptoms with the aid of various treatments. For a better quality of life with psoriasis, you can also experiment with lifestyle choices and coping mechanisms.

Psoriasis Meaning

Psoriasis is an autoimmune disorder that manifests as skin irritation. The characteristic symptoms include skin thickening and discoloured areas of skin covered with scales.

Psoriasis is a skin condition that often affects the knees, elbows, trunk, and scalp. It produces a rash with itchy, scaly spots. 

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Psoriasis Causes

Psoriasis is thought to be an immune system problem that causes hypertrophic skin cells. This rapid cell turnover is what causes the dry, scaly patches that define the most common kind of psoriasis, known as plaque psoriasis.

The cause of psoriasis is not well understood. It is thought to be an immune system problem wherein cells fighting infection inadvertently destroy healthy skin cells. Scientists believe that genetic and environmental factors have a role. This is not a contagious disease.

Many people who are genetically predisposed to psoriasis may not show any symptoms for years until something happens in their surroundings that sets off the illness. 

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Psoriasis Types

There are several varieties of psoriasis, and each has distinct symptoms and signs:

• Plaque psoriasis. Plaques, or raised, itchy, dry, scale-covered skin areas, are the hallmark of plaque psoriasis, the most common kind of psoriasis. A few or many may be present. They usually manifest on the elbows, knees, scalp, and lower back. The patches' color changes based on the skin tone. Injury to the skin may result in temporary color changes (post-inflammatory hyperpigmentation), especially on dark or black skin.
• Nail psoriasis. Psoriasis can result in pitting, uneven nail growth, and discoloration in the toenails and fingernails. Psoriatic nails become looser and separate from the nail bed, a condition known as onycholysis. If you are very sick, your nails can fall off.
• Guttate psoriasis. Young adults and children are the main groups affected by guttate psoriasis. It is typically brought on by a bacterial illness, such strep throat. On the arms, legs, or trunk, it is identified by tiny, drop-shaped, scaling lesions.
• Inverse Psoriasis. The groin, buttocks, and breast skin folds are the primary areas affected by inverse psoriasis. It results in smooth, inflammatory skin patches that get worse from friction and perspiration. This kind of psoriasis may be brought on by fungus infections.
• Pustular Psoriasis. The uncommon form of pustular psoriasis results in well-defined blisters filled with pus. It might affect just a tiny portion of the palms or soles or cover large regions.
• Erythrodermic Psoriasis. Erythrodermic psoriasis, the least frequent variety of psoriasis, can cause a peeling rash that burns or itches intensely throughout the entire body. It can be acute or chronic, and its duration can vary.

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Psoriasis Symptoms

Typical psoriasis signs and symptoms include the following:

• An uneven rash that varies in appearance on each person; it can range from massive eruptions across sizable portions of the body to spots with dandruff-like scaling
• Colorful rashes often appear as pink or red with the silver scale on white skin, and purple with the grayscale on dark or black skin.
• The tiny, bleeding spots of scaling that are commonly seen in children with chapped, dry skin
• Rashes that are painful, stinging, or itchy and that recur every few weeks or months before disappearing.

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Psoriasis Risk Factors

Psoriasis may affect anyone at any age. In one-third of the cases, the victim is underage. The following elements might make you more susceptible to getting the illness:

• History within the family. It's an inherited sickness. If one of your parents has psoriasis, you are more likely to have it yourself. Furthermore, having two parents with psoriasis increases your chances.
• Smoking. Smoking tobacco not only increases the risk of getting psoriasis, but it can also exacerbate the illness.

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Psoriasis Diagnosis

Your doctor will question you about your general health and inspect your nails, scalp, and skin. After that, your doctor may do a biopsy, or tiny skin sample collection, to examine the skin under a microscope. This aids in identifying the specific kind of psoriasis and helps rule out other illnesses.

Psoriasis Treatment

The main goals of psoriasis treatments are to get rid of scales and slow down the proliferation of skin cells. Oral or injectable medications, phototherapy (light treatment), and topical therapy (lotions and ointments) are among the options.

Your psoriasis severity and how well it responds to previous therapy and self-care practices will determine which treatments are best for you. You might need to try a range of drugs or therapies before you find one that works. Usually, the sickness returns even after receiving effective therapy.

Topical Treatment

• Corticosteroids. The most often prescribed therapies for mild to severe psoriasis are listed below. Among the forms they take are oils, ointments, creams, lotions, gels, foams, sprays, and shampoos. Mild corticosteroid ointments (hydrocortisone) are usually recommended for the treatment of broad patches and sensitive areas such as the face or skin folds. 
  • Topical corticosteroids can be used once daily during flare-ups and every other day or on weekends during remission. Your doctor could suggest a stronger corticosteroid cream or ointment, such as clobetasol or triamcinolone, for smaller, less sensitive, or more challenging-to-treat areas. Overuse or prolonged usage of strong corticosteroids can thin the skin. 
• Analogous to vitamin D. Vitamin D in synthetic form, such as calcitriol and calcipotriene, prevents skin cell proliferation. Topical use of this kind of medication can occur either alone or in combination with corticosteroids. Sensitive regions may not be as inflamed by calcitriol. Calcipotriene and calcitriol are often more costly than topical corticosteroids.
• Retinoidoids. There are gel and cream forms of Tazarotene available. It is used once or twice a day on average. Tazarotene should not be used if you are a nurse, intend to become pregnant, or are already pregnant.
• Agents that block calcineurin. Pimecrolimus and tacrolimus are examples of calcineurin inhibitors that reduce scaly accumulation and alleviate irritation. When applied to thin skin regions, such as the area around the eyes, where they may irritate or injure skin, retinoids and steroid creams can be quite beneficial. If you are trying to get pregnant or are nursing a newborn, you shouldn't use calcineurin inhibitors. We do not advise long-term use of this medication due to the possibility of increased risk of lymphoma and skin cancer.
• Salicylic acid. Salicylic acid-based shampoos and treatments for the scalp lessen scaling caused by psoriasis. Prescribed and non-prescription strengths are available. The medicine can be delivered either alone or in conjunction with this sort of solution since it makes the drug simpler for the scalp to absorb.
• Coal tar. Scaling, irritation, and inflammation are reduced by coal tar. Both prescribed and nonprescription strengths exist. It is available in a variety of forms, including shampoo, lotion, and oil. These goods could cause skin irritation. In addition, they have a strong odor, can be untidy, and stain clothes and bedding. If you are expecting or nursing a baby, coal tar treatment is not something you should do. 
• Anthralin. Tar cream, also known as anthralin, inhibits the growth of new skin cells. Additionally, it helps smooth out and eliminate skin scales. It is not recommended to use it on the face or genitalia. Anthralin stains practically everything it comes into contact with and might irritate skin. Applying it, letting it dry, and finally washing it off are the usual steps.

Light Therapy

Light therapy is the cornerstone of treatment for moderate-to-severe psoriasis. It can be used either by itself or in conjunction with prescription drugs. It entails exposing the skin to precise levels of artificial or natural light. It is necessary to repeat the therapeutic regimen. To find out if you are a good candidate for at-home phototherapy, speak with your doctor.

• Sunlight. Short daily sun exposures, or heliotherapy, may help with psoriasis. Find out from your doctor which natural light cure for psoriasis is the safest before starting a sun exposure routine.
• Goeckerman intervention. Coal tar treatment and light therapy are used in a method known as Goeckerman therapy. Because coal tar increases the skin's reactivity to ultraviolet B (UVB) radiation, this may function better.
• UVB broad bandwidth. If you have isolated spots of psoriasis or it is not improving with topical medication, you can treat it with carefully controlled doses of UVB broadband radiation using artificial light sources. Itching, dryness, and skin irritation might be transient adverse effects. UVB broadband therapy may not be as successful as UVB narrowband light therapy. It has taken the place of broadband treatment in many places. Until the skin becomes better, it is often used twice or three times a week. After that, maintenance treatments are applied less frequently. However, compared to broadband UVB phototherapy, narrowband UVB phototherapy may have more unfavorable side effects.
• UVA (photoluminescence) and psoralen. One of the therapy regimen's components is the administration of the light-sensitizing drug psoralen prior to the afflicted skin being exposed to UVA rays. Psoralen increases the skin's sensitivity to UVA radiation because UVA light causes deeper epidermal penetration than UVB light. This more intensive kind of therapy continuously improves skin and is effective for more severe cases of psoriasis. Burning, itching, and headaches are possible short-term adverse effects. Freckles, dry, wrinkly skin, increased UV sensitivity, and a higher chance of developing skin cancer, including melanoma, are some possible long-term adverse effects.
• Excimer laser. A powerful UVB light is exclusively pointed at the afflicted area during this type of light therapy. Since excimer laser therapy uses more powerful UVB light. Possible adverse effects include irritation and blisters.

Drugs injected intravenously or taken orally

If you have moderate to severe psoriasis and have tried several different therapies without results, your doctor may suggest injectable or oral (systemic) drugs. Many of these drugs are only used temporarily and may be used in combination with other therapies because of their potential for major side effects.

• Hormones. Should you have a few small, bothersome psoriasis patches, your physician could advise injecting triamcinolone straight into those regions.
• Retinoids. Acitretin and other retinol-containing pills are used to reduce the development of new skin cells. Possible adverse effects include dry skin and sore muscles. Use these drugs if you want to get pregnant, are a nursing mother, or are currently pregnant.
• Biological products. By changing the immune system, these often injected medications can stop the progression of disease and lessen symptoms and indicators of sickness in a few weeks. When first-line treatments fail, a few of these medications are authorized to treat moderate-to-severe psoriasis. Children can have etanercept, ibalizumab, and ustekinumab, three of these. These are pricey medications, which health insurance policies may or may not cover. The use of biologics should be done with caution since they have the potential to impair immunity and raise the risk of life-threatening infections. Patients receiving these therapies need to be screened for TB.
• Methotrexate. Methotrexate, often known as Trexall, is typically taken orally once a week in one dosage. It reduces skin cell growth and irritation. Compared to infliximab and adalimumab, it is less efficacious. Fatigue, appetite loss, and gastrointestinal distress are possible side effects. Long-term methotrexate users must undergo routine testing to keep an eye on their liver function and blood levels. Methotrexate must be stopped for a minimum of three months before trying to get pregnant. 
• Cyclosporin. Cyclosporine affects the immune system when used orally for severe psoriasis. It functions similarly to methotrexate but cannot be used continuously for longer than a year. Like other immunosuppressive medications, cyclosporine raises the risk of infection and other illnesses, including cancer. Long-term cyclosporine users must undergo routine testing to keep an eye on their blood pressure and renal function. You should not use these medications if you are a nurse, want to get pregnant, or are a nursing mother.

Additional prescription drugs. 

If earlier treatments are not tolerated, hydroxyurea (Droxia, Hydrea) and thioguanine (Tabloid) may be employed. Consult your physician for details on any potential adverse effects of these medications.

A treatment plan will be devised by you and your healthcare practitioner depending on your requirements as well as the kind and severity of your psoriasis. The least invasive treatments, such as topical lotions and UV light therapy, will probably be your first option (phototherapy). If your condition doesn't get better after that, you could switch to more potent medications.

Before beginning therapy, stronger (systemic) drugs are often needed for patients with pustular or erythrodermic psoriasis. The objective is to reduce cell turnover as much as is practicable in a particular circumstance while minimizing unwanted consequences.

Supplementary treatment

Based on certain research, complementary and alternative medicine which includes non-Western medical procedures and therapies may be able to alleviate psoriasis symptoms. Supplements, acupuncture, diet plans, and herbal skin care items are examples of alternative therapies for psoriasis patients. Despite the lack of evidence supporting any of these methods, they are generally safe and may help those with mild to severe psoriasis experience reduced scaling and itching.

• Cream containing aloe vera. Aloe vera leaf extract, found in aloe vera lotion, lessens irritation, scaling, and inflammation. To observe any improvements in your skin, you would need to apply the cream often during at least a month.
• Fish oil-containing tablets. When used in conjunction with UVB radiation, oral fish oil therapy may help to lessen the severity of the rash. Scaling may be assisted by applying fish oil to the afflicted area and leaving it there for six hours every day for four weeks.
• Oregon grape. Applying Oregon grape, sometimes known as barberry, topically can help lessen the severity of psoriasis.

Speak with your healthcare physician about the benefits and drawbacks of using alternative medicine to treat your psoriasis.

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Psoriasis Complications

If you have psoriasis, you are more likely to get other conditions like:

• Edema, stiffness, and joint discomfort are the hallmarks of psoriatic arthritis.
• Short-term changes in skin tone (hyper- or hypopigmentation after inflammation) in regions where plaques have healed.
• Eye disorders such as uveitis, blepharitis, and conjunctivitis.
• Being overweight
• Diabetes type 2
• Elevated blood pressure
• Heart-related conditions
• Additional autoimmune conditions, such as Crohn's disease, sclerosis, and celiac disease, are inflammatory bowel disorders.
• Mental health issues include sadness and poor self-esteem.

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