Psoriasis: Causes, Symptoms and Treatment
Psoriasis is a chronic skin condition causing red, scaly patches on the skin. It is non-contagious and affects millions of people worldwide.
Things worth knowing about "Psoriasis"
Psoriasis is a chronic skin condition causing red, scaly patches on the skin. It is non-contagious and affects millions of people worldwide.
What is Psoriasis?
Psoriasis is a chronic, non-contagious autoimmune skin condition characterised by the rapid overproduction of skin cells. This leads to the build-up of scaly, inflamed patches on the skin surface. It is one of the most common skin disorders, affecting approximately 2–3% of the global population. The disease typically follows a relapsing-remitting course and can occur at any age.
Causes
Psoriasis is driven by an autoimmune response in which the immune system mistakenly attacks healthy skin cells, triggering an abnormally accelerated cell turnover. While normal skin cells are replaced every 28 days, in psoriasis this process occurs within just 3–7 days.
Known triggers and contributing factors include:
- Genetic predisposition: A family history of psoriasis is a significant risk factor; several susceptibility genes have been identified.
- Stress: Psychological or physical stress is a common trigger for flare-ups.
- Infections: Particularly streptococcal throat infections, which can trigger guttate psoriasis.
- Medications: Certain drugs such as beta-blockers, lithium, and non-steroidal anti-inflammatory drugs may worsen the condition.
- Skin injury: The Koebner phenomenon refers to the appearance of psoriatic lesions at sites of skin trauma.
- Alcohol and smoking: Both are associated with increased severity and frequency of flares.
Symptoms
The most common form is plaque psoriasis (psoriasis vulgaris), which presents with the following features:
- Well-defined, raised red skin plaques covered with silvery-white scales
- Predilection for elbows, knees, scalp, and lower back
- Itching, burning, or soreness at affected sites
- Nail changes, including pitting and thickening (onycholysis)
Other clinical forms include:
- Guttate psoriasis: Small, drop-shaped lesions, often triggered by infection
- Pustular psoriasis: Pus-filled blisters on inflamed skin
- Inverse psoriasis: Affecting skin folds such as the armpits or groin
- Erythrodermic psoriasis: A severe, widespread form involving extensive skin redness and shedding
Diagnosis
Diagnosis is primarily clinical, based on the characteristic appearance of the skin lesions, and is made by a dermatologist. In uncertain cases, a skin biopsy may be performed to confirm the diagnosis histologically. Patients should also be assessed for psoriatic arthritis, which affects up to 30% of people with psoriasis and involves joint inflammation.
Treatment
While psoriasis currently has no cure, it can be effectively managed. Treatment is tailored to the severity of the condition:
Mild to Moderate Psoriasis
- Topical corticosteroids: Anti-inflammatory creams or ointments applied directly to lesions
- Vitamin D analogues (e.g., calcipotriol): Slow down skin cell overproduction
- Keratolytics (e.g., salicylic acid): Help remove scales and soften plaques
- Emollients and moisturisers: Reduce dryness, scaling, and itching
Moderate to Severe Psoriasis
- Phototherapy: Narrowband UVB light therapy or PUVA therapy
- Systemic medications: Methotrexate, ciclosporin, and acitretin are commonly used
- Biologics: Targeted therapies using monoclonal antibodies (e.g., TNF-alpha inhibitors, IL-17 inhibitors, IL-23 inhibitors) for severe or treatment-resistant cases
Living with Psoriasis
Psoriasis can significantly affect quality of life, including mental health and social well-being. A healthy lifestyle, including a balanced diet, regular exercise, stress management, and avoiding smoking and excessive alcohol, can help reduce the frequency of flares. Psychological support and patient communities are valuable resources for those living with the condition.
References
- World Health Organization (WHO): Global Report on Psoriasis. WHO Press, Geneva, 2016.
- Nestle FO, Kaplan DH, Barker J: Psoriasis. New England Journal of Medicine, 2009; 361(5):496–509.
- Menter A et al.: Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. Journal of the American Academy of Dermatology, 2019; 80(4):1029–1072.
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