December 11th, 2015
Image Courtesy: dpsw
Psoriasis is a fairly common chronic inflammatory disease of the skin characterised by the presence of thickened, scaly patches as a result of inflammatory reactions and increased growth of skin cells. Psoriasis is neither communicable, nor cancerous.
Why does psoriasis occur?
Keratinocytes are skin cells which make up the outermost covering of the skin.
Psoriasis is associated with abnormal T lymphocytes. The T cells (which normally act against infectious organisms) attack and kill normal keratinocytes, and trigger an inflammatory reaction. As a result, keratinocytes divide at an increased rate making the skin thick.
What causes psoriasis?
No particular cause has been identified so far. It is an autoimmune disease.
Certain factors may trigger or worsen the symptoms. These include
-Recurrent throat infection with beta-hemolytic streptococcus (bacterium).
-Skin injury or trauma .
-Stress and anxiety.
-Smoking and excessive alcohol consumption.
Anyone can develop psoriasis. However, the following individuals are at a higher risk (though, not always affected):
-Individuals infected with HIV.
-Those with a family history of psoriasis.
What are the symptoms of psoriasis?
The disease has several clinical presentations. The most common of these is called plaque psoriasis.
The skin has raised lesions called plaques. They are seen around the knees, elbows and the extensor surfaces of the forearms and legs. The plaques are
-Itchy and dry
-Covered with silver scales which flake off
In some cases, the plaques may be painful, or may bleed.
The nails may be thickened, pitted and brittle.
The disease commonly occurs in cycles. There are a few weeks of flare of the disease followed by asymptomatic periods. Very rarely, the disease may subside completely (complete remission).
The commonest complication is psoriatic arthritis, which presents with psoriasis of the skin + redness, swelling, pain and stiffness of joints.
How can the disease be treated?
Unfortunately, there is no definitive cure. On observation of any of the aforementioned symptoms, a dermatologist should be consulted. Treatment aims at controlling cell division and inflammation, and has three modalities:
1. Topical treatment: is in the form of creams applied to the skin. It is generally in the form of steroid creams, vitamin D analogues, and salicylic acid.
2. Phototherapy: application of ultraviolet radiation in a controlled manner.
3. Systemic: these drugs are taken orally and affect the entire body. Drugs given include retinoids, immune modulators like methotrexate and cyclosporine.
Self medication is harmful; the above treatment is to be prescribed only by a registered practitioner.
Self care steps, though not curative, after consultation with a doctor, do provide symptomatic relief:
-Daily baths with a mild soap and lukewarm water to keep the skin clean.
-Use of an ointment based moisturiser to reduce itching and scaling of skin.
-Brief sun exposure (for ultraviolet radiation) after consultation with a doctor, since at times, UV rays may trigger the symptoms and cause harm.
-Cessation of smoking and alcohol consumption.
-Control of triggering factors.
Before concluding, let us look at what the term disease means; a disease is defined as a disorder of structure of function of an organ, or an organ system of the body. It is a pathological condition that causes a deviation from a physiologically normal state. The word is a medical term, and it is wrong to consider the term derogatory or insulting.
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