Psoriasis

Some of the common symptoms include:

• Small or large raised, inflamed patches of skin that appear pink or red on light skin and brown or purple on dark skin.
• Presence of flaky skin with whitish-silver or gray scales.
• Dry skin that may crack, peel, or bleed.
• Burning, itching, or soreness near the patches.
• Presence of pus-filled boils (pustular psoriasis).
• The patches may be symmetrical (guttate psoriasis) and are generally seen over large joints.
• Thickened, pitted, or ridged nails.
• Painful, swollen joints.
• Rarely, the entire body may have redness and scaling, associated with fever and other symptoms.

Not every patient will experience all of the symptoms. Symptoms usually depend on the type of psoriasis. Many patients with psoriasis go through rhythmic cycles of symptoms. Severe symptoms might be seen for a few days or weeks, and then during the phase of remission, the symptoms may disappear for some time. Later, in a few weeks or due to exposure to some trigger, the symptoms may flare up again. However, the duration of both flare-ups and remission is difficult to predict.

While researchers do not know the exact cause of psoriasis, the immune system and genetics are key factors. The immune system typically attacks disease-causing germs; however, in psoriasis, similar to other autoimmune diseases, it begins to attack healthy cells as well. Normally, skin cells grow and shed completely in about 30 days, but in psoriasis, this process occurs in just 3 to 4 days. Instead of shedding, skin cells accumulate on the surface of the skin. Genetic factors also influence the type of psoriasis and its response to treatment.

Psoriasis is commonly associated with several risk factors and triggers such as:

• Stress
• Anxiety and depression
• Smoking
• Alcoholism
• Obesity
• An injury, cut, scrape, or sunburn on the skin
• Infection, such as streptococcal throat infection
• Certain medicines, such as interferon, antimalarials, nonsteroidal anti-inflammatories, lithium, or beta-blockers
• Stopping oral corticosteroids or strong topical steroids
• Cold weather, where people have less exposure to sunlight and humidity and stay in hot, dry indoor air
• Hormonal changes
• Immune response of an individual or immune disorders such as AIDS

The diagnosis of psoriasis includes physical examination, blood tests, and skin biopsy.

• Physical examination: Your doctor may examine your skin, nails, and scalp to check for the presence of lesions and flakes characteristic of psoriasis.
• Blood tests: While there are no specific blood tests or imaging studies that can directly aid in the diagnosis of psoriasis, if your doctor suspects psoriatic arthritis or if you exhibit symptoms such as swollen and painful joints, blood tests like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels may be recommended.
• Skin biopsy: A skin biopsy involves removing a skin lesion from the affected area and sending it for microscopic examination to determine the exact type of psoriasis and to rule out other skin disorders. This is a painless procedure performed on an outpatient basis.
• Psoriasis area and severity index (PASI): The psoriasis area and severity index (PASI) may also be recommended. This is the gold standard for assessing the severity of psoriasis, combining the assessment of lesion severity and the extent of the affected area into a single index score.

As the exact cause of psoriasis is not fully known, the prevention of this skin problem is aimed at controlling the risk factors. These include:

• Boosting your immunity and lowering your risk of infections
• Keeping your skin hydrated by drinking plenty of fluids
• Moisturizing the skin, especially for those with extremely dry skin
• Avoiding sunbathing and extremely cold conditions
• Managing stress and anxiety
• Quitting smoking and avoiding heavy alcohol consumption
• Consulting your doctor when taking lithium, high blood pressure medications, steroids, etc.

The treatment is aimed at:

• Stopping the skin cells from growing quickly
• Removing scales and softening the skin

Creams and ointments are used for mild to moderate psoriasis. In more advanced stages of the disease, topical creams are combined with injectable medicines, oral medicines, and light therapy (phototherapy).

1. Topical medications

Corticosteroids are the most frequently prescribed medications for treating mild to moderate psoriasis. Topical medications are available as ointments, creams, lotions, gels, foams, sprays, and shampoos. Topical corticosteroids might be applied once a day during flares, and on alternate days or weekends only to maintain remission.

Retinoic acid is available as a gel and cream and is applied once or twice daily. The most common side effects are skin irritation and increased sensitivity to light. These are not recommended when pregnant or breast-feeding.

Calcineurin inhibitors such as tacrolimus and pimecrolimus reduce inflammation and plaque buildup. They can be helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.

Other topical medications include:

• Salicylic acid, which is used to eliminate dead skin cells
• Coal tar, which works by reducing inflammation and scaling

2. Light therapy

This psoriasis treatment uses natural or artificial ultraviolet light. It involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with medications. Ultraviolet (UV) light, which is found in sunlight, slows the rapid growth of skin cells.

3. Oral and injectable medications

When psoriasis becomes severe, the doctor may prescribe oral or injected drugs. These include:

• Methotrexate: Usually administered weekly as a single oral dose, methotrexate decreases the production of skin cells and suppresses inflammation. People taking methotrexate long term need ongoing testing to monitor their blood counts and liver function. Men and women should stop taking methotrexate at least three months before attempting to conceive. This drug is not recommended when breast-feeding.
• Retinoids: Retinoids are pills used to reduce the production of skin cells. These are not recommended when pregnant or breast-feeding.
• Ciclosporin: This medication treats psoriasis by suppressing the immune system. Cyclosporin increases your risk of infection and cancer. People taking cyclosporine need ongoing monitoring of their blood pressure and kidney function. These drugs are not recommended when pregnant or breast-feeding.
• Steroids: Injection of steroids such as triamcinolone is given directly into the lesions if the psoriatic patches are persistent.
• Other medications: Thioguanine and hydroxyurea can be used when other drugs cannot be given.

In severe cases, surgical treatment may also be recommended.

Since psoriasis is a chronic disease, various measures can be taken to keep the disease under control and improve quality of life. Here are some simple things you can do:

• Take a bath daily: Having a bath daily helps to remove scales and calms inflamed skin. You can add bath oil, colloidal oatmeal, Epsom salts, or Dead Sea salts to the water and soak. Avoid hot water and harsh soaps; use lukewarm water and mild soaps.
• Use a moisturizer: Apply a heavy, ointment-based moisturizer while your skin is still moist. For very dry skin, oils may be preferable. During cold, dry weather, you may need to apply a moisturizer several times a day.
• Talk to your doctor about sun exposure: Exposing your skin to a controlled amount of sunlight can significantly improve lesions. However, too much sun can trigger or worsen outbreaks and increase the risk of skin cancer. Always consult your doctor for advice on sun exposure.
• Use sunscreen: It is crucial to protect your healthy and unaffected skin from sun damage. Apply sunscreen with an SPF of 30 or above and reapply every two hours.
• Avoid alcohol: Since alcohol intake can worsen symptoms, it is best to restrict your alcohol consumption or give it up altogether.

People who are diagnosed with psoriasis can develop various complications such as psoriatic arthritis, a rheumatic disease that leads to swollen joints and a loss of function in some joints.

Other complications include:

• Obesity
• High blood pressure
• Type 2 diabetes
• Heart diseases
• Metabolic syndrome
• Inflammatory bowel disease
• Eye problems such as conjunctivitis, blepharitis, and uveitis
• Other autoimmune diseases including celiac disease, sclerosis, and Crohn's disease
• Cancers such as lung and skin cancer

People with psoriasis also experience discrimination, self-image issues, and low self-confidence. Along with the discomfort and pain of psoriasis, these issues can lead to anxiety and depression.

You can try natural remedies to help keep your psoriasis under control. However, it is always advisable to consult your doctor before trying any home remedies for psoriasis. Some of the remedies include:

• Aloe vera is known to provide relief from the symptoms of psoriasis when applied externally as well as when consumed internally.
• Epsom salts/Dead Sea salts have been found to alleviate itching and burning. Add Dead Sea salt to warm water and soak for about 15 minutes.
• Vinegar, a strong disinfectant, helps relieve scalp itch. Dilute vinegar with water in a 1:1 ratio and apply it to the affected regions.
• Turmeric (in the form of a supplement or sprinkled on food) has been found to be effective in controlling flare-ups of the disease.

Homeopathy

Homeopathy is a safe and reliable method of treatment for psoriasis. It uses natural medicine, which is free from side effects, and a majority of cases can be treated with these remedies.

1. Arsenic album: Indicated for silver scales in people with psoriasis. The chief indicator for using arsenic album is the presence of dry, rough, red papular eruptions with scales. The eruptions cover most parts of the body, except the face and hands. Arsenic album also works well in cases of guttate psoriasis.
2. Graphites naturalis: Useful for scalp psoriasis and cracked skin. In such cases, eruptions with scales appear on the scalp. Cases where graphites naturalis works well tend to have patches of sore, dry, rough skin with scales.
3. Arsenic iodatum: Used when there is shedding of large scales from the skin eruptions.
4. Sulphur: Helps in cases with severe itching and burning in psoriatic skin lesions. Sulphur is also a remedy for skin ailments with a history of excessive use of ointments in the past.
5. Petroleum oleum: A suitable remedy for psoriasis where deep cracks appear on the skin.
6. Merc sol: A medicine for psoriasis of the scalp. In typical cases, the scalp is covered with abundant white scales, with the base underneath being raw.
7. Sepia succus: A beneficial medicine for psoriasis characterized by the presence of large oval lesions on the skin. The lesions are reddish papules, with eruptions present over the face, chest, back, arms, and legs.

Here are some practical ways of managing psoriasis:

1. Nourish your skin
   • Bathe with care. Avoid hot water or harsh soaps that strip your skin of natural oils.
   • Keep skin moist. Use essential oils, moisturizers, and creams generously.
   • Wear sunscreen if you need to be in the sun for extended periods. Sunburns may worsen the condition.
2. Eat healthy
   • Include anti-inflammatory foods in your diet, such as those rich in omega-3 fatty acids like fish, flax seeds, walnuts, chia seeds, and soybeans.
   • Add colorful vegetables and fruits, such as spinach, carrots, bell peppers, and blueberries, to help reduce inflammation.
   • Avoid foods like red meat, processed foods, fatty foods, dairy products, and those high in arachidonic acids.
3. Talk to your doctor about sun exposure
   • Exposing your skin to a controlled amount of sunlight can significantly improve lesions.
   • However, excessive sun can trigger or worsen outbreaks and increase the risk of skin cancer.
   • Always consult your doctor for guidance on sun exposure.
4. Tackle triggers
   • Identify your triggers and take steps to minimize their occurrence. For example, if smoking causes flare-ups, consider quitting; if sun exposure worsens your lesions, avoid going out during peak hours or wear protective clothing.
   • Since alcohol can exacerbate symptoms, it is best to limit or eliminate your alcohol intake.
5. Stick to your treatment plan
   • It is crucial to adhere to the medications prescribed by your doctor, which may include topical treatments, light therapy (phototherapy), and oral or injectable medications.
6. Manage stress
   • Psoriasis can impact your mental well-being, making you more susceptible to stress, anxiety, and depression.
   • Dedicate time each day to practice yoga or meditation for 10-15 minutes.
   • Engage in deep breathing exercises to help alleviate stress.
   • Consider joining yoga classes or practicing simple yoga postures at home. These therapies can positively influence coping with psoriasis.