Psoriasis

Ira Shah
Consultant Pediatrician, Nanavati Hospital, Mumbai, India
First Created: 01/25/2001 

Introduction

What is Psoriasis?

Psoriasis is a skin condition where the cells in the skin have an increased rate of turnover resulting in thick scales on the skin.

How does psoriasis occur?

The cause of psoriasis is not known. There may be a genetic predisposition that may be triggered off by unknown factors. Physical and emotional stress may aggravate psoriasis. Certain drugs such as steroid hormones, antihypertensive drugs, and infections may trigger psoriasis. REMEMBER PSORIASIS IS NOT CONTAGIOUS.

How does a patient with psoriasis present?

Patients have dry skin and affected area has red scaly patches. Itching may occur in a hot and humid climate. The common areas affected are the elbows, knees, and back. Plaques on hands and feet can prevent individuals from working at certain occupations, playing some sports, and caring for family members or a home. Plaques on the scalp can be particularly embarrassing as flaky plaque in the hair can be mistaken for dandruff.

Does psoriasis affect only the skin?

Nails may also be involved in about 50% of patients with psoriasis. Nails have a pitted surface. Some individuals may also have arthritis.

Psoriasis - Types

Classic plaques of psoriasis are seen in 80-90% of affected individuals. Erythrodermic psoriasis causes widespread inflammation and exfoliation of the skin over most of the body's surface. It may be accompanied by severe itching, swelling, and pain. It is often the result of an exacerbation of unstable plaque psoriasis.

When the skin lesions are filled with pus, it is called as pustular psoriasis. Sometimes psoriasis can involve the flexure folds of the skin such as genitals, armpits, under the breast. This is known as flexural psoriasis and is aggravated by friction and sweating. Guttate psoriasis is characterized by numerous small, scaly, red, or pink, teardrop-shaped lesions that appear over primarily the trunk, but also the limbs, and scalp. Guttate psoriasis is often preceded by a streptococcal infection.

Psoriasis can also affect the joints and is known as psoriasis arthritis. Psoriatic arthritis can affect any joint but is most common in the joints of the fingers and toes. Psoriatic arthritis can also affect the hips, knees, and spine (spondylitis)

Investigations

The diagnosis of psoriasis is usually made on clinical examination. There are no special blood tests or diagnostic procedures for psoriasis. When the plaques are scraped, one can see pinpoint bleeding from the skin below. This is known as Auspitz's sign.

Severity of Psoriasis

Psoriasis is usually graded as mild (affecting less than 3% of the body), moderate (affecting 3-10% of the body) or severe.

Treatment

Psoriasis is a disease of relapses and remissions. It seldom remits permanently. Treatment consists of the following:

  • Topical ointments
  • Phototherapy
  • Oral drugs

Patients with the mild disease get considerable relief with moisturizing creams. Ointments such as coal tar, anthralin, non-steroidal vitamin D3 (calcipotriol), and steroid creams are also useful.

Phototherapy is very effective in clearing psoriasis. Ultraviolet light (UVB or UVA) if used in gradual increasing doses and causes remission in most patients.

When psoriasis does not respond to creams and phototherapy, oral drugs such as methotrexate, cyclosporin, etretinate, and sulphasalazine may be prescribed by your doctor. These drugs are highly potent but can have serious side effects and need to be monitored by regular blood tests to prevent an adverse event.

Oral steroids should be avoided because even though it helps to clear psoriasis fast, it may result in a rapid and severe rebound of psoriasis once steroids are stopped.

Psoriasis - Precautions

There is no food or supplements that one needs to avoid to prevent psoriasis. However green leafy vegetables are preferred in the diet against meat. One needs to prevent scratching the skin as this may cause psoriasis to flare up at the site of injury. Also, try to keep the skin as moist as possible to reduce itching and scaling. Exposure to sunlight is welcome but prevents sunburn.

If active psoriasis is present, do not scratch the plaques as this may actually worsen psoriasis. Treatment is prolonged and one should not give up treatment too soon as it may take a few weeks for some effect. REMEMBER, THERE IS NO QUICK CURE FOR PSORIASIS.


Psoriasis Psoriasis Psoriasis 01/25/2001
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