PSORIASIS

Dr. Carla Perlas, FPDS

What is Psoriasis?

A disease that is characterized by inflammation caused by dysfunction of the immune system also called immune-mediated disease which causes inflammation in the body. A raised plaques and scales on the skin are mostly the visible signs of the inflammation.
The World Health Organization (2014) classified psoriasis as a chronic non-communicable disease, emphasizing the distress caused by misdiagnosis, inadequate treatment, and stigmatization of this disease.

What causes Psoriasis?

Although the exact cause of psoriasis is unknown, several factors such as genetics, environmental triggers, and your immune system can all play a role. As a result, psoriasis is not contagious and cannot spread from person to person.
Because of the overactive immune system that speeds up skin cell growth, the immune system and inflammation play a role in psoriasis. Normal skin cells grow and shed in a month, but in psoriasis, skin cells grow and shed in only (3) three or (4) four days, and instead of shedding, the skin cells pile up on the skin’s surface whereas, the genetics of psoriasis are complex, and it is possible to develop psoriasis even if you have no family history of the disease, as well as a triggering event may cause a change in the immune system, resulting in the onset of psoriasis symptoms, this may vary from person to person, and what may worsen your psoriasis may have no impact on someone else.
Common psoriasis triggers include;

  • Stress
  • Skin Injuries
  • Illness
  • Weather
  • Infections (e.g. strep throat, skin infection)
  • Some medications/drug reactions including lithium, prednisone and hydroxychloroquine
  • Smoking
  • Alcohol (heavy drinking)
  • Changes in hormone
  • Weight

A great way to learn about your unique set of triggers is to track them over time. Keeping records of your symptoms and triggers can help you anticipate and treat your flares.

Locations and Types of Psoriasis

Psoriasis can appear anywhere on the body even on the scalp,face ,skin folds, hands, feet and nails. Plaques can be a few small patches or can affect large areas and it’s also possible to have psoriasis plaques and scales in more than one location on the body at a time.
There are five types of Psoriasis

  • Guttate Psoriasis affects approximately 8% of people with psoriasis. This type usually begins in childhood or early adolescence, but it can begin at any age. It manifests as small, round spots called papules, which are caused by skin inflammation and commonly appear on the arms, legs, and torso. It may, however, develop papules on your face, ears, and scalp. Guttate psoriasis often appears suddenly and may be triggered by an infection such as strep throat, a streptococcal bacterial infection.
  • Pustular Psoriasis, about 3% of people with psoriasis develop pustular psoriasis. Although it can begin at any age, it is most commonly seen in older adults. Pustules, white, pus-filled, painful bumps surrounded by inflamed or reddened/discolored skin, are symptoms of pustular psoriasis. The ‘pus’ in pustules is caused by inflammation and is not contagious.
  • Plaque Psoriasis as the most common type of psoriasis, affecting approximately 80 to 90% of people with psoriasis. This manifests as raised, inflamed, scaly patches of skin that are itchy and painful. Plaques typically appear as raised, red patches covered with a silvery white buildup of dead skin cells or scale on Light skinned skin. On darker skin, the plaques may appear darker and thicker as well as more purple, grayish, or darker brown. It can appear anywhere on the body, but they are most commonly found on the scalp, knees, elbows, and torso.
    Plaques typically appear symmetrically on the body, affecting the same areas on the right and left sides of the body. Plaque psoriasis frequently coexists with nail psoriasis, which manifests as discoloration, pitting, or separation of the nail from the foreskin.
  • Inverse Psoriasis occurs in 21-30% of people with psoriasis. This manifests itself in body folds of people of color as lesions that are purple-ish, brown, or darker than the surrounding skin. On Caucasian skin, it appears as bright red lesions in body folds. It may appear smooth and shiny. Many people who have inverse psoriasis also have another type of psoriasis somewhere else on their body. Inverse psoriasis appears in the armpits, groin, under the breasts, and other skin folds on the body. Because inverse psoriasis is found in skin folds and tender areas, rubbing and sweating can complicate it further.
  • Erythrodermic Psoriasis is a very rare type of psoriasis that affects only about 2% of people who have psoriasis. It disrupts the body’s normal temperature and fluid balance, which can result in shivering episodes and edema (swelling from fluid retention) in areas such as the feet or ankles, as well as an increased risk of infection, pneumonia, and heart failure.
  • What are the treatment used for Psoriasis?

    The type and number of treatments involve are determined by the severity of your psoriasis that is determined by how much of your body it covers.
    Finding the right psoriasis treatment and understanding the severity of your psoriasis and different treatment options can help you and your dermatologist work toward meeting your treatment goals. This includes the following;

  • Topical Treatments, which come in the form of gels, ointments, or creams, are usually the first-line option for treating psoriasis. Topical treatments, when applied directly to the skin, can effectively treat psoriasis by slowing the growth of skin cells and, in some cases, decreasing inflammation and plaque buildup.
  • Light Therapy/ Phototherapy Treatment, which involves applying ultraviolet phototherapy directly to plaques and scales which can support in slowing the skin cell turnover of skin
  • Oral Systemic Treatment is another treatment option for moderate to severe psoriasis. Oral systemic work by acting on part or all of the immune system to reduce inflammation
  • Biologic Treatments, a systemic treatment option typically reserved for patients with moderate to severe psoriasis. They are frequently administered by injection or infusion. Biologics target specific proteins that are overproduced in the immune system, thereby reducing inflammation.
Reference
Raharja, A., Mahil, S. K. & Barker, J. N. (2021). Psoriasis: A Brief Overview. Royal College of Physicians. Clinical Medicine Journal. DOI: https://doi.org/10.7861/clinmed.2021-0257
Psoriasis. (2021). National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/
Psoriasis Treatments. (2019). Psoriasis Speaks: Abbvie Inc. https://www.psoriasis.com/psoriasis-treatment-doctor/psoriasis-treatment-options