Psoriasis affects an estimated 2% of the world's population.
That means there are 125 million people around the world who live with distressing red rashes all over their body, which itch, pain, and sometimes even bleed.
Rashes that cause everyone around to treat them like untouchables, even though they are not contagious.
That's why we decided to cover this topic in-depth with Dr. Mukta Sachdev, consultant dermatologist at Manipal Hospitals in Bangalore.
Please note: Phrases in [square brackets] are inputs from us.
1. What is psoriasis?
Psoriasis is a common skin condition caused by excessive production of the uppermost layer of the skin.
It typically affects the elbows, knees, lower back, and scalp, but can also affect the palms of the hand, soles of the feet, nails, groin, and sometimes the whole body.
2. It looks contagious. Is it?
No, psoriasis is not at all a communicable disease.
One will not contract it by shaking hands, hugging, or sharing fomites [like clothes, utensils, and furniture].
3. It is known that psoriasis is an autoimmune disorder. What causes the immune system to fail this way? Is it genetics? Or is it because of exposure to certain triggering factors?
The cause of psoriasis is multi-factorial.
One, patients with psoriasis can have genetic predisposition to the disease. The gene responsible for this has already been determined.
Therefore, a patient is at higher risk, if they have a positive family history of psoriasis.
Two, certain environmental factors trigger the exacerbation of this disorder.
Triggers like cold temperatures, trauma, infections (like streptococcal, staphylococcal, and HIV infections), drinking alcohol, smoking, and drugs (like blood pressure medicine, heart medicine, anti-psychotic drugs, malaria drugs), and withdrawal of oral steroids.
Three, hyperactivity of immune cells also plays a role in psoriasis.
And finally, stress.
It has been documented that mental or physical stress worsens this disorder.
4. Why do Streptococcal infections precipitate psoriasis? How common is this?
Psoriasis is related to hyper-stimulation of T-cell activity.
In streptococcal infections, peptides of the bacteria (streptococcal superantigens) cross-react with dermal collagen [of the skin] and cause increased T cells activity in patients.
This type of psoriasis is called Guttate Psoriasis.
5. Why do certain drugs, like ibuprofen (pain-killer), beta-blockers (medicine for hypertension), and hydroxychloroquine (anti-malarial) cause psoriasis?
These drugs triggers immunological cascade in the body, which worsens psoriasis.
6. What are the major types of psoriasis? Which one is the most common?
Chronic plaque psoriasis: [Red plaques on the skin with loose silver scales that itch, crack, pain, and bleed. It affects your fingernails, toenails, and scalp as well.]
Inverse psoriasis: [Bright red and shiny form of psoriasis that is seen mainly in the armpits and groin.]
Psoriatic arthritis: [Around 10 - 30% patients suffering from psoriasis get psoriatic arthritis, which affects almost all joints, and causes swelling and excruciating pain.]
Guttate psoriasis: [Starts early in childhood or adolescence, and is characterized by small, red spots on the arms, legs, and torso.]
Pustular psoriasis: [Red, scaly plaques over the skin, which also have oozing pustules.]
Erythrodermic psoriasis: [Occurs periodically, and is characterized by fiery red plaques with heavy shedding of scales. Needs immediate medical attention.]
Out of all these, chronic plaque psoriasis is the commonest type.
7. Tell us more about erythrodermic psoriasis. What should people do if they have it?
Erythrodermic psoriasis presents as generalized redness, pain, itching, and presence of fine scales. Various pustular forms may also exist.
It typically encompasses nearly the entire surface area of the body. And may be accompanied by fever, chills, low body temperature, and dehydration.
Patients with severe pustular or erythrodermic psoriasis require hospitalization for management of pain, rashes, nutrition and other systemic conditions.
Older patients with erythrodermic psoriasis may also experience cardiac instability and low blood pressure due to massive blood shunting in the skin.
8. Why is psoriasis cyclic in nature, even if it is an autoimmune disorder?
Psoriasis is a multifactorial complex disease. However, certain factors can trigger and worsen it. Such as infections, cold winter season, stress, and certain drugs.
9. Is psoriasis curable?
No, it is not curable in spite of multiple treatment options being available. However, with the treatments, psoriasis completely resolves or becomes better.
The goal of the treating dermatologist is to keep the disease in its remission period (disease free period) for as long as possible.
10. What are the various treatment modalities for psoriasis based on the degree of its spread (mild, moderate, and severe)?
There are various treatment modalities available in India. But the choice of treatment depends upon the site involved, percentage of the body involved, recalcitrant [resistant] nature of the disease, and other co-morbidities in the patient.
The following are topical treatments:-
#1 Topical corticosteroid: Mild to superpotent depending upon the site.
Should be used for only short durations.
#2 Topical salicylic acid: Used alone or in combination with topical corticosteroids.
#3 Non-steroid treatment: Usually used for maintenance once the thick plaque becomes better. It includes use of immunomodulators like tacrolimus, vitamin D analogs (calcipotriol), vitamin A and derivatives, and irritants like coal tar and dithranol (especially in scalp psoriasis).
Systemic treatment is given by mouth or by injections in severe cases. And should be given under a physician's strict supervision.
These are methotrexate, vitamin A derivatives (acitretin), cyclosporine, 6-thioguanine, azathioprine, or hydroxyurea.
Biological agents have also been recently added to the list of treatment options for psoriasis.
Phototherapy is also an option, which is a light therapy carried out as an out-patient procedure in hospitals and clinics.
Other than these, general measures must also be taken as they are equally important in maintaining longer remission periods.
Measures like keeping the skin moisturized, keep the stress level low, and cutting out the habits of smoking and drinking alcohol.
11. Systemic psoriasis medication can sometimes have some harmful drug interactions, which includes, precipitating type 2 diabetes, stroke, and heart attack. Tell us a bit more about it. And what should people do if they get psoriasis on top of any pre-existing medical conditions.
Systemic psoriasis medications are immune system stabilizing drugs. Hence, they should be taken only under supervision to detect side-effects early, if any.
Psoriasis patients with associated pre-existing medical conditions should be treated through a multi-disciplinary approach in the presence of a dermatologist, rheumatologist, general physician, cardiologist, and orthopedic surgeon.
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