Psoriasis

Psoriasis is a chronic, inflammatory disease which can affect the skin, joints and nails. The causes of psoriasis are not fully understood and are the subject of ongoing research. In psoriasis, the immune system is mistakenly activated, which leads to overproduction of skin cells. Skin cells build up too rapidly on the surface of the skin, forming raised, red, scaly patches (called plaques). These plaques are often itchy and sometimes painful. Psoriasis lesions commonly appear on the scalp, limbs and lower back, but they can occur anywhere on the body.
Some people are not very affected by their psoriasis symptoms, but for others, psoriasis is a disabling and embarrassing condition that affects their lifestyle and their interactions with others. There are many available treatments that may help to relieve symptoms and improve daily life.

IMPORTANT FACTS ABOUT PSORIASIS
1. Psoriasis is not contagious.
2. Sufferers develop psoriasis between the ages of 15-20 years or later between 50-60 years. Around 75% of patients are affected before the age of 40.
3. Psoriasis varies from person to person in severity, in clinical presentation and how it responds to treatments.
4. The scalp and limbs are the most common places where psoriasis appears, but it can occur anywhere on the body, especially the knees, elbows and trunk.

Symptoms
Symptoms of psoriasis vary from person to person and may include one or more of the following features:
1. Thick, red patches of skin (plaques) variable in size covered with silvery scales
2. Itching
3. Lesions on the body
4. Nail psoriasis and arthritis may be present

Disease severity
The severity of psoriasis can range from a few spots of scaling in only certain parts of the body to major eruptions that cover large areas and are difficult to treat. Mild cases may be a nuisance, but more severe cases can be painful, disfiguring and disabling. Roughly 20% of psoriasis case are moderate to severe.

Diagnosis
No special blood tests or diagnostic tools exist to diagnose psoriasis. A dermatologist or other health care provider diagnoses psoriasis from the signs and symptoms by examining the entire skin surface. Sometimes a skin biopsy is taken and examined under the microscope to help differentiate between psoriasis and other disorders.

Causes
The causes of psoriasis are not fully understood today. The current consensus is that the immune system, genetics and the environment (e.g. stress, cold weather, etc.) all play major roles in the development of psoriasis. As a result there is skin inflammation accompanied by overproduction of skin cells.
Cells in the upper skin layer normally mature and are shed from the skin’s surface every 28 to 30 days. With psoriasis, the cells can mature in 3 to 6 days then move to the skin surface and pile up.
Researchers think that both genetic and environmental factors play a role in causing T cells to malfunction.
a. Scientists believe that at least 10% of the general population inherits one or more of the genes that create a predisposition to psoriasis
b. However, only 2 to 3% of the population develops the disease
Researchers believe that for a person to develop psoriasis, the individual must have a combination of the genes that cause psoriasis and be exposed to specific external factors known as “triggers.”

Psoriasis Triggers
Like many other skin conditions, scalp psoriasis symptoms may come and go in cycles. Some people may not have symptoms for weeks, even months. You may notice that certain factors in your daily life may worsen (“trigger”) your scalp psoriasis symptoms to flare-up. Trigger factors can be different from one person to another. It is important to be aware of the factors and avoid them.

Factors that may trigger psoriasis include:
Infection • Bacterial throat infection
Stress • Relaxation and stress reduction may help prevent stress from impacting psoriasis
Injury to skin • Cut or scraped skin, severe sunburn
Other suspected factors • Smoking
• Heavy alcohol consumption

Risk Factors
Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:
Family history The most significant risk factor for psoriasis is having a family history of the disease. 1 out of 3 psoriatic patients has a close relative who also suffers from the disease.
Other medical conditions People with HIV are more likely to develop psoriasis than people with healthy immune systems.
Children and young adults with recurring infections – particularly streptococcal throat infection – may also be at increased risk.
Stress Stress can impact your immune system and may increase your risk of developing or worsening your psoriasis.
Obesity Excess weight increases your risk of psoriasis. In addition, plaques associated with all types of psoriasis often develop in skin creases and folds.
Smoking and alcohol Smoking tobacco and alcohol consumption increase your risk of developing or worsening psoriasis.

Treatments
There are many treatment options which can help control psoriasis and offer significant relief of its symptoms.
Psoriasis treatments aim to:
a. Interrupt the cycle that causes an increased production of skin cells. This reduces inflammation and plaque formation
b. Remove scales and smooth the skin
Your physician will help you to decide which treatment is best for you. In addition, you may want to consider the following factors when selecting a treatment that is agreeable to you:
a. First, the treatment should never be worse than the psoriasis itself!
b. When choosing the treatment your lifestyle, available time and your budget has to be taken into account to help decide among the options
c. The treatment has to be used until the condition is under control or as directed by your doctor. BUT! Remember that some products should only be used for a limited period of time because of risks of side effects, so speak to your physician about how long you can use the product safely.
d. Keep in mind: treatment compliance strongly influences treatment effectiveness (If you don’t use it, it won’t work! )

Types of Treatment
Treatments for scalp psoriasis can be divided into 3 main types:
a. Topical treatments (creams, foams, lotions or ointments applied to the skin)
b. Light (photo) therapy
c. Systemic therapies (taken by pill or injection)
For mild to moderate psoriasis, topical treatments can in many cases be used effectively on their own. But when the disease is more severe, your doctor may prescribe a regimen of different therapies to manage symptoms over time.
Attention!
Pregnant or breastfeeding women should consult a pharmacist or physician before taking any medication, in order to avoid doing harm to themselves or their babies. Make certain that you read the specific safety information about the therapy(s) prescribed for you, and speak to your physician about safety issues or concerns.

Light (photo) therapies
These treatments use artificial ultraviolet (UV) light to treat psoriasis.

Main systemic Medications
The oral medications and biologics may help to clear psoriasis, but are only appropriate for moderate to severe cases. These drugs are potent and can have side effects that must be considered before taking.
Practical Treatment Tips
Preparing the Skin for Topical Therapy
In some areas of the world, it is recommended that the surface of a psoriasis plaque be “smoothed” to allow better penetration of the topical medication. Your doctor my suggest that you use a preparation containing salicylic acid or lactic acid before you apply other topical treatments. Make certain that you understand your doctor’s instructions before using this type of regimen, as it may result in additional irritation. Note that even if you do not you a pre-treatment preparation, the skin and plaques should be kept clean using a gentle cleanser to remove dirt and debris from the area.
It is important to always use topical medications as prescribed by your doctor. The following tips may help you in applying topical medications to help treat your psoriasis.

Effective application of topical medications
1. Apply topical treatments only to psoriasis lesions if possible. This will help to avoid irritating unaffected skin.
2. A thin layer of medication is generally sufficient.
3. Wash your hands thoroughly after applying topical treatments, unless treating the hands.
4. Do not apply topical treatments in areas of the skin not discussed with your doctor, especially near the eyes, genitals or other sensitive areas.
5. When prescribed a regimen of topical treatments, apply them exactly as your physician instructed.
6. Cleanse or prepare the lesions for treatment as directed by your doctor. Do not cover or ‘occlude’ your topical medication with other products like moisturizers or other medications unless specifically directed to do so by your doctor.

HELPFUL HINT
Protect healthy skin with a thin layer of petroleum jelly before applying medications to the psoriatic lesions.

CAUTION:
Never cover or ‘occlude’ the treated skin, unless specifically directed by your doctor.

Stain protection
Here is a list of some easy and accessible household items you can use to protect from staining while treatments are active:
a. Towels
b. Plastic wrap
c. Plastic produce bags
d. Cotton socks
Do not occlude treated lesions and skin unless specifically directed by your doctor.
Keeping a Psoriasis Diary

KEY MESSAGES:
The goal of keeping a psoriasis diary is to help you and your doctor better manage your psoriasis symptoms and therapies.
A psoriasis diary can be useful for identifying triggers and determining the treatments that work well for you in relieving your psoriasis symptoms. The example diary here can help you to follow improvements in a psoriasis flare-up. Noting the factors that play a role in your psoriasis flare-ups is a small task, but it may go a long way in deciding on an effective treatment plan that works for you!
It is a good idea to take your psoriasis diary with you to your doctor’s visits. Make sure it is clear and legible. If you arrive prepared, many of the questions your doctor will ask can be answered quickly and more thoroughly.

Factors to Include in Your Psoriasis Diary:
1. When does your psoriasis seem to worsen?
a. This will help you to identify what factors trigger your psoriasis flare ups
b. When looking back at your diary, you may see that your psoriasis often occurs after certain types of events (e.g. environmental factors, emotional stress, with certain medications, after drinking alcohol, etc)
2. On a calendar, keep track of any treatments used for your psoriasis and the effect it had on your lesions
a. Make sure to record which symptoms, if any, improved after each treatment (e.g. itchiness, redness, scaling, etc)
b. Record changes in symptoms on a scale of 1 to 10, where 10 is the worse and 1 is better
Before beginning treatment for a flare-up, select and record your most distressing psoriasis symptom and note its severity
Use the table to record the psoriasis medications you are using, and how this symptom improves or worsens with each application of your psoriasis therapy. This will help you to follow the effectiveness of your psoriasis therapy.

See You Tomorrow

Until then, take care. Bye.

Meena

Reference :- https://www.psoriasis.org/