Definition

Psoriasis is a chronic skin condition characterized by a rash with itchy, scaly patches, predominantly affecting the knees, elbows, and scalp. Although incurable, it typically follows a cyclical pattern of flare-ups and remissions. This condition can develop at any age, with peak onset observed between 15-20 years and 55-60 years.

There are various forms of psoriasis, with psoriasis vulgaris being the most prevalent. The main symptoms include dry, itchy, scaly patches on areas such as the elbows, knees, lower back, and scalp. Other forms of psoriasis include:

• Nail psoriasis: leads to nail deformities, discoloration, and detachment from the nail bed.
• Guttate psoriasis: characterized by small, scaly lesions resembling dew drops on the torso, arms, and legs.
• Inverse psoriasis: resembling psoriasis vulgaris but commonly appearing in skin folds, such as the groin, buttocks, and under the breasts.
• Pustular psoriasis: identified by pus-filled blisters on the hands and soles.
• Erythrodermic psoriasis: a rare type, causing widespread red, peeling rashes with intense itching or burning.

This article will focus on psoriasis vulgaris specifically.

Causes

Psoriasis is associated with an immune system malfunction that accelerates skin cell turnover, resulting in dry, scaly patches. Although the precise cause remains unclear, current understanding points to immune system errors targeting skin cells, alongside genetic and environmental influences. Psoriasis is non-contagious.

Several factors are known to trigger psoriasis, including:

• Infections: Streptococcal infections, often associated with guttate psoriasis, or skin infections
• Weather: cold, dry climates
• Skin Trauma: Cuts, abrasions, insect bites, or sunburn
• Smoking: both active and passive exposure
• Alcohol Consumption: Excessive intake
• Certain medications, including lithium, antihypertensive drugs, and antimalarial agents
• Sudden discontinuation of corticosteroids

Risk Factor

Psoriasis can affect individuals of any age, with one-third of cases occurring in children. A family history of psoriasis significantly increases the likelihood of developing the condition, especially if one or both parents are affected. 

Additionally, smoking and alcohol consumption are recognized as contributing factors, with smoking specifically linked to both an elevated risk and greater disease severity.

Symptoms

Psoriasis is characterized by reddish or pink patches covered with white or silvery scales resembling mica. Removal of these scales can reveal pinpoint bleeding, known as the Auspitz sign. The most common sites for these plaques are the elbows, knees, scalp, and lower back, though they may appear on other body areas. The affected patches are often accompanied by pain and itching.

Diagnosis

Diagnosis of psoriasis vulgaris typically involves a review of medical history, presenting symptoms, and physical examination. Physicians observe lesions and may perform specific tests, including assessing for the Auspitz sign (bleeding points beneath the scales). In some cases, a small scratch is made on the skin to check for excessive cell growth, known as the Koebner phenomenon. A biopsy may also be performed to analyze skin tissue under a microscope.

Additional diagnostic tests can include:

• Complete Blood Count
• Liver Function Test
• Kidney Function Test
• Rheumatoid Factor: Detecting autoimmune antibodies.
• Uric Acid (Gout) Testing
• Pregnancy Test
• Hepatitis Serology

Management

Although there is no cure for psoriasis, numerous treatments are available to alleviate symptoms and reduce plaque visibility. Before initiating treatment, your doctor will evaluate how much psoriasis vulgaris is impacting your daily activities.

Typically, treatment starts with topical medications, such as corticosteroid ointments. This involves applying creams and ointments directly to affected areas. If these treatments prove ineffective or if the psoriasis is severe, your doctor may recommend phototherapy, which utilizes targeted ultraviolet light on the skin. Injectable and oral medications may also be prescribed for a more systemic effect.

Complications

Psoriasis can lead to various complications, including:

• Psoriatic arthritis An inflammatory joint disease common among psoriasis patients, resulting in joint pain, stiffness, and swelling
• Changes in Skin Pigmentation: Variations in skin color on healed plaques
• Eye Conditions:
• Conjunctivitis: inflammation of the eye’s clear layer and inner eyelids
• Blepharitis: eyelid infection
• Uveitis: inflammation of the eye’s front portion
• Obesity
• Type II Diabetes Mellitus
• High Blood Pressure
• Cardiovascular Disease
• Autoimmune Disorders: such as celiac disease and inflammatory bowel diseases, including Crohn's disease
• Mental Health Concerns: Including reduced self-esteem and depression

Prevention

Although psoriasis is largely hereditary and difficult to prevent entirely, recurrence can be minimized through the following strategies:

1. Manage stress
Psychological stress can trigger inflammatory responses in the body, increasing the likelihood of psoriasis flares. Techniques such as consulting with mental health professionals, practicing yoga, meditating, and performing relaxation exercises like deep breathing can help reduce stress.

2. Avoid certain medications
Some medications may prompt immune responses, leading to inflammation. These include:

• • Lithium, which is commonly prescribed for mood disorders.
  • Antimalarial drugs.
  • Inderal, used for hypertension.
  • Indomethacin, a pain relief medication.

If these medications are required for other conditions, consult with your doctor for alternative options.

3. Prevent skin injuries
In psoriasis patients, skin injuries may provoke psoriasis, a response known as the Koebner phenomenon. Protective measures include using sunscreen during outdoor activities, wearing long-sleeved clothing and gloves when gardening, applying mosquito repellent, and practicing caution during outdoor activities.

4. Avoid infections
Infections can prompt psoriasis flares by activating inflammatory responses. Common triggers include infections of the ears, tonsils, respiratory tract, and skin. Preventive measures include regular handwashing, avoiding the sharing of food, drinks, and utensils, and limiting contact with sick individuals, particularly children.

5. Adopt a healthy lifestyle
Excess weight may trigger psoriasis recurrence. Maintaining a healthy weight through regular exercise and a balanced diet is beneficial. For those who find dietary adjustments challenging, consulting a nutritionist may be helpful. Additionally, certain foods, such as red meat, dairy products, high-fat foods, processed items, sugars, tomatoes, potatoes, peppers, and citrus fruits, may exacerbate psoriasis.

When to See a Doctor?

If you suspect psoriasis, consult a doctor promptly to prevent the condition from worsening. Seek medical attention if the condition becomes more painful, causes significant discomfort, affects your confidence about your skin, or does not improve with current treatments.

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