Dealing with Psoriasis
Psoriasis is a chronic autoimmune disease characterized by thick, red, itchy patches on the skin.
These patches are covered with silvery scales and usually appear on your elbows, knees, scalp and lower back; but may cover the entire skin surface in severe cases. Affected areas look contagious, but they are not.
Psoriasis occurs when the immune system triggers the skin cells to multiply at an abnormally rapid speed. The extra skin cells then pile up on the surface of the skin to form raised, red patches that can be painful.
The exact cause of psoriasis is unknown, but it is believed that genetics plays a major role. There is no cure for the disease, but there are ways to manage it.
Psychologically, the condition may lead to feelings of fear and insecurity in the affected person. Prolonged battle with psoriasis may cause depression and anxiety attacks.
Psoriasis Signs and Symptoms
The physical manifestation of psoriasis depends on the type that you have. One type may evolve into another, though it’s also possible to have more than one kind of psoriasis at the same time.
Typical symptoms of the condition include:
- Thick red patches covered with silver-colored scales on the surface of the skin.
- Extreme dryness on localized areas of the skin (Though in very severe cases, psoriasis may cover the whole body).
- Itching, sore and burning sensation around the affected area.
- Thickened, ridged and discolored fingernails.
- Swollen, painful joints.
Different Types of Psoriasis
- Plaque psoriasis: also known as psoriasis vulgaris, is the most common form of the disease. This appears as dry, raised, red skin lesions (plaques) with white / silver scales on top. The itchy and painful plaques can occur anywhere on the body, but commonly affects the back of the forearms, elbows, knees, shins, lower back, the scalps and the area around the navel.
- Guttate psoriasis: commonly affects children and teenagers, and characterized by small (less than 1 cm in size) drop-shaped lesions on the arms, legs, chest and scalp. The plaques may also be covered by scales but they are not as thick as in plaque psoriasis. It usually occurs after a bout with a bacterial infection such as a streptococcal throat infection. Guttate psoriasis may disappear completely on its own after a few weeks, but it might also come back or develop into plaque psoriasis.
- Inverse psoriasis: also called flexular psoriasis; this occurs in skin folds or creases, such as the armpits, groin, under the breasts and between the buttocks. Inverse psoriasis causes smooth red patches in these areas. It can feel particularly sensitive during hot weather, as it is worsened by sweating and friction (tight, rough clothing around the area). Fungal infections might trigger inverse psoriasis.
- Pustular psoriasis: this type of psoriasis is less common, but tends to develop quickly. It appears in the form of small non-infectious pus-filled blisters on a wide area of the skin or in smaller localized areas. There are 3 kinds of pustular psoriasis:
- Generalized pustular psoriasis or von Zumbusch psoriasis occurs in widespread patches and may be accompanied by fever, chills, weight loss, fatigue, severe itching and diarrhea.
Palmoplantar pustular psoriasis commonly appears on the palms of the hand and the soles of the feet. The pus-filled pustules evolve into round, brown, scaly spots which gradually peel off. Palmoplantar pustular psoriasis may occur in repeated episodes every few days or weeks.
Acropustulosis affects fingers and toes. When the pustules burst, they leave inflamed areas that may ooze or become scaly and lead to nail deformities.
- Erythrodermic psoriasis: a rare but very severe form of psoriasis wherein the entire body is covered with a red, peeling rash. Intense itching and burning may accompany the rash. Erythrodermic psoriasis may also lead to loss in body proteins and fluid, which may in turn cause more serious problems such as infection, heart failure, hypothermia, dehydration and malnutrition.
- Nail psoriasis: affects the fingernails and toenails, causing dents, discoloration and abnormal nail growth. It may cause onycholysis- a condition wherein nails become loose and separate from the nail bed. In severe cases, nails may crumble.
- Scalp psoriasis: occurs on parts of the scalp, whole scalp or may extend beyond the hairline. Scalp psoriasis causes red, itchy, scaly areas that lead to flakes of dead skin when scratched.
- Psoriatic arthritis: involves swollen, painful inflammation of the joints, most commonly around the fingers and toes; but can affect any joint in the body. 30% of individuals with psoriasis will develop psoriatic arthritis. Skin manifestations of psoriasis typically appears days or weeks before the onset of psoriatic arthritis. In severe cases, the condition might lead to permanent deformity.
Psoriasis Causes and Risk Factors
Overactive T lymphocyte or T cells is the main culprit behind psoriasis. In a healthy immune system, T cells detect and fight off viruses, bacteria and other foreign substances. In individuals with psoriasis, the T cells attack the skin cells, which triggers more white blood cells to enter the outer layer of the skin.
Skin cells then start to multiply at an abnormal speed– cutting the lead time of the cycle from weeks to days. As the body cannot slough off the dead skin cells quickly enough, they pile up on the surface of the skin and result in thick, red, scaly patches.
The reasons as to why T cells malfunction in certain people is still unknown. Genetics (family history of the disease) and stress are found to be major contributing factors.
Other suspected psoriasis triggers are:
- Skin injury or infection, as such a scrape, cut, insect bite or severe sunburn- wherein plaques formed on the affected area (also known as the Koebner phenomenon).
- Infections such as streptococcal throat infection.
- Heavy consumption of alcohol.
- Hormonal changes, especially during puberty, menopause or pregnancy.
- Certain medications such as lithium (used to treat mental disorders), chloroquine and hydroxychloroquine (antimalarial drugs), indomethacin (anti-inflammatory drug), and inderal (used to treat high blood pressure).
- Other immune disorders, such as HIV.
- Studies have found a link between psoriasis and cardiovascular diseases. The chronic inflammation of psoriasis puts affected individuals at higher risk for heart attacks and strokes.
A physical examination is usually enough to diagnose psoriasis. Your physician or dermatologist will study the appearance of your skin, scalp and nails. There is no need for blood tests or special procedures to pinpoint psoriasis.
However, psoriasis may be confused with other skin ailment such as:
- Seborrheic dermatitis / eczema
- Discoid eczema
- Lichen planus
- Tinea corporis / Ringworm (of the body)
- Pityriasis rosea
- Nail fungus
- Cutaneous T cell lymphoma
- Rash associated with secondary syphilis
If deemed necessary, your doctor may perform a skin biopsy to identify the exact type of psoriasis and to rule out other skin disorders.
See your doctor immediately if you suspect that you have psoriasis. Be sure to let him know if you experience any of the following:
- Discomfort and pain affecting your sleep and ability to perform everyday duties.
- Affected areas are expanding.
- Stiffness and painful, swollen joints that hinder your movement.
Treatment Options for Psoriasis
There is no definite cure for psoriasis but different treatment options can help manage the condition. With the right combination of treatments, 85% to 90% of sufferers can find relief from psoriasis symptoms.
Topical creams, ointments and lotions can be used to treat mild to moderate psoriasis. Options include:
- Topical corticosteroids
- Vitamin D analogues (such as Calcipotriene/Dovonex/Sorilux and Calcitriol/Rocaltrol/Vectical).
- Anthralin (Dritho-Scalp)
- Topical retinoids, specifically tazarotene (Tazorac and Avage)
- Calcineurin inhibitors , specifically tacrolimus (Prograf) and pimecrolimus (Elidel)
- Salicylic acid
- Coal tar (Balnetar, Pentrax, Polytar, or Tera-Gel)
- Moisturizers (ointment-based recommended).
For severe psoriasis, doctors might recommend a combination of topical and oral treatments. However, due to the possible serious side effects of oral medications, they should be taken in limited periods and quantities only. Strictly follow your doctor’s instructions and never overdose.
Some oral treatments for psoriasis are:
- Other medications such as acitretin (Soriatane), apremilast (Otezla), cyclosporine (Neoral, Sandimmune), and methotrexate (Trexall)
Biologics- drugs that alter the immune system, have been approved as treatment for severe psoriasis, especially psoriatic arthritis. These drugs are administered via intravenous infusion, intramuscular injection or subcutaneous injection:
- etanercept (Enbrel)
- infliximab (Remicade)
- adalimumab (Humira)
- ustekinumab (Stelara)
Light therapy or phototherapy uses natural or artificial ultraviolet light to treat conditions. It includes the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light.
The different kinds of light therapy for the treatment of psoriasis are:
- Natural sunlight
- UVB phototherapy
- Narrow band UVB therapy
- Goeckerman therapy
- Photochemotherapy or psoralen plus ultraviolet A (PUVA)
- Excimer laser
Natural remedies might help relieve some of the pain, itching, inflammation and other symptoms associated with psoriasis.
Some commonly used home remedies include:
- Warm bath with oil, colloidal oatmeal, Epsom salt or Dead Sea salt.
- Aloe vera cream
- Cayenne pepper (rubbed directly into the lesions)
- Apple cider vinegar dip
- Wet skin wraps
- Fish oil supplements
Some individuals may be more predisposed to psoriasis, especially those with a family history of the disease. However, you can still do your best to prevent psoriasis from happening to you by following these tips:
- Reduce stress.
Stress lowers our immune response and causes inflammation in the body. Whether it’s psoriasis or any other ailment, stress is the mother of all diseases.
Reduce your stress levels by meditating, listening to relaxing music, taking a warm bath, doing yoga stretches, taking deep breathes or talking to a partner or friend.
- Eat healthy.
Adapt an anti-inflammatory diet. Some food to limit are: red meat, dairy
products, gluten (whole wheat flour), high-fat food, processed food and junk food, refined sugars, nightshades, such as tomatoes, potatoes, eggplants and peppers; and citrus fruits.
Consume more food rich in Omega 3, such as: fatty fish (salmon, sardines and tuna), seeds (flaxseeds, chia seeds, hemp seeds, sunflower seeds and pumpkin seeds), nuts (walnuts and almonds), green leafy vegetables (spinach and kale).
Try to minimize your intake of meat products and load up on fresh fruits and vegetables; oily fish and grains.
- Take regular baths.
Using natural bath solutions which includes Epsom salt, Dead Sea salt, oils or colloidal oatmeal can help slough off dead skin cells and relieve itching.
Avoid hot water and harsh soaps which can irritate and dry the skin. Use mild soaps that contain natural oils and fats.
- Apply moisturizer.
Ointment-based moisturizers are recommended since they are more readily absorbed into the skin. If your skin is very dry, you may want to opt for oils, which are more effective in sealing in the moisture.
Reapply moisturizers several times in a day, especially during cold, dry weather.
- Get more natural Vitamin D.
Soak in the natural sunlight. 20 minutes of early morning (before 9:30 am) sun exposure is enough to supply your skin and body with the needed amount of Vitamin D.
However, overexposure to sunlight can also trigger psoriasis and eczema flare-ups and increase the risk of skin cancer. Avoid sunbathing for prolonged periods of time especially during the hours when the sun is at its strongest (noon time).
- Avoid drinking alcohol and smoking.
Break the bad habits of consuming alcoholic beverages and smoking as these can trigger psoriasis and reduce your body’s capability of absorbing needed nutrients.
- Exercise daily.
Physical movement and activities benefits the body in countless ways, including improving blood and oxygen circulation around the body.
Exercising also releases endorphins (a happy hormone) that alleviates stress and can counter inflammation in the body.
Obesity is also associated with increased risk of developing psoriasis so try to achieve a healthy weight level.
Make sure to take a warm shower or bath after exercising to remove sweat from the surface of the skin.
- Supplement with Omega 3 fatty acids
Omega 3 fatty acids, found in fish oil, flaxseed, chia seeds and hemp seeds, are known for their anti-inflammatory properties.
Taking fish oil capsules that contain both eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) ensures that your body gets the needed amount of healthy fats.
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