Psoriasis is a common inflammatory disorder of the skin. It is an immune-mediated genetically determined skin disorder which affects the skin, nails as well as joints and has various systemic associations. Psoriasis can present at any age. Psoriasis is generally classified into early-onset and late-onset. The peak age of onset in adults is in the third and fourth decade of life, with men having slightly greater chances of being affected.
How to identify psoriasis?
There are many clinical presentations of psoriasis. The most common type is the chronic plaque-type psoriasis which presents as circumscribed, well-demarcated erythematous plaques that occur on the elbows and knees, buttocks, scalp and lower back. The scales are abundant, loose, dry and silvery-white. It can manifest on hand and foot as well, it may occur in isolation or along with elsewhere on the body. Nail involvement is also common and can be the initial and the only site of involvement in some patients. Involvement of the joints can lead to significant joint damage and disability.
Psoriasis is a disease of multifactorial origin. It is an outcome of certain environmental factors acting on individuals, especially in certain people with a specific genetic predisposition. It leads to immune dysregulation and abnormal keratinization which in turn results in the appearance of cutaneous lesions. Genetic predisposition has a significant role in psoriasis.
Some of the leading factors that can aggravate psoriasis are
- Local factors: Psoriatic lesions tend to develop at sites of injury. The trauma may be of any kind-physical, chemical, mechanical, allergic or any other nature.
- Seasonal variations: Most patients experience worsening of their skin lesions during winter. High humidity is usually beneficial.
- Emotional or stress-driven: Psoriasis is more ‘stress-sensitive’ than many other skin diseases. Emotional stress may influence the development and exacerbation of psoriasis in a large number of patients. It also lengthens the time taken to recover.
- Infections and drugs: Upper respiratory tract infections and tonsillitis may cause a flare-up of existing psoriasis. Exacerbation or even the initial manifestation of psoriasis has been observed in patients infected with HIV. Certain drugs can also trigger psoriasis.
- Smoking and alcohol: Smoking has been described as a risk factor for psoriasis. It affects the onset of psoriasis and its clinical appearance. Smoking more than 20 cigarettes daily is associated with a twofold increased risk of severe psoriasis. Heavy drinking worsens pre-existing psoriasis, with abstinence improving the severity of the disease. Obese patients are also more likely to present with severe psoriasis.
Psoriasis is usually a lifelong disease with variable periods of spontaneous improvement and worsening. Based on the extent and severity, various topical and systemic agents, along with other forms of therapy help in clearing the lesions.
Counseling the patient and explaining the nature of the disease, its non-contagious nature, its chances of remitting and relapsing and factors which lead to its exacerbation is important. Support group therapy may be beneficial.
Adopting healthy lifestyle habits like exercising, yoga, relaxation, and meditation are encouraged as they help in reducing stress and help in managing the intensity of the condition. Cessation of alcohol and smoking is also advised.
Some of the tips to prevent and manage psoriasis are
- Diet – Consume plenty of fruits, vegetables, whole grains and avoid saturated and trans fats, refined carbohydrate and processed foods. Dietary supplementation with oily fish such as mackerel, salmon, sardine or herring, might be a useful addition in the treatment.
- Baths- Daily sunbathing, sea-bathing and UV exposure are known to improve psoriasis. Bland soaps or soap substitutes should be used. Antiseptics should be avoided as they may irritate the skin.
- Emollients- Hydration and moisturizing are important in the treatment of psoriasis. They improve the skin barrier function and make it more resistant to external stressors and irritation. Ointments such as petroleum jelly or thick creams should be applied immediately after a hydrating bath or shower. It helps in reducing itching, redness, soreness, and extension of lesions.