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  5. Is Psoriasis A Serious Skin Condition? Can It Be Treated?

Are you troubled by constant flare-ups of itchy and red skin with scales? And, is your regular medication not helping? If your answers to these questions are an affirmative, you could have psoriasis.

There is no need to panic. We are here to tell you all about this skin condition and your options for its treatment. So, keep reading.

What Is Psoriasis?

Psoriasis [1] is a skin-related ailment, classified as an autoimmune condition [2]. In this condition, the immune system attacks the skin’s cells, which leads to their hyper proliferation. This excessive cell production leads to a buildup, which results in scaling on the surface of the skin.

The Th-1 type of immune response is responsible for psoriasis. It affects people of fair skin more than dark skinned people.

Normally, your skin’s cells grow deep within the skin and rise to the epidermis at a slow pace, after which they fall off. This process usually takes one month. If someone has psoriasis, this process is much faster (3-4 days); the cells are produced rapidly and the ones on top haven’t yet fallen off.

What Does Psoriasis Look Like? First Signs & Symptoms

The scales on the skin in psoriasis are white or silver coloured, and can have inflammation and redness around them. They are usually formed in thick patches of reddish skin, and can also crack and bleed at times.

When the skin tends to get extra scaly or develops flakes on the joints of the arms and legs, or elsewhere on the body, it could be an early sign of psoriasis. However, the symptoms differ for each person and are also based on the type of psoriasis.

Common Symptoms:

  • Swollen joints that are also painful.
  • Scales that are whitish or silvery in colour.
  • Plaque formed on red patches that are also sore.
  • Patches that give an itchy or burning sensation.
  • Thickened nails which are pitted.

Having said that, the rarer forms of psoriasis present different symptoms. And, not everyone who has psoriasis will have all the symptoms mentioned above.

The symptoms come and go in cycles. Psoriasis can cause severe symptoms for a few days to a few weeks. Then, they could clear up and become almost invisible. A trigger can make the condition get worse or flare up if it has subsided.

Sometimes, the symptoms vanish. However, even if the usual symptoms don’t occur, it is not an assurance that the psoriasis won’t recur. It just implies that you don’t have any symptoms of the condition at the moment.

Where Does Psoriasis Occur On The Body?

Psoriasis usually occurs on the joints of the arms and legs -- the elbows and the knees. But, it can also develop elsewhere on the body on areas like the face, the neck, the scalp, the hands and the feet.

Types Of Psoriasis

There are six variants of psoriasis, though one of them - plaque psoriasis is the most common.

1. Plaque Psoriasis

This is the most common type of psoriasis and affects 90% of all patients. The condition causes symmetrical red patches on the skin that are often inflamed. They are covered with plaque or scales that are white or silver in colour and are found usually on the scalp, elbows and knees. [3]

In this condition, the plaques can exist for months and years in the same places. This condition has four subtypes:

  • Flexural, where skin on two areas of the body rub against each other or touch each other, like the groin or under the breasts.
  • Scalp psoriasis is the most common area where the disease starts. It can be in patches or cover the entire scalp with scales.
  • Psoriasis of the palms and soles of the feet where there is redness, plaque formation and scaling. These can even spread out on to the wrists or the edges of the soles of the feet.
  • Seborrhoeic psoriasis shows up as thin lesions, separate from each other and scaly. It usually occurs in the areas around the nose and mouth, ears, scalp, hairline, eyebrows etc.

2. Guttate Psoriasis

This form of psoriasis is usually found to occur among children. Showing up as pink spots on parts of the body like the arms, legs and the chest, these spots are not thick or inflamed like plaque psoriasis.

They are small (less than half to one centimeter) and round or oval in shape. They may even have slight itching and the acute form is common among kids and young adults.

A streptococcal throat infection can trigger a flare-up of this form of psoriasis in children. The chronic version of Guttate psoriasis is usually present in adults who have had it for a long time.

3. Nail Psoriasis

This is one form of psoriasis that has reportedly affected 40-50% of psoriasis patients. Here, the nail matrix, the nail bed and the hyponychium of the fingernails are more affected than the nails of the toes. [4]

It leads to pits in the areas near the nail matrix. Patients who have this form of psoriasis usually develop symptoms of psoriatic arthritis before it shows up on the skin.

4. Pustular Psoriasis

Seen mostly among adults, pustular psoriasis causes blisters that are white in colour and full of pus. There are also larger areas of red and inflamed skin. It is restricted to smaller parts of the body such as the hands and the feet.

It can spread to other areas of the body. This form of psoriasis is quite rare and is seen on the fingers and toes. It also has nail dystrophy as a symptom.

5. Inverse Psoriasis

Usually found in sweaty areas of the body, inverse psoriasis can show up as bright red, inflamed and shiny patches. These typically occur in the armpits, under the breasts and in the skin around genitalia.

6. Erythrodermic Psoriasis

This is perhaps the most severe form of psoriasis. Erythrodermic psoriasis is also very rare. It engulfs large parts of the body simultaneously, giving the skin a sunburnt appearance. The scales are known to fall off in big portions, almost like sheets.

Word of Caution:

Sometimes, this condition is accompanied with fever or other ailments. It can also be a life-threatening condition. So immediate medical attention is recommended.

What Causes And Triggers Psoriasis?

While research has not been able to clearly state what causes psoriasis, it has narrowed it down to the human system and genetics as the primary factors.

There can be many triggers for symptoms to show up. And, they affect people differently; someone who drinks alcohol regularly may have a flare-up more often than someone who doesn’t.

Here are some of the main causes and triggers that have been widely observed:

1. Genetics

Psoriasis, as research has shown, may be hereditary. But, this percentage is quite small and you may develop this condition only if your immediate family members are affected.

2. Weather

The changing of seasons can be a trigger for a flare-up of psoriasis. The disease is known to get worse in winter.

3. Injuries

If you have an accident, cut yourself with a knife, or scraped your knee or elbow, it can trigger an outbreak. If you get sunburn, that too can cause a flare-up.

4. Medication

Lithium, shots and vaccines; and medicines consumed for high blood pressure and malaria (chloroquine) can be triggers for psoriasis. If a person is taking systemic steroids, [5] their withdrawal can be a trigger.

5. Infection

The primary cause of psoriasis is the fact that it is an autoimmune condition where the immune system attacks healthy cells. If you have an infection in the throat or elsewhere, your immune system will step up to fight it, which can be a trigger for psoriasis. The condition strep throat [6] is usually a trigger.

6. Stress

External factors such as a high level of stress due to personal or professional reasons can cause a flare-up. Reducing or managing stress levels better can bring down the frequency of an outbreak.

7. Substance Abuse

People who consume alcohol beyond normal levels can experience outbreaks more often than others. If you reduce or stop drinking completely, it will not only reduce flare-ups of psoriasis, but will benefit your skin and internal organs too.

Treatment Options For Psoriasis

If one were to consider allopathy, then treatment usually involves controlling the outbreaks and reducing the symptoms while providing relief to the skin. However, Ayurveda and Homoeopathy have treatment options that are more holistic in nature. Their treatments claim to cure it completely, leaving slightly scarred skin.

In allopathy, treatment is through topical creams, oral or injected medication or light therapy. Treatment options for psoriasis include:

1. Medical Treatments

A. Salicylic Acid

Salicylic acid is mostly used in treating this condition and a host of other skin ailments. It is defined as a keratolytic, as it peels off the top layer of the skin when applied. When used for the treatment of psoriasis, it removes the scaly patches of the skin, making it softer. [7]

Side effects:

Formulations with salicylic acid present in higher concentration can irritate the skin if left on for long periods of time. The body too can absorb it if it is applied over many areas of the skin. If applied on the scalp, it is known to weaken the hair shaft causing breakage and hair loss.

B. Coal Tar

Interestingly, coal tar, made from wood or coal is used for treating psoriasis. If it is a concentrated formulation, it works faster. Coal tar can reverse the damage on the skin and slow down the production of skin cells. It may also help to reduce inflammation and scaling.

Side effects:

Tar can cause redness on the skin and dry it out further. It also sensitises the skin to sunlight. Hence, using sunscreen and staying out of the sun are vital.

C. Cyclosporine and Methotrexate

This medication, used to treat rheumatoid arthritis, tones down the response of the immune system to ensure it doesn’t attack your skin’s cells. It eases the symptoms of psoriasis, but a weakened immune system could lead to you being vulnerable to other health issues and infections.

Side effects:

Methotrexate also suppresses the immune system. But if used in lower doses, can have fewer side effects. Long term side effects can lead to lowered red and white blood cells in the blood and liver damage. Side effects of cyclosporine could include high blood pressure and kidney problems.

D. Retinoids

Retinoids are also commonly used to treat skin related issues. Retinoids, when taken orally, can help slow down the cell production. But, the symptoms are back once you stop using retinoids.

Side effects:

Inflammation of the lips and hair loss may occur. Retinoids are not recommended for pregnant women and those planning a pregnancy for the next three years as they may cause congenital birth defects.

E. Biologics

This medication is administered through injections or intravenously. It acts on the immune system, altering it by blocking the interaction between the inflammatory pathways and your immune system.

F. UV Light Therapy

Here, ultraviolet or natural light is used as treatment. Sunlight or the UVA and UVB rays present in sunlight can kill the white blood cells that attack the normal skin cells. Sunlight can help in providing relief for mild and moderate symptoms only.

For those with severe symptoms, a combination therapy of one or more treatment types help to reduce symptoms. Sometimes, the skin stops responding to treatments in which case, people have to change the mode of treatment being used.

G. Alternative Treatment Options

Homoeopathy and Ayurveda have treatment options available for psoriasis without any known side effects. Homoeopathy [8] approaches the problem holistically where the person’s overall health both physical and mental are treated. It also treats the symptoms of psoriasis to give relief.

Ayurveda too approaches the problem in multiple ways by treating the doshas that cause an imbalance; with panchakarma, purgation treatments and changing the dietary habits of the person. There are also some herbal remedies involved.

In both Homoeopathy and Ayurveda, professional help is recommended.

2. Home Remedies

A. Turmeric

A known anti-inflammatory and potent antioxidant, thanks to the presence of curcumin, which is the active ingredient in turmeric. It can reduce inflammation and psoriatic arthritis. Curcumin is available in a concentrated form as a dietary supplement.

B. Oats

Though not proven, some reports suggest that a bath with oatmeal or a paste made from oats, can reduce symptoms of psoriasis like itching.

C. Apple Cider Vinegar

Organic Apple Cider Vinegar can help in reducing itching on the scalp due to psoriasis. Diluting it with water in equal quantities and applying frequently can also help, if your scalp feels a burning sensation. Rinse off after the scalp is dry.

Note:

If your skin is cracked or bleeding, avoid using ACV.

D. Aloe Vera

Research shows that applying aloe vera gel on the skin, even up to thrice a day can relieve redness and scaling. If you are buying a branded cream or gel, it should contain 0.5% of aloe.

E. Capsaicin

A known anti-inflammatory, capsaicin is what gives chillies and peppers their spice quotient. When used in topical formulations, it can reduce inflammation, ease pain if any and also control the redness and scaling. There may be a burning sensation when it is applied on the skin.

F. Dead Sea Salt

A known remedy to ease itching and reduce the scales that occur in psoriasis is by adding epsom salts, or dead sea salts to your bath water. Make sure the water is warm and not hot; and soak in it for 15 minutes or so. Moisturise your skin after you shower to prevent dryness.

G. Tea Tree Oil

Tea tree oil is a known antiseptic and can be used on the skin. Shampoos using this ingredient have helped relieve an itchy scalp for some people. An allergy test before using tea tree oil is recommended.

Foods That Trigger A Flare-Up?

Avoid inflammation-causing foods. These include red meat, dairy products, saturated fats, refined and processed foods. There is some evidence that fruits and vegetables such as brinjals, potatoes, tomatoes, paprika and cayenne pepper (not black pepper) can trigger some symptoms.

According to Ayurveda, the intake of contradictory foods like fish and milk can trigger symptoms. Also excessive intake of fresh grains, dairy, fish, black gram (urad dal), raddish, sesame seeds (til), jaggery and salty and sour foods can cause a flare-up.

Tips To Manage - DOs And DON’Ts

Psoriasis can be managed and flare-ups can be controlled with the right steps taken to prevent symptoms.

DOs

1. Weight Loss

Losing weight can help reduce the symptoms of psoriasis, toning down its intensity. While the connection between weight loss and psoriasis is not known, slimming down may also help your body absorb and process the medication better.

2. Vitamin Supplements

If you tick all the boxes on your diet and avoid triggers, you still might need some help with getting the right nutrients. Your doctor can advise you if you need some and even prescribe the right ones for you.

3. Emotional Health

People who have psoriasis are more prone to mental health issues like low self esteem and depression. Seeking professional help and joining a support group can go a long way in helping you feel better.

4. Eat More Of Omega-3 Rich Foods

Increase your intake of lean protein and Omega-3 rich foods -- seafood including prawns, sardines and salmon. Vegetarian sources of Omega-3 food include soybeans, flax seeds and walnuts.

DON’Ts

1. Alcohol And Cigarettes

Alcohol is a known trigger and can increase the frequency of flare-ups. Ideally, you should stop drinking completely; or cut down severely at the very least. Cutting down on cigarettes or stopping completely can improve your health and reduce symptoms.

2. Stress

Stress is a trigger for many ailments; especially psoriasis. Reducing and managing stress levels with practices such as meditation, yoga and exercise can help control outbreaks.

3. Strong Fragrances

The use of strong fragrances, in perfumes, bath gels, soaps or even shampoos and conditioners can trigger a flare-up. It is best to use mild or hypoallergenic products that do not have strong scents.

Is Psoriasis Contagious?

No, psoriasis is not contagious. Since it is an autoimmune condition, it cannot be transmitted from one person to another; unless there is a hereditary factor involved.

What Organs Can Get Affected

Psoriasis can increase a person’s risk of cardiovascular disease, diabetes and high blood pressure. Hence, the heart and the pancreas may be affected if a person has diabetes. [9]

What Happens If It Is Not Treated?

In some cases, the symptoms flare up and fade away on their own. However, if left untreated, it may lead to psoriatic arthritis. This affects the joints of the arms and legs, and the spine in some cases.

Wrapping Up

Psoriasis as a skin condition can be painful, difficult to manage and quite uncomfortable. But with the right treatments as mentioned above, symptoms can be controlled and triggers can be avoided. Alternate remedies do provide long term relief. However, ignoring or not taking care of the problem won’t make it go away. Do consult your doctor for the right solutions for your condition.

Did You Know?

  • According to the American Academy of Dermatology (AAD), 80% of people who have the condition have plaque psoriasis.
  • According to the National Psoriasis Foundation (NPF), approximately 2-3% of people with the genes develop psoriasis.
  • Psoriasis can be hereditary in 7-36% of patients. If one of your parents has psoriasis, there is a 7% chance you will get it and if both parents have it, the chances shoot up to 41%.
  • Statistics show that psoriatic arthritis affects 5-20% of the patients who have cutaneous psoriasis.

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