Psoriasis

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Psoriasis is a common, chronic skin disease which sometimes also involves nails and joints. It affects up to 2% of the world population.
Psoriasis is not a life-threatening disease generally but recurrences are common.
Psoriasis is a disease which is treatable and can be effectively and completely controlled but is not curable.

The exact cause of psoriasis is not known. It is a complex interplay between genetics and immunology.
Genetic susceptibility and environmental factors are responsible for disease.
Normally the epidermis or outer layer of skin is continuously replaced and it takes place in three and four weeks. There is increased turnover of skin cells in psoriasis so that the skin cells are formed and shed within a week.

Psoriasis is a multifactorial disease .
It can be inherited, but the mechanism are complex.
It is not necessary that children of affected parents will develop psoriasis but there is a higher chance of developing psoriasis compared to children of non-affected parents. If one parent is affected, then the chance of developing psoriasis in the child is approximately 15% and chance are increased to 40% if both parents are affected.
Psoriasis is not an infectious disease and cannot be transmitted by contact.

Many factors are known to aggrevate psoriasis.
Infections- sore throat and HIV infection can trigger psoriasis.
Certain medications such as antihypertensive drugs (beta-blocker) , anti-malarial(chloroquine), pain killer, lithium and withdrawal of systemic corticosteroids can aggravate psoriasis.
Physical trauma and mental stress can trigger psoriasis.
Cold climates and winters commonly aggravate psoriasis in most cases, but some patients may have summer aggravation.
Alcohol intake and smoking can aggravate the disease.
Obesity and decreased physical activity are well known aggravating factors for psoriasis as well as other co-existing diseases with psoriasis.

A dermatologist can easily confirm the diagnosis based on the appearance of skin lesions. No laboratory tests are usually needed for diagnosis.
A skin biopsy or a small sample of the skin tissue may be needed to confirm the diagnosis in doubtful cases.
Blood tests may be recommended to checkout for coexisting disease or when systemic medications are indicated.

Psoriasis, particularly moderate to severe psoriasis, is associated with an increased risk of anxiety, depression and harmful use of alcohol.
Moderate to severe psoriasis increases the risk of heart disease and stroke and treatment of psoriasis may reduce the risk.
Psoriasis can also be associated with diabetes, obesity, venous thromboembolism, inflammatory bowel disease, high cholesterol and high blood pressure.

Psoriasis can be treated by topical medicines, phototherapy and/or systemic drugs depending upon the severity of the disease.
Most people need to try different treatments or combinations of treatments before they figure out what work best.
Regular use of moisturizers and managing the aggravating factors play an important role.
Topical moisturizers, steroids, keratolytic agents , vitamin D analogues and immunomodulators are the chief treatment option in limited diseases. Tar based, ketoconazole and keratolytic based shampoo are helpful in scalp involvement.
Systemic drugs such as methotrexate, acitretin, cyclosporine, apremilast are recommended in severe cases.
Biological agents such as etanercept, infliximab, adalimumab, ustekinumab, can be used in cases that are unresponsive or difficult to treat.

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