Challenge to the physician because of the frequent worsening of psoriasis despite treatment and to the patient as it compromises the lifestyle and is a cause for shame and embarrassment among friends and relatives.
This series of articles will examine the history of psoriasis, triggers of psoriasis, various clinical aspects of psoriasis, its psycho-social implications and explore various modalities of treatment available.
What is Psoriasis?
Psoriasis is a lifelong disease akin to high blood pressure or diabetes causing dry, silvery white scales on red raised patches which can appear anywhere on the body. Commonly affected areas are the extensor (outer) side of limbs, especially the elbows, knees, trunk and scalp. It can affect the nails and the genitals. In its severe form psoriasis can cause joint disease, known as psoriatic arthritis, which could be a disabilitating and disfiguring disease. This painful, swollen and stiff joint disease is seen in 10-30% of psoriasis patients.
The name psoriasis is derived from ‘psora’, the Greek word for itching. Itching is indeed a major symptom in most cases of psoriasis, but not necessarily in all patients.
It is estimated that approximately 125 million people suffer from psoriasis worldwide, accounting for 3% of the population. In US alone there are 7.5 million psoriasis sufferers.
Genetic Basis of Psoriasis
Sometimes psoriasis runs in families. If a parent has psoriasis, there is a 25% chance that the children may suffer from it. If both parents have psoriasis, the chance doubles, i.e., 50% of children may suffer from psoriasis. This is a general rule. Most of the time, however, none of the children have psoriasis.
The genetic basis of psoriasis means that in predisposed individuals certain life style factors trigger body’s immune system to speed up the growth of skin cells. Usually the surface skin cells (epidermis) are regenerated regularly by a continuous supply of fresh cells from the basal layer of epidermis. A single cell usually takes around 28 days to reach the outer layer of epidermis and is shed off as dead cells. In psoriasis, because of the increased growth rate and turnover of epidermal cells, immature cells come to the surface within 3-4 days, causing accumulation of thick scales on the skin.
Psoriasis is not contagious. That means you do not get psoriasis by sharing rooms, toilets or beds with a psoriasis patient.
Natural Course of Psoriasis
The natural course of psoriasis involves periods of waxing and waning. The rashes clear for a period of time, known as remissions, then, following some triggers like stress, infections, some medications, alcohol etc, the rashes crop up again. Many a time when the treatment of psoriasis with medications like potent topical steroids are suddenly withdrawn or stopped, the disease can become worse, or a generalized form called exfoliative erythrodermic psoriasis may be precipitated.
Psoriasis Can be Controlled, Not Cured.
Psoriasis has no complete cure, but with proper treatment and life style changes, psoriasis can be kept under optimum control and remission so as not to affect the quality of life of the patient.
The absence of a specific cure also means that psoriasis requires lifelong care and management. The treatment of psoriasis involves, in addition to the life style management and avoidance of triggering factors, topical treatment with creams, systemic medication and light therapy.
Though there is no cure yet for the disease, recent introduction of new biological therapies has provided a fresh ray of hope for psoriatic patients for a better quality of life ahead. What is unique about biologic treatments is that they target certain immune responses that are involved in psoriasis, not the entire immune system, thus causing fewer side effects for the patient.
Next: History of Psoriasis
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
Reference
Psoriasis, in Rook’s Textbook of Dermatology, 7th Edition, 2004
Hanish Babu - Dr.Hanish Babu, MD is a dermatologist and a feature writer on Suite101.com with more than 200 articles related to skin diseases on the ...
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