What is Psoriasis, Causes and Types of Psoriasis
Psoriasis is a chronic autoimmune disease that appears on the skin. It occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells. Psoriasis is not contagious. There are five types of psoriasis: plaque, guttate, inverse, pustular and erythrodermic. The most common form, plaque psoriasis, is commonly seen as red and white hues of scaly patches appearing on the top first layer of the epidermis (skin). Some patients, though, have no dermatological symptoms.
In plaque psoriasis, skin rapidly accumulates at these sites, which gives it a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area, including the scalp, palms of hands and soles of feet, and genitals. In contrast to eczema, psoriasis is more likely to be found on the outer side of the joint.
The disorder is a chronic recurring condition that varies in severity from minor localized patches to complete body coverage. Fingernails and toenails are frequently affected (psoriatic nail dystrophy) and can be seen as an isolated symptom. Psoriasis can also cause inflammation of the joints, which is known as psoriatic arthritis. Ten to up to 40 percent of people with psoriasis have psoriatic arthritis.
The cause of psoriasis is not fully understood, but it is believed to have a genetic component, and local psoriatic changes can be triggered by an injury to the skin known as the Koebner phenomenon, see Koebnerisin. Various environmental factors have been suggested as aggravating to psoriasis, including stress, withdrawal of systemic corticosteroid, as well as other environmental factors, but few have shown statistical significance. There are many treatments available, but because of its chronic recurrent nature, psoriasis is a challenge to treat.
The symptoms of psoriasis can manifest in a variety of forms. Variants include plaque, pustular, guttate and flexural psoriasis. This section describes each type (with ICD-10 code ).
Psoriasis is a chronic relapsing disease of the skin that may be classified into nonpustular and pustular types as follows
Pustular psoriasis appears as raised bumps that are filled with noninfectious pus (pustules). The skin under and surrounding the pustules is red and tender. Pustular psoriasis can be localised, commonly to the hands and feet (palmoplantar pustulosis), or generalised with widespread patches occurring randomly on any part of the body. Types include:
Generalized pustular psoriasis (pustular psoriasis of von Zumbusch)
Pustulosis palmaris et plantaris (persistent palmoplantar pustulosis, pustular psoriasis of the Barber type, pustular psoriasis of the extremities)
Annular pustular psoriasis
Additional types of psoriasis include
Inverse psoriasis (flexural psoriasis, inverse psoriasis)(L40.83-4) appears as smooth inflamed patches of skin. It occurs in skin folds, particularly around the genitals (between the thigh and groin), the armpits, under an overweight stomach (pannus), and under the brests(inframammary fold). It is aggravated by friction and sweat, and is vulnerable to fungal infections.
Guttate psoriasis (L40.4) is characterized by numerous small, scaly, red or pink, teardrop-shaped lesions. These numerous spots of psoriasis appear over large areas of the body, primarily the trunk, but also the limbs and scalp. Guttate psoriasis is often preceded by astreptococcal infection, typically streptococcal pharyngitis. The reverse is not true.
Nail psoriasis (L40.86) produces a variety of changes in the appearance of finger and toe nails. These changes include discolouring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail, and the loosening (onycholysis) and crumbling of the nail.
Psoriatic arthritis involves joint and connective tissue inflammation. Psoriatic arthritis can affect any joint, but is most common in the joints of the fingers and toes. This can result in a sausage-shaped swelling of the fingers and toes known as dactylitis. Psoriatic arthritis can also affect the hips, knees and spine (spondylitis). About 10-15% of people who have psoriasis also have psoriatic arthritis.
Psoriasis is an autoimmune disorder of the skin results in hyper proliferation of the skin. It is a chronic skin disease characterized by dry skin and raised, rough, red areas on the skin covered with fine silvery scales. Psoriasis non-infectious and it is often seen in people between 15 to 40 yrs of age.
There are different types of psoriasis. They are :
Plaque psoriasis - Patches of raised, reddish skin covered by silvery-white scale
Psoriatic arthritis - Which causes inflammation of the joints.
Guttate psoriasis - Small, red spots on the skin
Pustular psoriasis - White pustules surrounded by red skin
Inverse psoriasis - Smooth, red lesions form in skin folds
Erythrodermic psoriasis - widespread redness, severe itching, and pain
Causes of Psoriasis
The exact cause of psoriasis is not known. It is believed that a combination of several factors contributes to the development of this disease.
Some common causes of psoriasis are the following:
Psoriasis occurs when the immune system overreacts, causing inflammation and flaking of skin.
Abnormality in the mechanism in which the skin grows and replaces itself causes psoriasis.
Psoriasis develops when the immune system tells the body to over-react and accelerate the growth of skin cells.
Heredity also plays a role in the development of psoriasis
Environmental factors such as trauma, sunlight, infection, emotional stress, climatic changes etc also causes.
he cause of psoriasis is not fully understood. There are two main hypotheses about the process that occurs in the development of the disease. The first considers psoriasis as primarily a disorder of excessive growth and reproduction of skin cells. The problem is simply seen as a fault of the epidermis and its keratinocytes. The second hypothesis sees the disease as being an immune-mediated disorder in which the excessive reproduction of skin cells is secondary to factors produced by the immune system. T cells (which normally help protect the body against infection) become active, migrate to the dermis and trigger the release of cytokines (tumor necrosis factor-alpha TNFα, in particular) which cause inflammation and the rapid production of skin cells. It is not known what initiates the activation of the T cells.
The immune-mediated model of psoriasis has been supported by the observation that immunosuppressant medications can clear psoriasis plaques. However, the role of the immune system is not fully understood, and it has recently been reported that an animal model of psoriasis can be triggered in mice lacking T cells.Animal models, however, reveal only a few aspects resembling human psoriasis.
Compromised skin barrier function has a role in psoriasis susceptibility
Psoriasis is a fairly idiosyncratic disease. The majority of people's experience of psoriasis is one in which it may worsen or improve for no apparent reason. Studies of the factors associated with psoriasis tend to be based on small (usually hospital based) samples of individuals. These studies tend to suffer from representative issues, and an inability to tease out causal associations in the face of other (possibly unknown) intervening factors. Conflicting findings are often reported. Nevertheless, the first outbreak is sometimes reported following stress(physical and mental), skin injury, and streptococcal infection. Conditions that have been reported as accompanying a worsening of the disease include infections, stress, and changes in season and climate. Certain medicines, including lithium salt, beta blockers and theantimalarial drug chloroquininine have been reported to trigger or aggravate the disease. Excessive alcohol consumption, smoking and obesity may exacerbate psoriasis or make the management of the condition difficult or perhaps these comorbidities are effects rather than causes. Hairspray, some face creams and hand lotions, can also cause an outbreak of psoriasis. In 1975, Stefania Jablonska and collaborators advanced a new theory that special antibodies tend to break through into the lower layers of the skin and set up a complex series of chemical reactions.
Individuals suffering from the advanced effects of the human immunodeficiency virus, or HIV, often exhibit psoriasis. This presents a paradox to researchers, as traditional therapies that reduce T-cell counts generally cause psoriasis to improve. Yet, as CD4-T-cell counts decrease with the progression of HIV, psoriasis worsens. In addition, HIV is typically characterized by a strong Th2 cytokine profile, whereas psoriasis vulgaris is characterized by a strong Th1 secretion pattern. It is hypothesized that the diminished CD4-T-Cell presence causes an overactivation of CD8-T-cells, which are responsible for the exacerbation of psoriasis in HIV positive patients. It is important to remember that most individuals with psoriasis are otherwise healthy, and the presence of HIV accounts for less than 1% of cases. The prevalence of psoriasis in the HIV positive population ranges from 1 to 6 percent, which is about three times higher than the normal population. Psoriasis in AIDS sufferers is often severe, and untreatable with conventional therapy.
Psoriasis occurs more likely in dry skin than oily or well-moisturized skin, and specifically after an external skin injury such as a scratch or cut (see Koebner phenomenon). This is believed to be caused by an infection, in which the infecting organism thrives under dry skin conditions with minimal skin oil, which otherwise protects skin from infections. The case for psoriasis is opposite to the case of athlete's foot, which occurs because of a fungus infection under wet conditions as opposed to dry in psoriasis. This infection induces inflammation, which causes the symptoms commonly associated with psoriasis, such as itching and rapid skin turnover, and leads to drier skin, as the infecting organism absorbs the moisture that would otherwise go to the skin. To prevent dry skin and reduce psoriasis symptoms, it is advised to not use shower scrubs, as they not only damage skin by leaving tiny scratches, but they also scrape off the naturally occurring skin oil. It is recommended to use talc powder after washing, as that helps absorb excess moisture which would otherwise go to the infecting agent. Additionally, moisturizers can be applied to moisturize the skin, and lotions used to promote skin oil gland functions.
Symptoms of Psoriasis
The symptoms of psoriasis vary from person to person. Some of the common symptoms of psoriasis are the following:
Raised, red patches of skin topped with loose, silvery scales, usually on the knees or elbows
Thick, red patches known as plaques, and dry, silvery scales appearing on the scalp, face, elbows, knees, palms, and soles of the feet.
Dry, cracked skin that may bleed
Joint swelling, tenderness, and pain
Thickened, pitted or ridged nails
Herbal treatment and Ayurvedic medicines for Psoriasis
Ayurveda believes that impurities in the blood associated with emotional factors are the cause of the disease. According to Ayurveda Psoriasis can be considered as the vitiation of Vata and Kapha.
Ayurvedic treatment for Psoriasis
Ayurveda suggests Panchakarma for the treatment of psoriasis. This is because detoxification of the body is very essential for the treatment of psoriasis.
Natural Herbal Treatment for Psoriasis
There is no treatment for psoriasis that can guarantee 100% result. A natural psoriasis treatment that may help one person may have no effect on another person. Psoriasis treatment requires strict dietary restictions and life style practives.
Some effective natural psoriasis treatment, Precautionary tips and natural cure for psoriasis
The use of curd in the form of buttermilk has proved useful in psoriasis and the patient should drink it in liberal quantities.
Do not control natural urges like vomiting, urination, bowel emptying etc.
Avoid taking spicy food and consume only easily digestable food.
Do not eat too much of salty, sour or acidic foods
Avoid consuming opposite foods
Include more fruits, vegetable, fruit juices in your diet. Bitter gourd, curd, boiled vegetables, pumpkin etc... are good psoriasis diet.
Avoid animal fats, eggs, processed canned foods from your diet.
Application of avocado oil gently on the effected part is found to be an effective treatment.
Cod liver oil, lecithin, linseed oil, vitamin E, and zinc fasten the healing process.
Apply moisturizing cream or gel at regular intervals to maintain the moisture level of the skin.
Avoid using soap while taking bath instead use gram flour and use a herbal scrubber.
Avoid pricking, peeling and scratching skin
Use separate, clean clothes and towel for your use.
Taking bath in sea water is found to be very effective in psoriasis treatment.
Drinking fresh bitter gourd juice mixed with one teaspoon of lime juice on an empty stomach is an effective psoriasis treatment
Applying aloe vera cream thinly to irritated skin and rubbing lightly is effective.
Mental health is absolutely necessary for an effective treatment of psoriasis. Try deep breathing and relaxation exercise to reduce stress.
Exposing to mild sunlight daily for 30 minutes will improve the texture of the affected area of the skin.
Self-care for psoriasis
Avoid all factors which trigger psoriasis.
Reduce stress levels through meditation and Yoga .
Do not prick, peel or scratch skin. This may trigger psoriasis.
After bath or wash pat dry the skin. Do not rub the towel vigorously on skin.
Avoid soap. Instead use gram flour (besan flour) as soap dries the skin.
After washing, pat the skin dry, don't irritate it by rubbing vigorously.
Apply moisturizing creams liberally on affected areas after
Opt for cotton clothes over synthetic ones.
Changes that occur on skin during psoriasis
It takes 27 days for skin to replace itself with new mature skin cells. But the regions of skin affected by psoriasis the skin replace itself within 3-4 days with plenty of immature skin cells forming thick psoriatic patches.
According to ayurveda principles the vitiated vata dries the water element of skin and also initiate rapid growth of skin tissue. The vitiated Kapha dosha causes itching on the affected skin. The blood which is affected by vata and kapha adversely influences healing process.
Psoriasis can affect children. Approximately one third of psoriasis patients report being diagnosed before age 20. Self-esteem and behavior can be affected by the disease. Bullying has been noted in clinical research
Living well with psoriasis
Living well with psoriasis and psoriatic arthritis is more than treating your disease. It means taking an active role in your care and developing habits and routines that support your well-being.
Developing a healthy lifestyle is important for everyone, but particularly for people with psoriasis and psoriatic arthritis. Psoriatic diseases affect not just the skin and joints, but other parts of the body as well. Research shows that psoriasis is associated with other serious conditions such as diabetes, heart disease, obesity, depression, and other health diseases.
Because psoriasis and psoriatic arthritis are whole-body conditions, a good disease-management plan incorporates treatment with a healthy diet, regular exercise, stress reduction, and a strong support network.