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Psoriasis

What is psoriasis?

Psoriasis is a chronic, relapsing, inflammatory skin condition characterised by red patches covered with silvery white scales. The disease gets worsened during winters. The presentation may vary from few localised patches (called as plaques) to widespread involvement of the skin (erythrodermic psoriasis). Rarely, it may present with pus filled lesions (pustular psoriasis). The sites more commonly involved are elbows, knees palms, soles and lower back; however it may also involve or may be limited to the scalp, nails or joints (psoriatic arthritis). The chronicity and relapsing nature is often distressing and also inhibits social interaction for patients suffering from this condition. Very rarely, the condition may be life - threatening.

What causes psoriasis?

The exact cause for psoriasis is not known. Psoriatic patients have a genetic predisposition for the disease. They often have a positive family history of psoriasis. There are certain factors (like throat infections, alcohol, stress, medications like anti - malarials and NSAIDs) which aggravate psoriasis.

What are the different types of psoriasis?

Therapy for psoriasis depends on the age of the patient, disease severity and the clinical presentation of the disease. Few localised patches may be well controlled with local applications while the widespread variants require treatment with oral drugs. Other modalities of treatment include phototherapy which involves treatment with ultraviolet light (either UVA or UVB).

Moisturisers form an integral part of therapy in all cases of psoriasis. They help to keep the skin hydrated and softening the scales thus enabling penetration of topical drugs for better action.

Topical therapy includes drugs that help to reduce inflammation (topical steroids), those that help to reduce the scaling (keratolytics) and vitamin D derivatives. Ointments are preferred for the thick skin areas of the palms and soles while lotions or foams are more suitable for hairy areas like the scalp. In addition, special shampoos containing tar lotions aid to get the disease under control.

Oral therapy includes drugs like Methotrexate, Acitretin and Cyclosporine. Oral therapy is given in combination with topical therapy or phototherapy. However, these treatments need careful patient selection and monitoring during the entire treatment duration as these medicines affect other body organs and their misuse could lead to unwanted side - effects and complications.

A new development in the field of psoriasis is the development of biologicals. Injections of the immunosuppressants like infliximab, adalimubab and etanercept target specific inflammatory cells involved in the disease pathology and have been found to give better disease control especially for those who have failed to respond to oral therapy or photochemotherapy, or for people who can't take or tolerate these treatments. Biologics are prescribed for individuals with moderate to severe cases of plaque psoriasis and psoriatic arthritis. However, even these are not without side - effects and it is hoped that more efficacious drugs which are well tolerated will be available in the future.

Based on articles by Gottlieb A., Schon MP, and Boehncke WH.

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