Psoriasis - Causes, Symptoms And Treatment
Psoriasis is a chronic, recurrent disease marked by epidermal proliferation and characterized by recurring partial remissions and exacerbations. Flare-ups are commonly related to specific systemic and environmental factors but may be unpredictable. Widespread involvement is called exfoliative or erythrodennic psoriasis.
Psoriasis affects about 21 % of the population in the United States. Although this disorder usually affects young adults, it may occur at any age, including infancy. Genetic factors predetermine the incidence of psoriasis; researchers have discovered a significantly greater incidence of certain human leukocyte antigens (HLAs) in families with psoriasis. Although some studies found that psoriasis is equally prevalent between men and women, other studies have found that psoriasis was slightly more prevalent in women.
Flare-ups can usually be controlled with therapy. Appropriate treatment depends on the type of psoriasis, extent of the disease, the patient's response, and the effect of the disease on the patient's lifestyle. No permanent cure exists and all methods of treatment are palliative.
What causes Psoriasis?
Causes of psoriasis include:
- genetically determined tendency to develop psoriasis
- possible immune disorder, as shown in the HLA type in families
- environmental factors
- isomorphic effect or Koebner's phenomenon, in which lesions develop at sites of injury due to trauma
- flare-up of guttate (drop-shaped) lesions due to infections, especially beta-hemolytic streptococci.
Other contributing factors include:
- endocrine changes
- climate (cold weather tends to exacerbate psoriasis)
- emotional stress.
Signs and symptoms of Psoriasis
Possible signs and symptoms include:
- itching and occasional pain from dry, cracked, encrusted lesions (most common)
- erythematous and, usually, well defined plaques, sometimes covering large areas of the body (psoriatic lesions)
- lesions most commonly on the scalp, chest, elbows, knees, back, and buttocks
- plaques with characteristic silver scales that either flake off easily or thicken, covering the lesion; scale removal can produce fine bleeding
- occasional small guttate lesions (usually thin and erythematous, with few scales), either alone or with plaques.
Rarely, psoriasis becomes pustular, taking one of two forms:
- localized pustular psoriasis, with pustules on the palms and soles that remain sterile until opened
- generalized pustular (von Zumbusch) psoriasis, typically occurring with fever, leukocytosis, and malaise, with groups of pustules coalescing to form lakes of pus on red skin (also remain sterile until opened), commonly involving the tongue and oral mucosa
- erythrodermic psoriasis least common form), which is an inflammatory form of the disorder characterized by periodic fiery erythema and exfoliation of the skin with severe itching and pain.
Possible complications of psoriasis include spread to fingernails, producing small indentations or pits and yellow or brown discoloration (about 60% of patients); accumulation of thick, crumbly debris under the nail,causing it to separate from the nail bed (onycholysis); infection, secondary to itching; and arthritic symptoms, usually in one or more joints of the fingers or toes, the larger joints, or sometimes the sacroiliac joints, which may progress to spondylitis, and morning stiffness (in some patients)
Diagnosis is based on:
- patient history, appearance of the lesions and, if needed, the results of skin biopsy
- serum uric acid level (usually elevated in severe cases due to accelerated nucleic acid degradation) without indications of gout
- human leukocyte antigens (HLA)Cw6, .B13, -B27 and .BS 7 (may be present in early-onset familial psoriasis).
Treatment of Psoriasis
Treatment for psoriasis may include:
- aspirin and local heat to help alleviate the pain of psoriatic arthritis; NSAIDs in severe cases
- ultraviolet B (UVB) or natural sun. light exposure to retard rapid cell production to the point of minimal erythema
- tar preparations or crude coal tar applications to the affected areas about 15 minutes before exposure to UVB, or left on overnight and wiped off the next morning
- gradually increasing exposure to UVB (outpatient treatment or day treatment avoids long hospitalizations and prolongs remission)
- steroid creams and ointments applied twice daily, preferably after bathing to facilitate absorption, and overnight use of occlusive dressings to control symptoms, if necessary.
- intralesional steroid injection for small, stubborn plaques
- anthralin ointment (Anthra-Derm) or paste mixture for well-defined plaques (not applied to unaffected areas due to injury and staining of nor. mal skin) with application of petroleum jelly around affected skin before applying anthralin
- anthralin (Anthra-Derm) and steroids (anthralin application at night and steroid use during the day)
- calcipotriene ointment (Dovonex), a vitamin D analogue (best when alternated with a topical steroid)
- Goeckerman regimen (combines tar baths and UVB treatments) to help achieve remission and clear the skin in 3 to 5 weeks (severe chronic psoriasis)
- Ingram technique (variation of the Goeckerman regimen) using anthralin (Anthra-Derm) instead of tar
- administration of psora lens (plant extracts that accelerate exfoliation) with exposure to high intensity ultraviolet A
(UV A); also called psoralen plus UVA (PUVA) therapy
- cytotoxin, usually methotrexate (Mexate) last-resort treatment for refractory psoriasis)
- acitretin (Soriatane), a retinoid compound (for extensive psoriasis)
- cyclosporine (Neora), an immunosuppressant (in resistant cases)
- tar shampoo followed by a steroid lotion (psoriasis of the scalp).
Home remedies to cure psoriasis
- Sarsaparilla, and yellow clock are good detoxifiers
- Silymarin (milk thistle extract) increases bile flow and protects the liver, which is important in keeping the blood clean. Take 300 milligrams three times daily. Helps to cure psoriasis.
- Take chickweed, dandelion, red clover, redmond clay, and yellow dock for symptom relief.
- Psoriasis is a metabolic disease. It is very much essential to take less spicy and easily digestible food to take in this disorder. More fruits, vegetable, fruit juices etc are very valuable for this. Bitter gourd, curd, boiled vegetables pumpkin these are good for this disease. All animal fats, eggs, processed canned foods are not to be taken.
- Apply aloe vera gel, garlic oil, and comfrey and goldenseal tea.
Special considerations and Prevention
Design your patient's care plan to include patient teaching and careful monitoring for adverse effects of therapy:
- Make sure the patient understands the prescribed therapy; provide written instructions to avoid confusion. Teach correct application of prescribed ointments, creams, and lotions. A steroid cream, for example, should be applied in a thin film and rubbed gently into the skin until the cream disappears. All topical medications, especially those containing anthralin and tar, should be applied with a downward motion to avoid rubbing them into the follicles. Gloves must be worn because anthralin stains and injures the skin. After application, the patient may dust herself with powder to prevent anthralin from rubbing off on her clothes. Warn the patient never to put an occlusive dressing over anthralin. Suggest use of mineral oil, then soap and water, to remove anthralin. Caution the patient to avoid scrubbing her skin vigorously to prevent Koebner's phenomenon. If a medication has been applied to the scales to soften them, suggest the patient use a soft brush to remove them.
- Avoid hot water.
- Pat yourself dry; never rub.
- Wear loose fitting comfortable brathable clothing, such as cotton.
- Watch for adverse effects, especially allergic reactions to anthralin, atrophy and acne from steroids, and burning, itching, nausea, and squamous cell epitheliomas from PUVA.
- For patients on methotrexate therapy, initially monitor the patient and his CBC (red blood cell, white blood cell, and platelet counts) weekly, then monthly, because cytotoxins may cause hepatic or bone marrow toxicity. Liver biopsy may be done to assess the effects of methotrexate. Patients taking methotrexate shouldn't drink alcohol due to the increased risk of hepatotoxicity.
- Do not consume citrus fruits, fried foods, processed foods, saturated fats (found in meat and dairy products), sugar, or white flour.
- Caution the patient receiving PUVA therapy to stay out of the sun on the day of treatment, and to protect her eyes with sunglasses that block out UVA rays for 24 hours after treatment: Tell her to wear goggles during exposure to this light.
- Know that there's no effective topical treatment for psoriasis of the nails.
- Be aware that psoriasis can cause psychological problems. Assure the patient that psoriasis isn't contagious and, although exacerbations and remissions occur, they're controllable with treatment. However, be sure she understands that there's no cure. Also, because stressful situations tend to exacerbate psoriasis, help the patient learn effective stress management techniques and coping mechanisms. Explain the relationship between psoriasis and arthritis, but point out that psoriasis causes no other systemic disturbances.