Psoriasis

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How common is psoriasis and is it hereditary?

Psoriasis is a genetic disorder of the skin that affects 1% of the population.  By genetic disorder is meant a disorder resulting from a defect in the gene and not necessarily hereditary.  Many people with psoriasis may have another family member with psoriasis.  Though a genetic disorder, psoriasis begins in 80% of the people who get it after the age of 30 about 10% get it before 30 years of age and 10% after 60 years of age.

If one parent has psoriasis, the chance of the child getting it is about 16% and if both parents have it, the risk is around 50% or over.

 

How does Psoriasis behave?

Psoriasis is unpredictable in its behaviour, meaning that it is hard to say in a given individual with freshly diagnosed as to how his or her skin will behave.  It is comforting to know that of all the people who have psoriasis, 70 to 80% will have localized psoriasis, meaning involvement of less than 20% of the body surface area.

 

Is Psoriasis incurable? Do I have to live life long with it?

Psoriasis remits i.e. it clears with treatment and recurs.  Once treated, psoriasis stays away for a period ranging from 2 months to a year or so, and then comes back in the same or different area.  It would be reasonable to say that 60 to 70% of people with psoriasis will enjoy remissions for around a year once the patches are cleared.  The remaining may enjoy longer remissions, almost all dermatologists will know of patients who have had remissions of 5, 7, 10 or even 30 years.  A small number may require constant attention to keep their skin clear and prevent it from interfering with their day-to-day activities.

Up to 59% of patients with psoriasis get spontaneous remissions, viz the patches disappear without any treatment,  however, immaterial of whether the remission is spontaneous or treatment-induced, recurrences are the rule in most people with psoriasis.  If one were to clear of lesions, the remaining will be on the way to a remission are the recurrence.  This means that having psoriasis implies setting aside 10 to 30 minutes a day for skin care, in addition, the regular time set aside for toilet and grooming.

20 to 25% of patients with psoriasis get joint pain and about 7% get joint swelling and deformity.  This is because the same thing that happens in the skin also happens to the joint lining.  About 30% get the involvement of the nail because the tissue that produces the nail is derived from the skin.

 

Why do you get psoriasis?

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. 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.

 

How is psoriasis diagnosed?

Doctors usually diagnose psoriasis after a careful examination of the skin.  However, diagnosis may be difficult because psoriasis can look like other skin diseases.  A pathologist may assist with diagnosis by examining a small skin sample (biopsy) under a microscope.

There are certain do’s and don’ts for prolonging remissions and making management of psoriasis that much easier.

 

What precautions can I take to avoid a flare-up of psoriasis?

Avoid the following factors as they are known to worsen psoriasis:-

Alcohol, tobacco, winters, dry skin, severe hygienic measures, excessive rubbing and scrubbing, scratching, using very hot water to cleanse the skin or to relieve the itch in psoriasis.  Physiological stresses include pregnancy, surgeries, and infectious diseases.  If you have painful teeth, cavities or swollen gums, sore throat, cough, loose motions, burning in the urine, vaginal discharge, boils on the skin, tell your doctor of this and have it attended to at the earliest.

The following drugs are known to worsen psoriasis or precipitate it in those who are predisposed to psoriasis:

Steroids by mouth or injection

Potent locally applied steroid creams/ointments

Beta-blockers( anti-hypertensives)

Antimalarials

ACE inhibitors

Indomethacin

Painkillers (NSAIDS)

Lithium

Gemfibrozil

Gold salts

Consider leaving a copy of this list with your family physician, paracetamol in limited quantities can be used to treat fever or pain.

 

Can a person die of psoriasis?

Two types of severe psoriasis called erythrodermic psoriasis and generalized pustular psoriasis are known to be capable of causing death due to the acute and severe burden they place on the body’s metabolism, various organ systems and the heart.

With modern medication, inpatient care and intensive care, these risks are significantly reduced.

 

Does psoriasis involve other organs?

20 to 25% of patients with Psoriasis get joint pains and about 10% get joint swelling and deformity. This is because the same thing that happens in the skin also happens to the joint lining. About 30% get the involvement of nail because the tissue that produces the nail is derived from the skin.

 

What treatments are available for psoriasis?

Doctors generally treat psoriasis in steps based on the severity of the disease.  The extent of the areas involved the type of psoriasis or the patient’s responsiveness to initial treatments.  This is sometimes called the “1-2-3” approach.  In step 1, medicines are applied to the skin (topical treatment).  Step 2 focuses on light treatments (Phototherapy).  Step 3 involves taking medicines internally usually by mouth (systemic treatment).

Topical treatments applied directly to the skin are sometimes effective in clearing psoriasis. Doctors find that some patients respond well to sunlight, corticosteroid ointments, medicines derived from vitamin D3, vitamin A  (retinoids), coal tar or anthralin.  Other topical measures such as bath solutions and moisturizers, may be soothing but are seldom strong enough to clear lesions over the long term and may need to be combined with more potent remedies.

 

How to keep psoriasis from affecting one’s emotional well being?

Psoriasis is best faced with a measure of equanimity in that when a patch is noted, it is no cause for fear, for treatment can rid you of it, and a cleared patch is no cause for

celebration, as a new lesion can occur there or elsewhere someday. The focus is to keep Psoriasis from coming in the way of your routine, livelihood and quality of life, with the means available.

 

Is it true that alternative systems of medicine can cure psoriasis?

Many alternative systems of medicine have effective treatments for Psoriasis to the point of inducing remissions, but none can cure it as matters stand today, immaterial of what is promised. Quacks abound in the real world and on the net. Be wary of those who promise you what you wish to believe, and love to hear.

 

Why can doctors not promise an outright cure for psoriasis?

As the genes cannot be corrected with currently available medicines, the cure cannot be assured. This may change in a few years with advances in genetics. You can read more about the recent advances in the genetics of Psoriasis at www.psoriasis.org, which is also the most genuine site for all information on Psoriasis.

Recent research indicates that Psoriasis is a likely disorder of the immune system. This system includes a type of white blood cells called as T-cells that normally helps protect the body against infections and diseases. Scientists now think that in Psoriasis, an abnormal immune system causes activity by T- cells in the skin. It is not yet clear what triggers the T- cells to act this way but these T-cells lead to inflammation and excessive skin production seen in people with Psoriasis. In a genetically predisposed person, an inflamed and irritated (no thanks to T- cells), is more prone to Psoriasis. This ‘inflammation’ can be environmental or emotional. Newer biotech treatments aimed at the T cells and the substances produced by them are now available and are vastly superior to the treatments currently in use.

 

What is new in the treatment of psoriasis?

Today patients also have the option to use Biological Therapies, the newest treatment option for Psoriasis, with the least side-effects they offer the longest remission among all the current treatment options.

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