Psoriasis occurs when skin cells, which originate below the surface of the skin, pile up on the surface before they have fully matured. This process can take as short as a few days up to a month. Psoriasis is an auto-immune disease involving T cells, a type of white blood cell. T cells’ job is to protect the body from diseases and infections. When psoriasis occurs, T cells are mistakenly active and trigger other immune responses, causing inflammation and rapid turnover of skin cells.
People with psoriasis may experience skin flares, when the condition worsens and then improves. Some triggers for flares include stress, infections, too much alcohol, and climate changes which cause skin dryness. Certain medicines, like lithium, may cause an outbreak or exacerbate the condition.
Symptoms of Psoriasis
Psoriasis can appear suddenly or gradually. It goes away and flares up repeatedly. Patches of skin which are itchy and irritated appear, as well as redness, on different parts of the body. The skin patches can be covered with silvery, flaky skin and may be raised and thick. Psoriasis symptoms include joint pain, thickening of the nails, yellow or brown spots on the nails, and separation of the nail from its foundation.
It can be hard to diagnose psoriasis because it is similar to other skin conditions. A detailed examination, sometimes with a microscope, may be necessary by a Dermatologist. There are different types of psoriasis including:
1- Plaque Psoriasis. The skin cells accumulate, forming silvery-white scales.
2- Pustular Psoriasis. In Pustular Psoriasis, blisters of pus which are not infectious appear on the skin. This type of psoriasis can be triggered by stress, exposure to specific chemicals, infections or medications.
3- Guttate Psoriasis. In Guttate Psoriasis, little teardrop shaped lacerations appear on the skin. This type of psoriasis is commonly triggered by upper respiratory infections such as streptococcus.
4- Inverse Psoriasis. Red, smooth patches appear in the folds of skin in the genital area, under breasts or in the armpits. Friction and sweat may exacerbate this condition.
5- Erythrodermic Psoriasis. This condition involves reddening and scaling of the skin throughout the body. It can be a reaction to extreme sunburn, specific medications, or an extended case of psoriasis which was inadequately cared for.
Depending on the psoriasis type, severity, size in the affected areas, and the patient’s response to initial treatment, doctors choose the appropriate treatment. There is a process also known as the “1-2-3” approach, which helps treat psoriasis. In step 1 doctors apply a topical medication on the area. Step 2 involves light treatment, also called phototherapy. Medicines can also be taken orally or via injection which treats the entire immune system, also known as systemic therapy.
Recently, combination therapy, using lower doses of various topical creans, lights and systemic treatments has an increase in its effectiveness. Additionally, laser therapy, using an advanced pulse dye laser has successfully treated various kinds of skin lesions in both adults and children. This has proven to be a highly effective form of treatment for psoriasis. Five to six monthly treatments would be necessary for its effectiveness.
All forms of treatment have different success rates on each patient. What works for one does not necessarily work for the other. Therefore, doctors will use a trial-and-error approach and may need to switch forms of treatment in order to find the most effective kind of treatment for the patient.
To learn more about Psoriasis, contact us today to schedule an appointment with our dermatologists.