Dr. Devraj Dogra, Dr. Mubashar Mir
Psoriasis is a long-term disease associated with inflammatory lesionsand scaling over the skinsurface, witha worldwide prevalence of about 1-3 %.It appears as red, scaly papulesand plaques. Any part of the skin surface may be involved but the lesions most commonly appear over theelbows, knees, scalp andlower back. Itching is variable and is usually not a major presenting complaint. Nail changes are present in over 50% of people during course of the disease and up to 20-30% of patients may have joint pains which may hamper the normal routine activities of the patient.
What is the cause of psoriasis?
Although exact etiology of psoriasis is unknown, it is believed to be caused due to a complex interplay of genetic predisposition in individuals triggered by environmental precipitating factorslike infections,trauma, certain drugs, etc. This leads to activation of body’s immune system leading to formation of classical ‘red raised inflammatory and scaly plaques’.
Does unhealthy diet cause psoriasis?
Good nutrition is believed to help control psoriasis as well as preventing other associated comorbidities like obesity, heart ailments and diabetes. Diet which is low in calories with less of fatty and fried food is beneficial. Avoid taking alcohol and smoking. Fresh fruits and vegetables like Carrots and Tomatoes, Fish oil etc. have been reported to be have beneficial effects.
I have psoriasis, will it affect my children?
The exact inheritance pattern is not known, however hereditary factors do play a part in the causation .If both the parents have psoriasis then the risk of children developing psoriasis is about 40% and if only one parent has psoriasis, the risk of children developing the disease is 15%. If one child has psoriasis then the risk of other siblings developing psoriasis is about 6%.
Is Psoriasis contagious?
Well, the answer is a clear ‘No’. Psoriasis is not a contagious disease and does not spread from one person to the other. Historically psoriasis was often confused with leprosy and other infectious diseases which has now been widely refuted.
What factors can precipitate psoriasis?
Psoriasis has a tendency to wax and wane with flares related to systemic or environmental factors, including life stress events and infection.
* Season: Majority of the patients of psoriasis get new flares of psoriasis during cold and dry seasons while 10 % may have exacerbations during the summer season secondary to photo exposure.
* Stress: Having psoriasis can cause stress itself and patients often report that outbreaks of symptoms come during particularly stressful times like exams, tragedies in the family etc.
* Medications: Certain drugsused in treatment for bipolar disorder, drugs for malaria, and some drugs used to treat high blood pressure, heart disease, sudden withdrawal of steroids can cause exacerbation of psoriasis. Some common painkillers (NSAIDs) like aspirin may also aggravate psoriasis.
* Infections: Certain infections, such as sore throat or tonsillitis, can result in guttate or other types of psoriasis. Psoriasis may worsen in people who have HIV positive.
* Injury to the skin: In some people with psoriasis, trauma to the skin — including cuts, bruises, tattoos etc. can lead to development of psoriatic skin lesions at the site of trauma known as the Koebner’s phenomenon.
* Smoking: Smoking can worsen psoriasis by causing an early onset of disease in smokers as well as increasing the severity of disease in smokers.
* Alcohol: increases the severity of disease by increasing the histamine release and also amplifying the cardiovascular risk.
Is there a cure for psoriasis?
Generally speaking, psoriasis is a disease of relapses and remissions. Most of the patients would get a flare up in the disease activity once in a while with variable periods of remissions in between lasting from months to years or even decades. The guttate form generally has a better prognosis and usually resolves with 3-4 months on its own. It is pertinent to mention that some patients may even get complete remission on their own.
What are the treatment options available?
Psoriasis may not be curable in all but it is definitely treatable and proper control can be achieved with avoiding the precipitating factors and adhering to adequate treatment regime prescribed by your dermatologist.
In a recent multinational survey done on psoriasis and psoriatic arthritis patients (MAPP) revealed that most of the patients are frequently undertreated or not treated at all. Nearly half of psoriasis patients surveyed had not seen a doctor in the past year and two-thirds of psoriatic arthritis patients surveyed were not receiving medical treatment for their condition. Results suggest need for greater awareness and better communication between physicians and patients. Thepatient should be comfortable with the treatment and needs to be compliant for successful treatment. Many patients have underlying medical problems like obesity, hypertension, hyperlipidemia etc.All of which should be properly assessed in order to determine whether systemic treatment is appropriate or not.
Local Treatment in the form of emollients to keep the skin hydrated and scale free along with topical medications may suffice in majority of patients.
Others with increased severity may require additional treatment in the form of phototherapy with UVA OR UVB radiation. Few patients in which these modalities cannot control the disease or are not tolerated may require oral drugs to be instituted especially during periods of exacerbations.
Recently newer drugs known as biologicals targeting specific inflammatory mediators in the pathogenesis of psoriasis have shown exciting results.
What can I do to help treat my psoriasis?
Generally speaking, patient can live a good quality life with the judicious use of medications from the available range of treatment modalities tailored according to the patient profile along with a combination of good dietary habits, lifestyle changes, exercise and a positive mindset. Patients should be open to discuss their concerns and apprehensions along with the psychosocial problems which they are facing with the treating doctor so that they can be counselled accordingly.
Unfortunately due to the notoriously unpredictable nature of the disease and its chronic course patients often land up in the trap of quacks who often guarantee cure and prescribe dangerous and unscientific form of treatment which can be disastrous for the patient. Thus it is advised to always consult a qualified doctor who can in consultation with the patient provide an appropriate treatment so that the person leads a healthy and productive life.
(The authors are the Head, Department of Dermatology GMC Jammu , and M.D. Resident Department of Dermatology GMC Jammu)
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