Do you have dandruff that never goes away? Or a chronic fungal nail infection? It may actually be Psoriasis. Psoriasis is a long-term skin disease, which can also affect certain joints, fingernails and toenails.
What causes psoriasis?
- the cause is not fully known.
- it seems to be related to three things:
- an immune system disorder (T-cells that malfunction)
- specific inherited genes (a family history is common in psoriasis)
- environmental triggers (infections, certain drugs, stress, skin injury/sunburn, alcohol excess, smoking)
- in psoriasis, the immune system overreacts, causing skin cells to form too quickly (in days, rather than a month).
- these skin cells stay on the surface on the skin, and aren’t shed, like normal skin cells.
- this results mostly in thick red plaques or patches forming, covered by silver scales.
What does psoriasis look like?
- The appearance depends on the type of psoriasis a person has.
- Symptoms can vary from person to person.
- Psoriasis patients experience cycles of flare-ups and periods of better control.
Different types of psoriasis:
a) Plaque psoriasis (psoriasis vulgaris = meaning “common”)
- The most common type -red, raised patches on the skin, covered by silver scales.
- Knees, elbows, scalp, lower back commonly affected (can occur anywhere).
- Can itch.
b) Guttate psoriasis
- Small red spots, often triggered by an infection (upper airway, Strep throat).
- Limbs, trunk, face, scalp (can occur anywhere, all over the body).
- It can clear up spontaneously within a few months.
c) Pustular psoriasis
- Pus-filled lumps with red, swollen skin.
- Affects soles of feet and palms of hands.
- If involving other parts of the body and the person is ill with a fever, urgent medical help must be sought.
d) Inverse psoriasis (intertriginous/flexural psoriasis)
- Red skin patches that appear raw and smooth.
- In areas of skin to skin contact (armpit, groin, genital area, buttock, below breasts).
e) Erythrodermic psoriasis (exfoliative psoriasis)
- Can be a serious medical emergency.
- Nearly all the skin on the body looks bright red/burnt.
- Often very itchy and painful, associated with fever/chills.
f) Psoriatic arthritis and nail changes
- swollen, tender or painful joints (knees, hands, ankles)
- nails often develop pits, discolour and separate from the nail-bed
How is psoriasis treated?
- Treatment depends on: the type of psoriasis, severity and size of areas affected,
- Although currently not curable, psoriasis is controllable with medication and many promising new treatments are on the horizon.
- Following a healthy lifestyle is important as smoking, alcohol consumption and being overweight have all been shown to make psoriasis worse,
There are 3 main types of treatment:
a) Topical
- topical corticosteroids
- vitamin D analogues
- coal tar
- anthralin
- salicylic acid
- topical retinoids
- calcineurin inhibitors
- moisturisers, lubricants and bath solutions
b) Light therapy
- Involves natural or artificial UV light.
- Can be used on its own, or in conjunction with medication.
c) Systemic therapy (oral or injected)
- retinoids
- methotrexate
- cyclosporin
- immune-modulator drugs (biologicals)
- other medications (hydroxyurea, thioguanine)
- medications still under research