Psoriasis

Winter is not a particularly time for people suffering from psoriasis. The diagnosis of psoriasis often evokes a lot of anxiety. It is considered to be incurable. On the other hand you have people guaranteeing a 100% cure for psoriasis. It is probably time to demystify psoriasis and know the facts.

What is psoriasis?

Psoriasis is a chronic inflammatory skin disease characterized by red, thick and flaky areas on various parts of the body. Interestingly, though it is derived from the Greek word, psora, which means to itch, itching may or may not be present in psoriasis. Psoriasis typically occurs on the elbows, knees, lower back and scalp, but the distribution of skin lesions can be quite varied. Some people can have nails that are disfigured by psoriasis and others may have associated joint involvement, called psoriatic arthritis. There is recent evidence that seems to suggest that people with extensive psoriasis may be at a slightly higher risk for heart attacks.

Why do some people get psoriasis?

The exact cause of psoriasis remains elusive. What is known is that a subtype of white blood cells called T lymphocytes, which are a part of our body’s immune system, start behaving weirdly. This leads to inflammation in the skin and an increase in skin turnover. What this means is that as compared to normal skin that gets renewed every 20 to 30 days normally, in areas with psoriasis, skin gets replaced every 3 to 5 days. Thus new skin forms much faster than it can shed and accumulates on top of each other in the form of flakes. Also, the skin cells do not get enough time for maturation, somewhat like how a premature baby’s organ systems are not adequately developed.

Psoriasis is not of a contagious nature, and is not transmitted from one person to another. But psoriasis can run in families. One cannot quantify the odds of the offspring of a psoriatic developing psoriasis. Suffice to say that like in diabetes & coronary artery disease, the risk of developing psoriasis is greater than the general population if one or both parents have psoriasis.

So is there any hope for people with psoriasis?

The problem is there is a lot of negativity associated with psoriasis. There are excellent treatment options that can control the inflammation and regularise the skin cell cycle. However extensive the psoriasis, it can be treated. Unfortunately the remedies often work only as long as they are used, and psoriasis often relapses. So patients are on the lookout for some treatment that can "eradicate psoriasis from its roots", and that they are free from it forever. Of course it is foolhardy to promise that any treatment modality will completely rid somebody of psoriasis for good. But there is a magic word for psoriasis called REMISSION. This is a phase of psoriasis wherein even after discontinuing treatment, there is no sign of psoriasis for weeks, months or years. I have had some patients who have been in remission for as many as 12 years, and they swear that I have “cured” their psoriasis. At the same time I do also have patients in whom psoriasis recurs as soon as they stop treatment.

What are the factors that improve or worsen psoriasis?

Psoriasis typically flares up during dry, cold climate. Emotional stress and alcohol too worsen psoriasis. Exposure to sunlight for 15 to 20 minutes is good for psoriasis.

What is the best treatment for psoriasis?

The decision of treatment is based primarily on the extent and severity of psoriasis. When the area of involvement is less than 10% of the body surface area, ointments may be chosen. Options include a vitamin D derivative, a vitamin A derivative, corticosteroid ointments, coal tar applications and an agent called anthralin. For psoriasis that is more extensive or unresponsive to local applications, there are certain oral agents that are very effective against psoriasis. These include an anticancer agent, an immunosuppressive agent also used in transplant patients and a vitamin A derivative. The oral medications have a pretty decent safety record. The only issue is they are safe only when monitored by certain laboratory investigations at regular intervals. Any deviations from normal entail either a reduction in dose or discontinuing the medication so that no real harm occurs. For those people who would prefer to keep away from oral medications and have some time to spare, being treated in a chamber by narrow band ultraviolet B light is an excellent option. Patients need to spend a few minutes in this chamber 2 to 3 times a week. The latest medications for psoriasis, called biological agents target specific immune responses. The major downsides to these are that they are administered using a battery of investigations and they are prohibitively expensive.

The winning mantra against psoriasis is "We Shall Overcome"!