Psoriasis is an autoimmune skin disorder which typically manifests as patches of abnormal red, painful, swollen and itchy scaly skin. The presentation of psoriasis varies from small, localized patches to complete body coverage with patches. This chronic inheritable skin disease speeds up the life cycle of skin cells by promoting rapid build-up of surplus skin cells on top of the skin. Psoriasis can appear and disappear.
In addition to other major parts of the body, psoriasis can affect the nails, producing a variety of changes in the appearance of finger and toe nails. Psoriasis can look like holes in the nails or cause nail discoloration.
This discomforting skin condition may start at any age, but it is mostly diagnosed in adulthood. The average age of onset is between 15 to 35 years old. According to the World Health Organization (WHO), some studies estimated that 75% of psoriasis cases are diagnosed before age 46; with second peak period occurring in the late 50s and early 60s. Males and females are affected equally. Caucasians are not affected on equal ratio. Coloured people have report of very small proportion of psoriasis cases. A family history of psoriasis increases the risk of the disease in people. Psoriasis signs and symptoms often worsen during winter and with certain medications. The proper management of types of this incurable skin disorder is of public health concern.
What is psoriasis?
Psoriasis is a non-contagious but chronic autoimmune health problem that results to rapid buildup of excess skin cells which show as swollen and red scales on the surface of the skin. The surface of scales/patches can be whitish, thick, bleeding and crackly.
Typically, Psoriasis manifests due to excessive speedy skin production process. Normally, skin cells grow deep in the skin, slowly rise to the surface and fall off naturally. The usual life cycle of a typical skin cell is 28–30 days. In psoriasis, this production process can happen in 3–5 days causing inability of the skin cells to fall off; then the pile-up of surplus skin cells. The surplus skin cells can form patches on the hands, neck, feet, face, scalp, genitals, nails, mouth, elbows and knees. Psoriasis can be associated with type 2 diabetes, heart diseases, arthritis and inflammatory bowel diseases among others.
Causes of Psoriasis
It is not very clear what causes psoriasis. However, research reports and theories make genetics and immune system factors major suspects. According to the National Psoriasis Foundation, about 3% of the global population inherit genes that expose them the more to psoriasis attacks.
Psoriasis is an autoimmune system disorder where the body attacks itself. The skin problem results from erroneous attack of the healthy skin cell by white blood cells (T cells). This mistaken attack causes speedy skin cell production process which makes the abnormally excessive and fast developed new skin cells to pile-up on the skin’s surface, causing discomforts.
Incidence of Psoriasis
Psoriasis is a public health challenge, affecting two to four percent of the global population especially in western world. Men and women of any age are affected equally. However, the frequency is more during adulthood; and the first time attack occurs between the ages of 15 and 25 years. The rate of psoriasis attack varies according to region and ethnicity due to possible combinations of environmental and genetic factors. Psoriasis particularly affect about 6.7 million Americans, especially adults.
Types of psoriasis
Psoriasis is of five main types. They are:
Plaque or vulgaris psoriasis: This is most common, accounting for more than 80% of cases. Usually, it causes red, inflamed patches covered with whitish-silvery scales or plaques on the elbows, back, knees, shin, navel and scalp.
Inverse psoriasis: Presents as smooth areas of shiny, red and inflamed skin patches that can worsen with fungal infection, friction and sweating. Inverse psoriasis develops under breasts, overweight abdomen, armpits or around the genitals.
Erythrodermic psoriasis: This is very rare but can be life-threatening because it makes large areas of the body to appear sun-burnt with red and peeling rash that can itch or burn intensely. The formed scales often pull off in large sheets and can cause very ill-health to sufferers.
Guttate psoriasis: Is common in children and young adults. It forms numerous small, scaly, rarely thick or raised pink drop-shaped spots on the legs, scalp, arms and torso. Guttate psoriasis is often triggered by streptococcal bacterial infection.
Pustular psoriasis: Is more common in adults. It causes whitish, non-infectious pus-filled blisters just few hours after the broad areas of skin become red and swollen. The blisters may appear and disappear often. This type can be generalized or localized on the hands, feet or fingertips. Generalized pustular psoriasis can cause chills, severe itching, fever and diarrhea.
Signs and symptoms of psoriasis
Depending on the type and severity of psoriasis, the signs and symptoms are different for everyone. But the common presentations include:
- Red and raised patches of skin covered with thick whitish- silvery scales.
- Small dandruff-like scaly spots (commonly seen in children).
- Dry, cracked skin that may bleed (pinpoint bleeding when scale is removed).
- Localized pain, itching, burning or soreness around patches.
- Thickened, pitted or ridged nails.
- Swollen, painful and stiff joints.
- Inflamed, red areas of skin with plaques.
Complications of Psoriasis
Psoriasis can cause the following health complications:
- High blood pressure.
- Cardiovascular diseases.
- Metabolic syndrome.
- Other autoimmune diseases.
- Psoriatic arthritis.
- Lymphomas and cancers.
- Eye problems.
- Crohn’s disease.
- Type 2 diabetes.
- Parkinson’s disease.
- Kidney disease.
- Emotional problems.
Conditions that trigger/worsen Psoriasis attack
Usually, psoriasis begins or worsens due to identifiable and avoidable triggers. Factors that may trigger/worsen psoriasis include:
- Chronic infections such as HIV/AIDS, streptococcal throat or skin infections.
- Changes in season and climate.
- Hot water.
- Skin dryness.
- Excessive alcohol consumption.
- Cigarette smoking.
- Certain drugs including lithium, beta blockers, antimalarial and iodides.
- Wound on the skin caused by such as accident, deep tattoo, cut, scrape, bug bite or severe sunburn.
- Vitamin D deficiency.
Impact of Psoriasis
Psoriasis is popular for its degrading impact on the meaningful life of the sufferer and his/her family members. There are remarkable difficulties associated with psoriasis which are related to the severity and location of the attacks. The significant physical discomforts and disabilities include:
- Itching and pain which can alter basic functions of things like self-care and sleep.
- Inability to participate in sports.
- Difficulty engaging in certain occupations.
- Patches located on the hands, feet and scalp can be embarrassing.
- Individuals with psoriasis may have problems of poor self-image, public rejection and psycho-sexual concerns due to the erroneous belief that psoriasis is contagious.
- Psoriasis patients may be victims of low self-esteem, social isolation, depression and suicidal push in reaction to psychological distress.
- Psoriasis can cause unfulfilled quality of life and expectations.
Diagnosis and Treatment of psoriasis
Psoriasis can be diagnosed with simple physical examination of the affected skin portions; and biopsy where a small sample of skin is tested in the laboratory for definite confirmation of the disorder. After proper diagnosis by experts, appropriate combinations of treatment options are initiated.
The major goal of treatment is to break the rapid growth of skin cells and manage the manifested signs and symptoms. Psoriasis has no cure; however, various treatment options are available for the control of its signs and symptoms. These treatments include topical creams, ointments, immune system modulators plus ultraviolet or natural light and systemic drugs.
Psoriasis can be managed through careful Lifestyle modification measures. Proper skin moistening, avoiding smoking and good stress management are highly recommended. The useful moisturizers/emollients include shear butter, mineral oil, petroleum jelly, salicylic acid and coconut oil.
Preferable diets that can alleviate psoriasis attack
- Fruits and nuts.
- Cold water fish (preferably wild fish) such as salmon, herring and mackerel.
- Fish oil rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
- Extra virgin olive oil.
- Whole grains.
Lifestyle modifications that can alleviate Psoriasis attack
These major lifestyle changes may help to ease signs and symptoms of psoriasis; and reduce remission and flare-ups:
Guided weight reduction: Reducing body weight can check the severity of psoriasis, help treatment and remove surplus skin flesh where psoriasis can thrive. Engage in effective exercises which is equally good for overall good health promotion.
Alcohol consumption: Alcohol consumption which increases risks of psoriasis flare-up should be minimized or totally avoided.
Vitamins in-take: The in-take of vitamin-rich diet is highly recommended for ideal nourishment during psoriasis attacks. The use of vitamin supplements should be under expert medical advice so as to avoid adverse reactions and complications.
Heart-healthy foods: Eat more of lean proteins that contain omega-3 fatty acids from such as salmon, sardines and shrimp. Plant sources of omega-3 fatty acids include soybeans, walnuts and flax seeds.
Avoid trigger foods: Psoriasis and certain foods trigger inflammation. The foods that promote inflammation and should be cautiously avoided especially during psoriasis attacks are refined sugar, dairy products, processed foods and red meat.
Managing stress: Living with psoriasis can be quite frustrating, but prevention of flare-ups; and enjoying healthy and fulfilled life is achievable through effective management of stress. The activities that can help in managing stress during psoriasis attacks are praying, praising God, yoga, meditation and journaling.
Sharing emotional feeling: A patient with psoriasis should willingly share his /her emotional feeling so as to get encouragement on how to cope with this ill-health condition. This may include having early and regular contacts with professional mental health expert, dermatologist, society or group for people with psoriasis.