1. What is psoriasis?

Psoriasis is a condition of the skin characterized by itchy rashes which appear and disappear on its own, anywhere on the body.

2. How does psoriasis occur?

There is no exact cause of psoriasis but it’s known to be an autoimmune condition.There is inflammation in the skin which causes increased production of the skin cells.Normally, new skin cells are produced and replaced at a constant rate, in about 10-30 days.
Psoriasis causes increased skin production leading to accelerated turnover of cells every 3-4 days.

3. What is the age group and other predilections to get psoriatic patches?

Psoriasis often develops between the ages of 15 to 35, but it can occur at any age. About 10 to 15 percent of those with psoriasis get it before age 10.
Some infants have psoriasis, although this is a rare scenario .
Men and women develop psoriasis at equal rates.

4. Is it a genetic or hereditary problem?

At least 10 percent of the general population inherits one or more of the genes that create a predisposition to psoriasis. However, only two percent to three percent of the population develops the disease. So having psoriasis in your family has higher risk, but getting psoriasis is not a certainty.

5. What are the triggers for worsening of psoriasis?

Psoriasis triggers are not universal , however established psoriasis triggers include:
• Stress: Stress can cause psoriasis to flare for the first time or aggravate existing psoriasis.
• Winter season
• Injury to skin:Psoriasis can appear in areas of the skin that have been injured or traumatized. This is called the Koebner phenomenon.Vaccinations, sunburns and scratches can all trigger such response.
• Medications: Certain medications are associated with triggering psoriasis, including:
• Lithium: Used to treat manic depression and other psychiatric disorders.
• Antimalarials: Chloroquine and hydroxychloroquine may cause a flare of psoriasis, usually two to three weeks after the drug is taken.
• Beta blockers for HTN
• Quinidine
• NSAIDs or painkillers like Indomethacin, Ibuprofen, diclofenac etc
• Infections:streptococcus infection (strep throat) is associated with guttate psoriasis. Patients might experience a flare-up following an earache, bronchitis, respiratory infection, vaginal infection, urine infection, loose motions etc.

6. What are the co morbidities associated with psoriasis ?

Psoriasis is a skin disease and more often than not, it is limited to the skin of the patient. In around 30% of patients, joints also can get affected , known as Psoriatic arthritis. Around 50-60% patients also have co existing nail psoriasis.

Patients with severe uncontrolled psoriasis are known to be affected with co existing conditions like:
• Cardiovascular disease
• Diabetes
• Metabolic syndrome(heart diz, high BP & abdominal obesity)
• Obesity
• Liver disease
• Crohn disease

7. What are the symptoms of psoriasis and how is it diagnosed?

Psoriasis usually presents as red scaly rash present over the elbows, knees and other joints of the body, associated with itching. It can involve any or entire surface area of the skin. When present over the palms or soles, the thick patches might crack causing pain and discomfort while doing day to day activities.

Types of psoriasis:
Guttate psoriasis: Usually occurs in children, following throat infection.
Inverse psoriasis: Seen in body folds, as bright shiny rashes.
Pustular psoriasis: Tiny pus filled boils seen over the entire body or limited areas like hands and feet.
Erythrodermic psoriasis: A medical emergency where more than 90% of the skin is involved and associated with redness and scaling all over the body.
Palmoplantar psoriasis: limited to the hands and feet.

Diagnosis is usually straight forward done by your dermatologist .
Rarely, it might be difficult to differentiate from conditions like eczema, Atopic dermatitis etc .In those cases Skin biopsy might be required from the psoriasis lesions.

8. What is the treatment of psoriasis?

Psoriasis is not a curable condition, rather it can be controlled and a symptom free period of remission might be achieved.
The periods of remission vary from person to person and can vary from months to years.
Treatment options vary from Crems, to medications and newer biological & biosimilar injections.

Topicals: Given for smaller areas involved
Moisturizers
Corticosteroid creams
Coal tar
Salicylic acid formulations
Creams contain Vitamin D and Calcineurin inhibitors
Retinoids

Systemic medications:Given for larger areas or if no response is achieved with topicals.
Methotrexate
Retinoids
Cyclosporine
Phototherapy
Newer medications like Apremilast
Biological injections like Infliximab, Etanercept.

General advice for psoriasis patients:

• Lose weight: Losing weight reduces the severity of psoriasis and also makes treatment more effective.
• Regular exercise
• Avoiding scratching & causing any damage to your skin.
• Eat healthy diet:Reduce your intake of saturated fats. It is also advised to increase intake of proteins contain omega-3 fatty acids, such as salmon, sardines, and shrimp. Plant sources of omega-3s include walnuts, flax seeds, and soybeans.
• Avoid trigger foods:Avoiding those foods might help in improvement of psoriatic patches. The foods include:
- Red meat
- Refined sugar
- Processed foods
- Dairy products
• Drink less alcohol:Alcohol consumption can increase your risk of a flare-up.
• Managing your stress well: Journaling, Yoga ,Exercise & meditation can help you reduce your stress level.For more information on stress level, visit:https://www.beautifulmindhealthcare.com/services/stress-its-managem/22
• Emotional health:People with psoriasis are more likely to experience depression and self-esteem issues. It’s important you find a resource for handling them. This may include speaking with a professional mental health expert or joining a group for people with psoriasis.