Psoriasis

Psoriasis is a chronic, non-contagious autoimmune disease which affects the skin and joints. It commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis, called psoriatic plaques, are areas of inflammation and excessive skin production. Skin rapidly accumulates at these sites and takes on a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area including the scalp and genitals. In contrast to eczema, psoriasis is more likely to be found on the extensor aspect of the joint.
The disorder is a chronic recurring condition which varies in severity from minor localized patches to complete body coverage. Fingernails and toenails are frequently affected (psoriatic nail dystrophy) and can be seen as an isolated finding. Psoriasis can also cause inflammation of the joints, which is known as psoriatic arthritis. Ten to fifteen percent of people with psoriasis have psoriatic arthritis.

Types:
The symptoms of psoriasis can manifest in a variety of forms. Variants include plaque, pustular, guttate and flexural psoriasis.

Plaque psoriasis (psoriasis vulgaris) is the most common form of psoriasis. It affects 80 to 90% of people with psoriasis. Plaque psoriasis typically appears as raised areas of inflamed skin covered with silvery white scaly skin. These areas are called plaques.

Flexural psoriasis (inverse psoriasis) appears as smooth inflamed patches of skin. It occurs in skin folds, particularly around the genitals, the armpits, under an overweight stomach and under the breasts. It is aggravated by friction and sweat, and is vulnerable to fungal infections.

Guttate psoriasis is characterized by numerous small round spots. These numerous spots of psoriasis appear over large areas of the body, such as the trunk, limbs, and scalp. Guttate psoriasis is associated with streptococcal throat infection.

Pustular psoriasis appears as raised bumps that are filled with non-infectious pus (pustules). The skin under and surrounding the pustules is red and tender. Pustular psoriasis can be localised, commonly to the hands and feet (palmoplantar pustulosis), or generalised with widespread patches occurring randomly on any part of the body.Psoriasis of a fingernail

Nail psoriasis produces a variety of changes in the appearance of finger and toe nails. These changes include discolouring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail, and the loosening (onycholysis) and crumbling of the nail.

Psoriatic arthritis involves joint and connective tissue inflammation. Psoriatic arthritis can affect any joint but is most common in the joints of the fingers and toes. This can result in a sausage-shaped swelling of the fingers and toes known as dactylitis. Psoriatic arthritis can also affect the hips, knees and spine (spondylitis). About 10-15% of people who have psoriasis also have psoriatic arthritis.

Erythrodermic psoriasis involves the widespread inflammation and exfoliation of the skin over most of the body surface. It may be accompanied by severe itching, swelling and pain. It is often the result of an exacerbation of unstable plaque psoriasis, particularly following the abrupt withdrawal of systemic treatment. This form of psoriasis can be fatal, as the extreme inflammation and exfoliation disrupt the body's ability to regulate temperature and for the skin to perform barrier functions.

Clinical classification
Psoriasis is a chronic relapsing disease of the skin, which may be classified into nonpustular and pustular types as follows:

Nonpustular psoriasis

• Psoriasis vulgaris (Chronic stationary psoriasis, Plaque-like psoriasis
• Psoriatic erythroderma (Erythrodermic psoriasis)Pustular psoriasis
  

Pustular psoriasis

• Generalized pustular psoriasis (Pustular psoriasis of von Zumbusch)
• Pustulosis palmaris et plantaris (Persistent palmoplantar pustulosis, Pustular psoriasis of the Barber type, Pustular psoriasis of the extremities)
• Annular pustular psoriasis
• Acrodermatitis continua
• Impetigo herpetiformis

Additional types of psoriasis include

• Drug-induced psoriasis
• Inverse psoriasis
• Napkin psoriasis
• Seborrheic-like psoriasis

Triggers:
The following may trigger an attack of psoriasis or make the condition more difficult to treat:

• Bacteria or viral infections, including strep throat and upper respiratory infections
• Dry air or dry skin
• Injury to the skin, including cuts, burns, and insect bites
• Some medicines, including anti-malaria drugs, beta-blockers, and lithium
• Stress
• Too little sunlight
• Too much sunlight (sunburn)
• Too much alcohol

Symptoms:
Persons with psoriasis have irritated patches of skin. The redness is most often seen on the elbows, knees, and trunk, but can appear anywhere on the body. For example, there may be flaky patches on the scalp.
The skin patches or dots may be:

• Pink-red in color (like the color of salmon)
• Dry and covered with silver, flaky skin (scales)
• Raised and thick

Additional symptoms may include:

• Genital lesions in males
• Joint pain or aching (psoriatic arthritis)
• Nail changes, including nail thickening, yellow-brown spots, dents (pits) on the nail surface, and separation of the nail from the base

Diagnosis:
A diagnosis of psoriasis is usually based on the appearance of the skin. There are no special blood tests or diagnostic procedures for psoriasis. Sometimes a skin biopsy, or scraping, may be needed to rule out other disorders and to confirm the diagnosis. Skin from a biopsy will show clubbed Rete pegs if positive for psoriasis. Another sign of psoriasis is that when the plaques are scraped, one can see pinpoint bleeding from the skin below (Auspitz's sign).
Treatment:
The goal of treatment is to control your symptoms and prevent secondary infections.
Psoriasis that covers all or most of the body is an emergency that requires a hospital stay. You may receive painkillers, medicines to make you sleepy (sedatives), fluids through a needle in your vein, and antibiotics to fight any infection.
Mild cases of psoriasis are usually treated at home. Your doctor may recommend any of the following:

• Cortisone (anti-itch) cream
• Creams or ointments that contain coal tar or anthralin
• Creams to remove the scaling (usually salicylic acid or lactic acid)
• Dandruff shampoos (over-the-counter or prescription)
• Moisturizers
• Prescription medicines containing vitamin D or vitamin A (retinoids)

Oatmeal baths may be soothing and may help to loosen scales. Over-the-counter oatmeal bath products may be used. Or, you can mix one cup of oatmeal into a tub of warm water.
If you have an infection, your doctor will prescribe antibiotics.
Sunlight may help your symptoms go away. Be careful not to get sunburned. Some people may choose to have phototherapy. Phototherapy is a medical procedure in which your skin is carefully exposed to ultraviolet light. Phototherapy may be given alone or after you take a drug that makes the skin sensitive to light.
Persons with very severe psoriasis may receive medicines to suppress the body's immune response. These medicines include methotrexate or cyclosporine. (Persons who have psoriatic arthritis may also receive these drugs.)
Newer drugs called biologics specifically target the body's immune response, which is thought to play a role in psoriasis. These drugs are used when other treatments do not work. Biologics approved for the treatment of psoriasis include:

• Adalimumab (Humira)
• Alefacept (Amevive)
• Efalizumab (Raptiva)
• Etanercept (Enbrel)
• Infliximab (Remicade)

inspite of the above treatment it is uncurable or have to use medicine for life time. There is no permanent treatment in modern medicine.