What is Psoriasis?
Psoriasis is a non-contagious, T-cell-mediated chronic autoimmune disease manifesting in the skin or joints or both and characterized by an excessively aberrant hyperproliferation and poor differentiation of epidermal keratinocytes.
It will be incredibly itchy and form silver plaques/ patches on the skin that may be embarrassing, and have both physical and psychological effects.
These plaques/patches are usually red flaky and crusty and they’re often covered with a silver scale.
The exact appearance of psoriasis might depend on each person and the type of psoriasis they have but the overall idea is that the person has abnormal patches on the skin and the disease itself is a long-term autoimmune disease.
It is due to overstimulation of immune cells and excessive proliferation of keratinocytes within the epidermis that don’t mature correctly.
It is a kind of genetic disease which keep on elapsing and remitting.
As a disease of systemic inflammation, psoriasis is associated with increased risk of comorbidities, such as psoriatic arthritis, Cohn’s disease, malignancy, obesity, and cardiovascular diseases including malignancy.
At present there is no cure for psoriasis and much of the treatment option available involves managing the symptoms.
It has an equal prevalence rate in males and females globally.
Know about your skin
To understand this autoimmune disease, one should know their skin layer very well.
You may get more information about it here. In short, our skin is divided into three layers-epidermis, dermis, and hypodermis.
Hypodermis is made of fat and connective tissue that anchors the skin to the underlying muscle. Just above the hypodermis, there is dermis, which contains nerves, sweat glands, lymph and blood vessels and finally above the dermis, there is the epidermis.
How psoriasis actually occurs?
It main cause is due to infiltration of CD3 T-cells and CD11C + dendritic cells into the skin.
These cells are part of the immune system and once these cells go inside the skin it causes the release of pro-inflammatory mediators which causes inflammation in the skin.
These pro-inflammatory mediators are tumor necrosis factor and interleukin 7. The overall effect of this is the activation of keratinocytes.
In normal healthy skin keratinocytes make up most of the epidermis. They are produced from the basal layer and throughout their lifecycle of 21 days. They just migrate to the surface and lose their nucleus in cases of psoriasis.
This process of the migration of these keratinocytes which make keratin takes three to five days to reach on the surface.
Some of the current studies have identified that epigenetic factors including deregulated DNA methylation, abnormal histone modification and microRNAs expressions are involved in the development of psoriasis.
Subtypes of psoriasis and their symptoms
Different psoriasis have different symptoms.
Plaque psoriasis is one of the most common type with flattened areas of epidermal elevation. They are inflamed and red colour due to underlying dilated blood vessels with topped white-silvery scales. These plaques are characteristically itchy and found on the scalp, elbows, groin, lower back, and knees.
In case of Guttate psoriasis a small, red, individual spots were observed on the trunk and limbs. This type is triggered by an infection and usually starts in childhood.
Inverse psoriasis is another kind of this diasese which appears as smooth and shiny red lesions, lacking scales and typically form within skin folds like in the genital region, under arms or under the breasts.
Another type of psoriasis known as Pustular psoriasis which appears as areas of red skin with small, white elevations of cloudy pus and generally noticed on the hands and feet.
Erythrodermic psoriasis is another one and most severe subset. They appears as fire-red scales that can cover a large area of the skin. They fall off in large sheets and are often tremendously itchy and painful.
Psoriatic arthritis is another one which manifests as an inflammation in the joints.
Pathogenesis, risk factors and triggers
Evidence shows a significant association of psoriasis with arthritis, depression, inflammatory bowel disease and cardiovascular diseases.
In the past two decades of the advances in the understanding of the pathogenesis of psoriasis have been interpreted into targeted and highly effective therapies providing essential understandings into the pathogenesis of chronic inflammatory diseases.
The underlying pathogenesis involve complex interactions between the innate and adaptive arm of immune system. In which, T cells interact with dendritic cells, macrophages and keratinocytes via cytokines. Targeting tumor necrosis factor-α, interleukin-23, and IL-17 have been developed as a viable treatment for psoriasis.
A plentiful of factors contribute into the onset and exacerbation of this diasese.
Genetic risk factors such as HLA-Cw6 and mutations in CARD14 gene (caspase recruitment domain family member 14 gene) and environmental risk factors (such as infectious diseases, medications, and lifestyle) have played important role in it pathogenesis.
The cause and mechanisms of psoriasis are quite complicated.
It is a multiple factorial disease means a combination of genetics and susceptibility factors. So, one of your parents has psoriasis you’re also more likely to get it, because it’s in your genes which you’ve inherited from your parents and also psoriasis often occurs alongside other diseases like type 2 diabetes, obesity, depression, cardiovascular diseases and metabolic syndrome.
Diagnosis of Psoriasis
It diagnosis is typically based on the distribution of the skin damage, tissue biopsy, scalp and nails.
Doctor can do diagnosis by looking for some of the classic changes in the epidermal layers.
There is not a specific treatment method for this disease, so the overall aim is just reducing the symptoms and the psoriatic lesions.
There are several new systemic agents to treat the psoriasis treatment but selection of the right therapy in certain patient became challenging.
Many of the psoriasis patient asked whether dietary changes can improve their condition.
Now a days many of the psoriasis patients are willingly opting the alternative and complementary medicine to manage their psoriasis.
Research have shown that, diet has play an important role in the etiology and pathogenesis of psoriasis.
Vegetarian diets and low-energy diets with fasting has improved psoriasis symptoms.
Diets rich in omega-3 polyunsaturated fatty acids also displayed positive effects.
Vegetarian diets and low-energy diets with omega-3 polyunsaturated fatty acids have modify the polyunsaturated fatty acid metabolism and influence the eicosanoid profile and suppressed the inflammatory processes.
Increased body mass index and weight gain are risk factors for psoriasis, and the occurrence of obesity in patients with psoriasis is higher than normal one.
Weight management and a healthy lifestyle have shown to be very beneficial. Thus, nutritionists and dermatologists cooperation will be useful in the management of psoriasis.
For mild to moderate disease, first-line of treatment involves topical therapies including corticosteroids, vitamin D3 analogues, and combination products.
Use of moisturizers and emollients help in psoriatic plaques and minimize itchiness. These are usually applied onto the lesions directly.
People also uses topical or systemic immunosuppressive therapies to diminish the immune response.
Patient can be prescribed certain medications systemic medications which are things like methotrexate and cyclosporine which are immune suppressive medications.
A combination of the topical therapy and ultraviolet light therapy is also quite successful. So either sunlight or ultraviolet lamps is usually quite effective because it induces DNA damage in the keratinocytes and stop their proliferation.
Disclaimer: This content including advice provides a general information only. It is in no way a substitute for trained medical practitioner opinion. Always consult a specialist or your own doctor for more information. We does not claim obligation for this information.