WHAT IS PSORIASIS?
Psoriasis is an autoimmune disorder which is characterized by epidermal thickening and scaling orin other words, we can say that it is epidermal hyperplasia (over growth of epidermis) in which there is accelerated epidermal turn over. It is non-contagious and chronic (long term) illness. It’s commonly affecting extensor (muscles which contract or straighten the limbs or any part of body) and scalp.
SIGN AND SYMPTOMS
Rashes on brown or black skin are like purple shade with grey scale. On white skin they are pink or red with silver scales While on dry skin these patches can bleed and there is inflammation of skin also. Scratching and itching are also present in psoriasis.
TYPES OF PSORIASIS
There are many types of psoriasis and sign and symptoms varies in each type. Different types of psoriasis are as follow,
PLAQUES PSORIASIS
It’s characterized by clear prominent raised red scaly patches especially on elbows, knees, scalp and back.
SCALP PSORIASIS
It is psoriasis of scalp which some time mis concept with dandruff.
NAIL PSORIASIS
Affects nails of the body. It’s usually occurring with other type of psoriasis.
GUTTATE PSORIASIS
It’s characterized by little red bumps which are smaller than a fingertip. They scattered themselves on legs, arms and torso.
INVERSE PSORIASIS
It appears in unusual places like groin, armpits, belly button, genital, under the breast and behind the knees. It’s usually due to sweat, friction and skin to skin rubbing of skin folds especially in obese people.
PUSTULAR PSORIASIS
It’s characterized by bumps with pus means outer barriers of skin damage and skin is unable to hold nutrients and water and become prone to get infection.
ERYTHRODERMIC PSORIASIS
It’s occurring from head to toe and rash resembles to burn. it requires immediate medical attention.
FACTORS WHICH TRIGGER PSORIASIS
Weather condition such as cold and dryness or changes in temperature
Skin trauma or injury likes cuts, scrapes or surgery
Genetics
Smoking / Alcoholism
Bacterial infection such as streptococcal infection
Obesity
Emotional stress
Abrupt with drawl of systemic corticosteroids or with drawl of potent topical steroids Psoriasis is provoke or exacerbated by drugs such as Lithium, Chloroquine, Hydroxychloroquine, Beta -blockers, non-steroidal anti-inflammatory drugs (NSAID) and ACE Inhibitors, Interferons, Imiquimod and terbinafine. Mono clonal antibodies and small molecules like tumor necrosis factor -alpha antagonists used in oncology and immunology are also associated with psoriasis.
AFTER HOW MUCH TIME THE ABOVE-MENTIONED DRUGS CAUSES PSORIASIS?
Classical non drug related forms of psoriasis are different from the drug induced psoriasis. These changes can be observed through the histopathological (pathology of tissues) features. There is a lag between start of medications and onset of psoriasis which is called as LATENCY PERIOD. Latency period can be different for different medicine. For some medicine, it can be too short while for some it can be too long.
POSSIBLE MECHANISM OF ACTION
Exact mechanism of action is not clear. Basically, it’s autoimmune and inflammatory disorder in which there is interaction between predisposing (making liable) genetic and triggers factor. Possible mechanism of action may be as the immune system get confused and brain receive mixed up the signals and attacks the healthy skin also. Cytokines, Interferons, interleukin and growth factors released by immune cells have effects on others cells. There is sustained inflammation which leads to uncontrolled keratinocyte proliferation. In the plaques of psoriasis, inflammatory infiltrate like dermal dendritic cell, macrophages, T-cells and neutrophils are present which indicates that both immune system disorder and inflammatory disorder potentiate their effects in psoriasis.
COMORBIDITIES ASSOCIATED WITH PSORIASIS
Comorbidities means presence of one or more disease in your body. Sustained and chronic inflammation is basically a common link between comorbidities and psoriasis. The following comorbidities are observed with psoriasis.
PSORIATIC ARTHRITIS
Over the period of time, psoriasis affects joints, spine and those body parts of body where tendons and ligaments are attached to bones such as fingers, toes, wrists and knees. There is stiffness and swelling which create problem in mobilization. Early treatment of PSORIATIC ARTHRITIS is required otherwise, irreversible damage will occur.
METABOLIC SYNDROME (MS)
MS is sum up of many risk factors like central/abdominal obesity, dyslipidemia, hypertriglyceridemia, hypertension, insulin resistance which leads to hyperglycemia, pre-diabetic (patients don’t have hyperglycemia but high level of insulin present). The association between MS and psoriasis depends on severity of psoriasis or in other words, we can say that both have direct relation.
MORE SEVERITY OF PSORIASIS THAN STRONGER MS ASSOCIATION.
CARDIOVASCULAR DISEASE
Chronic inflammation of psoriasis is risk factor of cardiovascular disease. Chances of MI i.e., myocardial infarction are also increase especially in psoriatic arthritis woman.
NAFLD AND PSORIASIS INCREASE RISK OF CIRRHOSIS
In NAFLD, there is deposition of fat in liver. Psoriatic patients having NAFLD are at greatest risk of developing Cirrhosis may be due to release of inflammatory substances from liver.
ERECTILE DYSFUNCTION
Genital lesions results decrease the libido (desire of sex) and sexual dysfunction. Its Prevalence is very high in psoriatic patients.
PSYCOLOGICAL AND PSYCHIATRIC DISORDER
Severity of disease and control of disease are major contributing factors of anxiety and depressive disorders.
EYES
There may be conjunctivitis and uveitis (intraocular inflammatory disorder).
CELIAC DISEASE
In this condition, patient cannot take gluten a protein which is found in wheat. If patient take it then small intestine start immune system response.
CROHN ‘S DISEASE
It’s inflammatory bowel disease (IBD) in which there is inflammation of tissue of digestive tract.
ARE PSORIATIC PLAQUES CAUSES ITCH
Yeah, psoriatic plaques cause the itch. Exact mechanism of action is unknown but it’s supposed that inflammatory mediators present in plaques send signals to brain which in turn make a person feeling of itch. Can scratching of plaques are allowed? No, it’s not allowed because scratching makes psoriasis worst. Because there will be new lesion formed due to scratching and old one gets worse. There will be change in the chemical composition of plaques which ultimately affects treatment of psoriasis. There will be more itchy sensations at night because at night body temperature increases which decreases cortisol (controls inflammation for short term) level. Stressis also responsible for increasing itchy sensations by releasing more inflammatory mediators.
PSORIASIS AND MENTAL HEALTH
The disease is characterized with high physical and psycho-social burdens. Patients lose their confidence and there is low self-esteem (self-respect). Patients are not only worried because of severity of disease but also annoyed how to control this cutaneous disease? Psoriasis is very difficult to cure. we just try to manage the symptoms and to improve quality of life. Some patients get well completely while huge numbers of patients go through cycles of symptoms which are severe ones.
There is pain, bleeding, itching and others afore- mentioned comorbidities which are associated with psoriasis. Itchiness left patients depressed, irritated, angry and stressed. As we already, discussed that stress increase inflammatory substances which further worsen psoriasis lesions. There are sign and symptoms of Alexithymia also in which person is unable to identify their emotions. Itchiness of genital parts in public places is also bothersome. Genital lesions also result in sexual dysfunction. A psoriatic patients have greater psychological burdens. There is increase tendency of suicidal ideation. There is increase Prevalence of anxiety and depression. Hypo or Hyper pigmentation of skin left the patient low self-esteem. Patients feel shame and there is also a daily battle for those who suffered from immobilization due to psoriatic arthritis. Due to all above mentioned factors, low income and treatment cost there is endogenous stress, anxiety and depression. Flare of skin at any time is also a great problem. People think that it is contagious disease so, they try to maintain a distance with psoriatic patients.
With some life style modification, topical and systemic treatment psoriasis can be treated. In short, there should be complete evaluation of patients with possibility of risk factors presence. Depression and anxiety should be addressed with good counseling and medication. Psoriasis treatment also decrease symptoms of anxiety and depression. Collective efforts of qualified professionals will definitely improve quality of life of psoriatic patients.