Psoriasis

What is Psoriasis?

Psoriasis is a chronic, systemic, inflammatory skin disorder in which there is an increase in the rate at which skin cells are produced and shed from the skin.

Normally, skin cells reproduce and mature as they move from the deeper layers of the epidermis (the outermost layer of the skin) to the surface. This process is called proliferation and usually takes approximately 28 days. In psoriasis, this process is accelerated, only taking about 4 days. The new skin cells reproduce too quickly and move toward the skin surface in an immature form, causing a build-up of silvery scale (dead skin cells). There is also an increased blood flow to the skin and a thickening of the epidermis, leading to the development of red, raised plaques (a plaque is a raised, red, scaling, well defined area more than 1cm in size).

Psoriasis can affect any part of the skin surface, but most commonly involves the elbows, knees, scalp, and the sacrum (lower back).

Psoriasis is a condition which tends to run in families. Several different genes have been identified but the exact way in which the disorder moves from generation to generation has not yet been established. What is known is that both the immune system and genetics are important in its development. So although the potential to develop psoriasis is genetically inherited, it is by no means certain that it will ever occur.

Environmental factors can also play a role in developing the condition. In some cases, emotional stress (like moving house, a divorce or bereavement), infection (such as a strep throat), injury to the skin or certain medications can trigger the first episode of psoriasis, while certain lifestyle factors (such as heavy drinking and smoking) may worsen it.

Psoriasis is not contagious, infectious or the result of poor hygiene.

Psoriasis: The Facts

Psoriasis may seem only skin deep, but it begins inside the body within the immune system. The red, scaly, flaky, and itchy patches occur when the skin cells grow too quickly as a result of inflammation caused by the body’s immune system.

Triggers for this abnormal immune reaction can include physical injuries or infections (in particular, a streptococcal throat infection), certain medicines, and emotional stress.  Psoriasis varies in severity from person to person and can vary in severity in the same person at different times.

Occasionally psoriasis can disappear without treatment but more usually, it is a chronic disease that requires treatment.  Patches (also called plaques or lesions) can occur on various parts of the body, including the scalp, elbows, and or knees.

Some things you should know about psoriasis

• It is a chronic, systemic, inflammatory skin disease.
• It is related to the immune system – an autoimmune disease.
• It may run in families (there are several different genes involved in psoriasis).
• It is not curable, but treatments are available.
• It is not contagious.
• It is sometimes associated with psoriatic arthritis.
• It is associated with a slightly higher risk of diabetes, high blood pressure, high cholesterol and obesity.
• It is associated with a slightly higher risk of cardiovascular disease (angina, heart attack and stroke).
• There is a strong association between psoriasis and depression.

Co-morbidities (associated conditions)

People who have psoriasis are at risk of developing psoriatic arthritis, which commonly affects the joints of the fingers, toes and spine. Psoriasis is associated with a slightly higher risk of diabetes, high blood pressure, high cholesterol, cardiovascular disease (angina, heart attack, stroke), and obesity. There is also a strong association between psoriasis and depression.

Here are some of the symptoms associated with psoriasis and psoriatic arthritis. You may not experience all of these, but if you experience any of them, you should consult your doctor.

Red, scaly patches (also called plaques or lesions) with sharply defined edges, that occur most commonly on both elbows, both knees, the scalp, under arms, under breasts, natal cleft (groove between the buttocks) and genitalia, or at the site of an injury

If the scales are gently scraped off, a number of small, bleeding points can be seen underneath

Nail changes – loosened, thickened or pitted nails (pits are small dents/ice pick like depressions on the surface of the nails)

Some symptoms associated with psoriatic arthritis

Joint pain, especially with redness, swelling, and tenderness

Pain in your heel(s) or tennis elbow

A finger or toe that was completely swollen (sausage shaped) and painful for no apparent reason

Morning stiffness/pain in the back that improves with movement

How is it diagnosed?

Most cases of psoriasis are diagnosed by GPs, who is usually best placed to give advice on how to manage and treat your condition; sometime however onward referral to a dermatologist may be necessary.

What can be done?

Psoriasis varies in severity from person to person, and in the same person at different times. Occasionally psoriasis can disappear spontaneously, but more usually, it is a chronic condition that requires treatment. If you discover that certain things make your psoriasis worse, try to avoid them. It should be noted that all degrees of psoriasis can be treated effectively. The treatment is not a cure, but it will ensure a better quality of life.

The future

Psoriasis affects millions of people around the world. It is important to remember that psoriasis does not define you as a person. There are many different treatment options. Finding the treatment that works best for you can help you feel better about your condition.

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