Psoriasis treatment depends on the type, severity and location of the disease
Psoriasis is a common chronic (longlasting) recurring disease known for ages, first described by the Greek physician Hippocrates (460-377 BC). It develops when a person’s immune system sends faulty signals that tell skin cells to grow too quickly.
Types of psoriasis
In classical cases (psoriasis vulgaris) the patient develops red scaly lesions on the outer aspect of elbows, knees or on the scalp.
> Red itchy persistent rashes on the inner side of elbows, knees, neck folds, inner thigh or below the breast (involving skin folds) is a kind of psoriasis called flexural psoriasis and is mistaken for fungal infection.
> Another kind of psoriasis which is quite disabling for the patient is the one affecting hands and feet. It may present as itchy scaly lesions or fissured or pustular lesions involving fingers, toes, palms, soles etc and is known as palmoplantar psoriasis. It is most frequently mistaken for bacterial infection or contact allergic dermatitis.
Generalised pustular psoriasis is associated with pustulation of whole body. The patient will develop skin lesions, like lakes of pus. It is a very serious life-threatening condition requiring immediate hospitalisation and intensive care management.
A rare variety can affect the whole body with redness and scaling along with constitutional symptoms like fever, myalgia , extreme weakness, nausea, vomiting etc and is called psoriatic erythroderma. This is also considered as a medical emergency requiring hospitalisation to avoid systemic complications.
> Psoriasis patients should avoid things that can make psoriasis worse. Eating a healthy diet, exercising, not smoking and drinking very little alcohol will help. Smoking, drinking, and being overweight make psoriasis worse. These habits also can make treatment less effective. People who have psoriasis also have an increased risk for developing heart disease, diabetes and other diseases, so taking good care is essential.
> Certain medications are associated with triggering or exacerbation of psoriasis eg. Lithium for psychiatric disorders, antimalarial drugs like chloroquin, blood pressure lowering medicines like inderal and pain killers
Be aware of your joints. If your joints feel stiff and sore, especially when you wake up, see a dermatologist. Stiff or sore joints can be the first sign of psoriatic arthritis. About 10 per cent to 30 per cent of people who have psoriasis get this type of arthritis.
Moisturisers are very important in the treatment of psoriasis. They reduce dryness, scaling cracking and fissuring. Local application includes creams containing coal tar, salicylic acid, vitamin D derivatives and steroid.
Since it is a disease with rapid multiplication of normal cells due to an altered immune mechanism, oral tablets which will slow the multiplication of cells can be given as pulse therapy (single dose in a week). Vitamin A derivatives, which will slow the multiplication of cells and promote normal maturation of skin cells, are given orally on a daily basis as a part of the treatment .These vitamin A derivatives have got an anticancerous action too.
Another kind of treatment is ultraviolet light therapy, which is relatively a very safe modality of treatment. Narrow band UVB therapy is given thrice weekly. It takes only a few minutes for the treatment. Patient has to visit the hospital thrice weekly. Depending on the area of disease, whole body treatment chambers and small units for hands and feet are available. All these modalities of treatment give relief not only to the psoriatic skin lesions but also to psoriatic arthritis and further internal damage to the joints and to the vessels as described earlier.
> There are injectable medicines known as biologics which can be taken by patients at home (self injection, like insulin taken for diabetes mellitus). Patient may need one injection a week or once in two weeks, or only five injections in a year, depending on the medicine selected for the treatment. Biologics are a breakthrough in the treatment of psoriasis. Though these injections are expensive, these are very effective and convenient for the patient. Proper evaluation of the patient to rule out infections like tuberculosis is absolutely essential before starting biologics.
All these treatments can be tailored in a way to suit the patient’s needs. The treatment will depend on the type, severity and location of the disease and the general health of the patient.
With all these modern modalities of treatment, psoriatic patients can lead a normal healthy life without being ashamed of the appearance of their skin.