My Skin, My Health

PSORIASIS, AN AUTOIMMUNE DISEASE

Psoriasis is a skin disease that results from a faulty immune system. Instead of only targeting viruses and bacteria, your immune system turns on healthy tissue. It attacks your skin, which speeds up how quickly your skin cells multiply.

Skin usually takes a month to grow and fall off. With psoriasis, the process takes only 3 or 4 days. Skin cells build up, causing thick, red patches called plaques. They’re often covered in white or silvery scales. Although plaques and scales can grow anywhere, they’re most common on your knees, elbows, and scalp.

It can be painful, interfere with sleep, and make it hard to concentrate. Common triggers in people with a genetic predisposition to psoriasis include infections, cuts or burns, and certain medications.

Psoriasis usually first appears in young adults.

Once you have psoriasis, you’ll deal with the condition for the rest of your life. Most of the time, the disease flares up for a few weeks or months, followed by a stretch of fewer or no symptoms. Triggers, such as stress or infections, can set off a flare.

Psoriasis can be unpredictable. In some people, the disease stays mild for years. In others, it worsens quickly. The disease is also more than skin deep. The same inflammation that causes plaques and scales can affect your entire body. This sets the stage for other health issues.

Treatments are available to help you manage symptoms. And you can try lifestyle habits and coping strategies to help you live better with psoriasis.

SIGNS AND SYMPTOMS

· Rashes: A patchy rash that varies widely in how it looks from person to person, ranging from spots of dandruff-like scaling to major eruptions over much of the body.

· Rashes that vary in color, tending to be shades of purple with grayscale on brown or Black skin and pink or red with silver scale on white skin

· Small scaling spots (commonly seen in children)

· Dry, cracked skin that may bleed

· Itching, burning, or soreness

· Cyclic rashes that flare for a few weeks or months and then subside

· Fatigue

· Stiff, tender, swollen, and throbbing joints or tendons

· Reduced range of motion

STAGES OF PSORIASIS

Some scales sort psoriasis into just two camps instead of three: mild and moderate-to-severe.

Mild

Most people with psoriasis have it to this degree. Mild cases affect less than 3% of your body (your palm is about 1%). You might have a few lesions scattered on your arms and legs. Patches on your scalp may have fine, thin scales. Topical drugs like creams or ointments are usually all you need.

Moderate

This is when psoriasis patches cover 3% to 10% of your body. Creams and other topical meds probably won’t be enough. Instead, your doctor may recommend phototherapy (also known as light therapy) alone or combined with drugs that you will take by mouth or with a shot. You’d likely report a major impact on your quality of life. About one-quarter of people with psoriasis have cases deemed moderate to severe.

Severe

You fall into this group if your psoriasis covers more than 10% of the skin. But size isn’t everything. Smaller patches in sensitive places like your palms or soles of your feet can be even more severe than larger and more widespread lesions elsewhere on your body. Fewer than 20% of people with psoriasis have the severe type. You’ll likely need the strongest treatments -- like biological drugs and other “systemic” therapy -- that work on your whole body, not just the skin.

Rare but Serious

About 3% of people with psoriasis have a type called erythrodermic psoriasis. Scales and blisters called pustules can cover 75% or more of your body surface. Your skin can peel off in large, red sheets. It’s painful and itchy. It can be deadly and it needs medical care right away. Another type, called pustular psoriasis, has a version that also can be an emergency. It starts with widespread areas of reddened skin that fill up with pus within hours.

PASI Score

There are no universal standards to measure how bad your psoriasis may be. The most widely used scale for physical symptoms is the Psoriasis Area and Severity Index (PASI). It divides your body into four zones: head and neck; hands and arms; chest, stomach, and back; and legs, thighs, and buttocks. Each region is scored on a scale. Zero means none of the areas are affected and 6 means all of it is. Then, your skin is graded on thickness, redness, and scaliness, and the results are combined for a final severity score.

TYPES

There are several types of psoriasis, each of which varies in its signs and symptoms:

Plaque psoriasis: The most common type of psoriasis, plaque psoriasis causes dry, itchy, raised skin patches (plaques) covered with scales. There may be few or many. They usually appear on the elbows, knees, lower back, and scalp. The patches vary in color, depending on skin color. The affected skin might heal with temporary color changes (post-inflammatory hyperpigmentation), particularly on brown or Black skin.

Nail psoriasis: Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth, and discoloration. Psoriatic nails might loosen and separate from the nail bed (onycholysis). Severe disease may cause the nail to crumble.

Guttate psoriasis: Guttate psoriasis primarily affects young adults and children. It's usually triggered by a bacterial infection such as strep throat. It's marked by small, drop-shaped, scaling spots on the trunk, arms, or legs.

Inverse psoriasis: Inverse psoriasis mainly affects the skin folds of the groin, buttocks, and breasts. It causes smooth patches of inflamed skin that worsen with friction and sweating. Fungal infections may trigger this type of psoriasis.

Pustular psoriasis: Pustular psoriasis, a rare type, causes clearly defined pus-filled blisters. It can occur in widespread patches or on small areas of the palms or soles.

Erythrodermic psoriasis: The least common type of psoriasis, erythrodermic psoriasis can cover the entire body with a peeling rash that can itch or burn intensely. It can be short-lived (acute) or long-term (chronic).

When to see a doctor

If you suspect that you may have psoriasis, see your healthcare provider. Also, seek medical care if your condition;

· Becomes severe or widespread

· Causes you discomfort and pain

· Causes you concern about the appearance of your skin

· Doesn't improve with treatment

CAUSES

The cause of psoriasis isn't fully understood. It's thought to be an immune system problem where infection-fighting cells attack healthy skin cells by mistake. Researchers believe that both genetics and environmental factors play a role. The condition is not contagious.

PSORIASIS TRIGGERS

Many people who are predisposed to psoriasis may be free of symptoms for years until the disease is triggered by some environmental factor. Common psoriasis triggers include:

· Infections, such as strep throat or skin infections

· Weather, especially cold, dry conditions

· Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn

· Smoking and exposure to secondhand smoke

· Heavy alcohol consumption

· Certain medications — including lithium, high blood pressure drugs, and antimalarial drugs

· Rapid withdrawal of oral or injected corticosteroids

RISK FACTORS

Anyone can develop psoriasis. About a third of instances begin in childhood. These factors can increase the risk of developing the disease:

· Family history: The condition runs in families. Having one parent with psoriasis increases your risk of getting the disease. And having two parents with psoriasis increases your risk even more.

· Smoking: Smoking tobacco not only increases the risk of psoriasis but also may increase the severity of the disease.

· Alcohol consumption: Drinking alcohol may also be a risk factor for psoriasis. People with alcohol use disorder may be at higher risk for a more severe disease course.

· Obesity: Research suggests that obesity may have a link to more severe psoriasis symptoms.

· Depression: Because psoriasis is a chronic condition that can affect self-esteem, confidence, and quality of life, a person with the disease may be more likely to experience depression.

· Cancer: A 2019 systematic review and meta-analysis concluded that people with psoriasis may be more likely to develop site-specific cancers such as squamous cell carcinoma and basal cell carcinoma.

· Diabetes: People with psoriasis may have a higher risk of developing type 2 diabetes. However, there’s limited evidence to suggest diabetes increases the severity of psoriasis symptoms.

· Arthritis: About one-third of people with psoriasis also have psoriatic arthritis, which can cause additional symptoms such as joint pain and swelling.

· Kidney, cardiovascular, and respiratory diseases: People with psoriasis may be more likely to develop these conditions. Cardiovascular disease, in particular, has a strong association with psoriasis. And evidence suggests that severe psoriasis can increase a person’s chance of experiencing a stroke or other serious cardiac event

· Certain environmental toxins

· Some medications

· Specific infections

· Excessive mental stress

COMPLICATIONS

If you have psoriasis, you're at greater risk of developing other conditions, including;

· Psoriatic arthritis, which causes pain, stiffness, and swelling in and around the joints.

· Temporary skin color changes (post-inflammatory hypopigmentation or hyperpigmentation) where plaques have healed

· Eye conditions, such as conjunctivitis, blepharitis, and uveitis

· Obesity

· Type 2 diabetes

· High blood pressure

· Cardiovascular disease

· Other autoimmune diseases, such as celiac disease, sclerosis, and the inflammatory bowel disease called Crohn's disease

· Mental health conditions, such as low self-esteem and depression

TREATMENT

Psoriasis treatment varies, depending on the specifics of your condition and your overall health.

The process starts with a complete review of your medical history and a comprehensive exam. From there, your triggers are identified and a plan may be created to help you avoid flare-ups. Your treatment plan may also include;

· Topical moisturizers and medications for reduced itching and plaque buildup

· Oral, anti-inflammatory medications for symptoms that don’t respond to other treatments

· Biologic injectibles, which help to mediate the autoimmune response that can cause flare-ups

· Phototherapy, which uses blue light and laser therapy to target and minimizes symptoms

· Coal tar: a thick, heavy oil and is probably the oldest treatment for psoriasis. How it works is not exactly known, but it can reduce scales, inflammation, and itchiness. It may be used to treat psoriasis affecting the limbs, trunk, or scalp if other topical treatments are not effective. Coal tar can stain clothes and bedding and has a strong smell. It can be used in combination with phototherapy.

· Tablets, capsules, and injections

If your psoriasis is severe or other treatments have not worked, you may be prescribed systemic treatments by a specialist. Systemic treatments work throughout the entire body.

These medications can be very effective in treating psoriasis, but they all have potentially serious side effects. All the systemic treatments for psoriasis have benefits and risks. Before starting treatment, talk to your doctor about your treatment options and any risks associated with them.

There are 2 main types of systemic treatment, called non-biological (usually given as tablets or capsules) and biological (usually given as injections).

Non-biological medications

· Methotrexate

· Ciclosporin

· Acitretin

· Other drugs: Apremilast and dimethyl fumarate

Biological treatments

Biological treatments reduce inflammation by targeting overactive cells in the immune system. They are usually used if you have severe psoriasis that has not responded to other treatments, or if you cannot use other treatments.

· Etanercept

· Adalimumab

· Infliximab

· Ustekinumab

· Other drugs: guselkumab, brodalumab, secukinumab, ixekizumab, and bimekizumab.

They're recommended for people who have severe psoriasis that has not improved with other treatments or when other treatments are not suitable.

EFFECTS OF PSORIASIS ON LIFE

Psoriasis isn’t just a physical disease. It has a huge impact on how you feel about yourself and how you carry on day to day. So doctors are relying more and more on quality-of-life measures in their diagnoses.

TIPS TO PREVENT PSORIASIS FLARE-UPS

When you have psoriasis, it's important to follow the advice of your doctor. Still, you can do a lot on your own to help control and prevent flare-ups.

Use Moisturizing Lotions.

Symptoms get worse when your skin is dry, so keep it moist with creams and lotions. Thick and oily ones, like petroleum jelly, are usually best. They're better at trapping moisture beneath the skin. To help remove scales, apply the cream on top of them, then cover the area with plastic wrap or another waterproof material. Leave it on for a few hours, then remove it.

Take Care of Your Skin and Scalp

Be careful with your skin. Never pick at patches or scales, as you may make your psoriasis worse. Use caution when trimming your nails. If you cut yourself, it might make symptoms flare. If you have psoriasis on your scalp, rub your topical treatments such as tar shampoos into your scalp. Regular bathing with soothing products, such as tar solutions, may bring relief, too.

Avoid Dry, Cold Weather

Climate can have a big effect on psoriasis. For many people, cold, dry weather makes symptoms worse. Hot weather usually makes it better, but not always.

Use a Humidifier

It's important to keep your skin moist. Turn on the humidifier when the air inside your house is dry.

Avoid Medications That Cause Flare-Ups

Let your doctor know about all the medications you take, even over-the-counter ones. Ask if they could affect your psoriasis. Drugs that are known to make things worse include;

· Lithium, used to treat psychiatric disorders

· Propranolol and possibly other beta-blockers, which are prescribed for heart conditions

· Quinidine, medication for an irregular heartbeat

If you're using any of these medications, ask your doctor about substitutes.

Avoid Scrapes, Cuts, Bumps, and Infections

It's extra important for people with psoriasis to avoid bumps and cuts. Trauma to the skin can cause a flare, a condition called "Koebner's phenomenon." Infections can also cause problems. Be especially careful when shaving. Avoid acupuncture, and tattoos, and do your best to prevent insect bites and chafing.

Get Some Sun, But Not Too Much

The ultraviolet rays in sunlight slow the growth of skin cells, so getting moderate doses of the sun is good. But make it brief -- about 20 minutes or so at a time. And use sunscreen. Sunburn can trigger psoriasis, and it raises your risk of skin cancer. Some medications can make your skin more sensitive to ultraviolet rays, so talk to your doctor first.

Zap Stress

Although it hasn't been proven, many people link flare-ups to stress. So, try to relieve your anxiety. That may be easier said than done, but you can try relaxation techniques like meditation or yoga, for starters.

Exercise, Eat Right, and Maintain a Healthy Weight

Although no studies have shown a link between diet and psoriasis, experts recommend that people with the condition eat a well-balanced diet that's high in fruits and vegetables. Some people say their symptoms improve when they remove dairy or gluten. Exercise may also help. Some studies show excess weight can trigger flares, so stay at a healthy weight.

RELATIONSHIP BETWEEN PSORIASIS AND YOUR DIET?

Neither of the psoriasis-related conditions is caused by anything you eat, but there’s an important link between your diet and psoriasis. Many foods are known to cause inflammation throughout the body. In some people, this widespread irritation can make the symptoms of psoriasis worse.

Foods to Avoid With Psoriasis

Many of the same high-calorie foods that can lead to weight gain and increase the risk for obesity, diabetes, and heart disease are also inflammatory. There are several categories of inflammatory foods that can make psoriasis symptoms worse.

Alcohol

Excessive alcohol consumption makes your liver work overtime. It has to produce chemicals to metabolize the alcohol, which can lead to long-term inflammation if you drink heavily or regularly. Alcohol can also damage the good bacteria in your gut, which can lead to inflammation in your colon and intestines.

Dairy

Many dairy products tend to be high in fat, which can lead to inflammation. Products that contain cow’s milk also contain casein, a protein that some people have trouble digesting. People who are lactose intolerant don’t have enough of the digestive enzyme lactase. Chronic gastrointestinal irritation from these conditions can make inflammation worse. For some people, psoriasis symptoms improve when they cut dairy from their diet.

Foods containing refined carbohydrates

Refined carbohydrates are highly processed (think white bread, white rice, pasta, pastries, and some breakfast cereals). They’ve been stripped of fiber and whole grains and tend to contain a lot of sugar, which can cause your blood sugar to spike. Refined carbohydrates also increase advanced glycation end products, which are substances in your blood that can lead to inflammation.

Foods with saturated fats and trans fats

Fats in red meat, cheese, fried food, margarine, fast food, and many processed snacks are known to trigger inflammation in the body. These fats increase the amount of low-density lipoprotein (LDL) in your blood, also called “bad cholesterol.” Studies suggest there may be a link between excess fat in the body and the development of psoriasis and the worsening of psoriasis symptoms.

Foods high in added sugar

Added sugars in soda, fruit juices, candy, baked goods, and other sweets are different from natural sugars in food such as fruit. Our bodies produce insulin to process sugar, but too much added sugar forces our bodies to store that extra energy in fat cells and inflame the fat tissue. Foods with lots of added sugars can also lead to increased levels of inflammatory proteins called cytokines. Some studies suggest that artificial sweeteners such as aspartame may also lead to chronic inflammation.

Foods that contain gluten

Research suggests that people with psoriasis tend to have higher rates of celiac disease. In people with celiac disease, gluten (a protein in wheat and some other grains) triggers an autoimmune response that causes the body to attack tissues in the small intestine. People with celiac disease need to avoid gluten completely, though some people without the disease have found that reducing gluten in their diet lessens psoriasis flare-ups.

Foods to Eat if You Have Psoriasis

Just as some foods trigger inflammation, others can help combat inflammation. In general, having a balanced whole-food diet is the best approach to reducing inflammation throughout the body. It may reduce psoriasis flare-ups or make your symptoms less severe. Following a Mediterranean diet for psoriatic arthritis or psoriasis can also reduce chronic inflammation that contributes to heart disease, type 2 diabetes, cancer, and other conditions.

Foods to be taken if you have psoriasis include;

· Fish, lean protein, or plant-based proteins such as tofu or tempeh

· Fruits and vegetables

· Legumes (beans and lentils)

· Nuts and seeds

· Olive oil

· Small amounts of low-fat dairy

· Whole grains

There’s no evidence that vitamins or supplements help ease psoriasis symptoms. The best way to get all the vitamins and minerals you need is from the foods you eat. But it’s generally safe to take a daily multivitamin. Talk to your doctor or a registered dietitian about other supplements that might be right for your needs.

How can I get started with a psoriasis diet?

If you’re going to change your diet to combat psoriasis, it is recommended that you start slowly. Jumping into a highly restrictive diet isn’t usually sustainable and may deprive you of important nutrients. Instead, start by cutting out some highly processed foods.

Substitute the pastries and cookies with fresh fruit. Opt for herbal tea or water flavored with fresh fruit, mint, or cucumber. If you think there’s a specific food or ingredient that’s triggering psoriasis flare-ups, talk to your doctor or a registered dietitian.

Being overweight or obese can also make psoriasis worse, so you may want to start a weight loss plan that includes fewer calories and smaller portion sizes. Any psoriasis treatment diet should be accompanied by healthy lifestyle choices. Get plenty of sleep and regular exercise, and try to reduce stress in your life. If you smoke, talk to your doctor about a plan to quit.

Does psoriasis get worse with age?

Most people develop psoriasis between the ages of 15 and 35. While psoriasis may get better or worse depending on different environmental factors, it doesn’t get worse with age.

Obesity and stress are two possible components that lead to psoriasis flares. However, the severity of your psoriasis is ultimately determined by your genetics. The longer you live with psoriasis, the more likely you are to develop psoriasis-related health issues. But psoriasis itself won’t necessarily make you look older. People with psoriasis develop signs of aging, just like people without the condition.

HOME REMEDIES FOR PSORIASIS

Home remedies aren’t a replacement for your doctor’s prescriptions to treat psoriasis. Every case of psoriasis is unique, so there isn’t a single method for effectively treating the disease.

Along with discussing treatment options with your doctor or dermatologist, there are home remedies that you may find work well for you.

Below are some home remedies that have shown some promising results in providing relief for psoriasis symptoms.

Salt baths

A warm (not hot) bath can be soothing to the skin, especially for people with psoriasis. You can try adding Epsom salt, mineral oil, colloidal oatmeal, or olive oil to help with itching and irritation.

Bathing with Dead Sea salts in particular has shown a beneficial effect on treating psoriasis. The Dead Sea contains a wealth of minerals and is much saltier than the ocean.

In one small clinical trial, participants who bathed in a Dead Sea salt bath or a bath with common salt for 20 minutes per day for 3 weeks saw a significant improvement in their psoriasis symptoms. Those who took Dead Sea salt baths had an even higher improvement in symptoms compared to people who took common salt baths.

Aloe vera

Creams made from extracts of the aloe vera plant can be applied to the skin to help reduce redness, scaling, itching, and inflammation. The results of clinical studies testing whether aloe vera creams help with psoriasis have shown mixed results.

The National Psoriasis Foundation doesn’t recommend taking aloe vera in an oral tablet form.

Omega-3 fatty acids

Omega-3 fatty acids are known to help decrease inflammation in the body. This can be beneficial for psoriasis symptoms. Inflammation is what causes the itchy, red flakes.

Omega-3s can be found in a variety of foods, including;

· flaxseed oil

· nuts

· seeds

· soy

· fatty fish

· Fish oil is also available as a dietary supplement.

In a recent survey of 1,206 people with psoriasis, about 45 percent of those who added omega-3 fatty acids to their diet saw an improvement in their skin.

If you decide to take fish oil supplements, read the label carefully. Taking more than 3 grams per day can thin your blood. This is especially important if you’re taking blood-thinning medications, like warfarin (Coumadin).

Turmeric

There haven’t been any large clinical trials on the use of turmeric in treating psoriasis. However, the results of smaller studies using a topical turmeric gel have been encouraging.

A small study of 34 people with mild to moderate psoriasis found that turmeric gel applied twice daily for nine weeks helped improve the size, redness, thickness, and scaling of their psoriasis lesions.

Oregon grape

Oregon grape or Mahonia aquifolium is an antimicrobial herb in the barberry family.

Research has found that a cream containing an extract of the herb might help with psoriasis. In one open clinical trial, a total of 433 people with psoriasis were treated with a Mahonia aquifolium ointment.

After 12 weeks, psoriasis symptoms improved or disappeared in over 80 percent of the study participants. The extract was also shown to be safe and well-tolerated.

Maintaining a healthy weight

Obesity not only increases a person’s risk of having psoriasis but also is associated with having more severe symptoms.

If you’re overweight or obese, research shows that losing weight could help improve psoriasis symptoms. Shedding some pounds can also make psoriasis treatments more effective.

Some ways to lose weight include;

· eating more whole foods, such as fruits and

· vegetables

· eating lean meats and other healthy proteins

· eating less sugar

· cutting out highly processed foods

· exercising consistently

Stress-relieving activities

Stress is a known trigger for psoriasis flare-ups. Finding ways to reduce and manage your stress can potentially prevent flares or lessen their severity.

While no studies have been done to find out if the following activities have a direct effect on psoriasis symptoms, they have been shown to reduce stress in general;

· meditation

· yoga

· deep breathing exercises

· aromatherapy

· writing in a journal

NB: Remedies like fish oil supplements, Oregon grape, and Dead Sea salt baths do show consistently strong evidence of helping with psoriasis symptoms.

However, there aren’t enough large, well-controlled clinical trials to prove that these remedies work well for everyone.

HOW CAN SUNLIGHT HELP PSORIASIS

Most people who have psoriasis find that the sun helps to improve their skin’s appearance. For some, the change is dramatic, with red scaly patches almost disappearing altogether during the summer months in a warm climate.

To help clear psoriasis, sun exposure needs to be spread over time. A week on a sunny holiday may help but rarely completely clear psoriasis, and if the skin is exposed too soon for too long, sunburn can result, which could cause injury to the skin.

In some people with psoriasis, such an injury can start a new plaque of psoriasis at the site of the injury. This is known as Koebnerisation, named after the German dermatologist Heinrich Koebner. Therefore it is important to increase exposure to the sun gradually, to allow your skin to adapt to the sun without burning.

Because ultraviolet light is so effective for many with psoriasis, it is often used in various artificial forms. Ultraviolet (UV) phototherapy is a highly effective set of treatments for psoriasis given by hospital dermatology departments and specialist phototherapy centers.

PSORIASIS VS HIV/AIDs

Problematic gene variants typically vanish over time. They cause people to have fewer children and hence pass on their genes less frequently. As a result, these gene variants will gradually disappear over time. This, however, is not always the case. One of these genes may occasionally persist. especially if there is a bright side.

Many of these genetic disorders may also serve beneficial purposes, according to doctors and scientists. They are still around because of this. The genes that produce psoriasis may therefore be assisting us in some way, even though we perceive it as a problem.

One hypothesis is that many of the genes we discover in psoriasis patients are advantageous in the battle against HIV. Having genes that prevent AIDS is advantageous. But it's crucial that we remember two things.

First, we are aware that individuals with psoriasis and those who are adept at combating HIV share the same genes. However, this does not imply that the genes that fight HIV are the same ones that cause psoriasis. We frequently observe them together because they may be two distinct genes that are located close to one another. These genes, according to scientists, are "connected."

Second, we must keep in mind that evolution is a slow process and that HIV has just recently been found in humans. Even while we may perceive 100 years as an eternity, evolution takes thousands of years to take place. Because they prevent humans from contracting HIV, we may conclude that psoriasis genes are no longer in existence. But these same genes might shield us from a different pathogen that has been there for a lot longer (perhaps related to HIV).