How to tackle Psoriasis

THIRUVANANTHAPURAM: Psoriasis is a common, chronic, inflammatory non-communicable skin disease most commonly characterised by well-demarcated reddish lesions with silver scales. Most cases can be treated in the out-patient setting. Rare, life-threatening presentations are far less common than in the past due to the many highly-effective systemic medications now available for treating psoriasis.
Psoriasis can begin at any age. The prevalence of psoriasis in adults ranges from 0.9-8.5%, and in children from 0-2.5%. Geographic location influences the likelihood of having psoriasis.

Risk factors: Genetic predisposition plays a role in the development of psoriasis. Approximately 40% of patients with psoriasis or psoriatic arthritis have a family history of these disorders. 

Multiple other factors are: Environmental and Smoking: The intensity and duration of smoking appear to increase the risk of psoriasis of the palms and soles. 

Obesity: It has been associated with obesity and higher Body mass Index (BMI) in adults and children. Obesity may contribute to the development of more severe disease
Drugs: Many drugs are associated with worsening of psoriasis. Common ones are beta-blockers (anti-hypertensive), lithium, pain-killers, antimalarials and antibiotics.

Infection: Bacterial and viral infections may be associated with worsening of psoriasis.
Alcohol consumption: It has been linked to psoriasis or its worsening. Alcohol consumption decreases response to psoriasis treatment. Alcohol consumption and psoriasis itself have been linked to increased risk of liver damage.

Vitamin D deficiency may be associated with psoriasis.

Types There are different types of psoriasis, such as scalp psoriasis, nail psoriasis, flexural (occurring over skin folds). Psoriasis can cause affliction of the joints (psoriatic arthropathy). Diseases reported to occur with higher frequency in patients with psoriasis are: cardiovascular diseases, diabetes, hypertension and autoimmune disease.

Clinical Course: A given patient’s course is unpredictable. It is a chronic condition. Achieving cure could be difficult; however, in many patients, the disease manifestations can be kept under control with careful treatment planning and follow-up. Psoriasis is rarely a direct cause of death.Diagnosis is based on history and physical examination. Skin biopsy aids in the diagnosis of difficult cases, or when there is uncertainty. Psoriasis needs to be differentiated from other skin conditions such as dandruff, skin allergies, eczema, etc.

Treatment
This is mainly focused on improving symptoms. Management involves addressing psychological as well as physical aspects of the disease. Various treatment modalities are available based on disease severity, patient preference (taking into account cost and convenience), efficacy and evaluation of individual patient response.

Mild-to-moderate psoriasis can be treated with topical medications. Moderate or severe cases may be treated with phototherapy (UVB light). If feasible, oral medication or injections can be given. In recent years, a newer type of drugs called biologic has become available. Improvement should be observed within weeks. Once the patient is on systemic therapy, regular follow-up and blood tests are essential
(The author is the senior consultant in Dermatology and Cosmetology, KIMS Trivandrum. The views expressed by the author are her own.)