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Jan 31, 2008

Psoriasis

Psoriasis

Psoriasis is a chronic,non-infectious disease. It has thick,well defined plaques of inflammatory silvery scales. 1-3% population suffer by this disease. Psoriasis is a long term disorder, exacerbation and remissions are very common. Generally people of 10-45 year of age suffer more by Psoriasis.
This disease is Non-infectious.But genetic predisposition is found ,it means if one or both parents have Psoriasis then chances of this disease in children are much more.

                                                                © Dr. R. S. Mann 2010

Psoriasis




What happen in Psoriasis?

Our skin is made up of two layers, outer layer is epidermis and inner layer is dermis. Our outer layer of skin- Epidermis shed off in every 35 days and a new layer of epidermis grow up and takes place . But in Psoriasis this process of growing new layer of epidermis becomes fast,and whole process now complete in 3 to 5 days in place of normal 35 days.

Types of Psoriasis


1. Plaque Psoriasis:- This is most common type of psoriasis. Lesions have clear cut boundaries, size may be from a few millimeters to several centimeters in size. Psoriasis spots are red and covered with dry-silvery-scales. Usually knees,elbows and back involved in this type of Psoriasis.

2. Guttate Psoriasis:- Psoriasis spots are droplet-shaped small in size less then 1 centimeter usually and covered with scales. Often throat infection by hemolytic streptococcal bacteria is cause of this type of Psoriasis. This type of Psoriasis resolves in few months commonly but later Plaque Psoriasis can develop in these persons.Usually lesions of Guttate Psoriasis are found on trunk,upper arms,thighs,face,ears and scalp.

3. Erythrodermic Psoriasis:- Whole skin becomes red and scaly. this is an Universal pattern of Psoriasis.

4. Pustular Psoriasis:- Pustule(eruptions fill up of Pus) formed on spots of Psoriasis. Fever may or may not be present with these spots. Mostly this type of Psoriasis spots develop on palms and soles.

Causes of Psoriasis

1. Trauma- Trauma or injury to skin may produce Psoriasis. Common sites for Psoriasis is Knees,Elbows has to bear low grade injuries in day to day practices. Trauma to skin must be avoided. Concept of Kobner phenomenon is concerned with this cause of Psoriasis.

2.Infection- Streptococcal bacterial infection of throat may cause guttate Psoriasis.

3. Drugs- Several drugs causes Psoriasis.
A. Anti-Malarial drugs such as hydroxychloroquine which are used as long term therapy for arthritis and lupus.
B. Beta Blockers - Propanolol used in Hypertension(High Blood Pressure).
C. Lithium Salts.
D. Calcium channel blockers and Angiotensin Converting Enzymes(ACE) used for High Blood pressures.
E. Smoking Cessation Drug -Bupropion may cause Psoriasis.

4. Sunlight- Severe ultra violet radiation may increase Psoriasis.

5. Emotional stress,Anxiety may flare up Psoriasis.

Symptoms and Signs of Psoriasis


1. Typical spots of Psoriasis with red, thick,scaly plaques are marked.

2. Itching may or may not be present .

3. Joint pains and inflammation- About 10% patient of psoriasis may have one or more joints involved this is called Psoriatic Arthritis or Arthropathy.

4. Nail changes-Pitting, Ridges and thickening.

5. Hair falling- Psoriasis of scalp presents as falling of flakes from head like dandruff with falling of hairs.

Treatment of Psoriasis


Conventional Medicine


1. Coal Tar preparations - Crude coal tar inhibit DNA synthesis.It is effective in few patients.
2. Dithranol- It also inhibit DNA synthesis and used more commonly.
3. Calcipotriol.
4. Steroid Creams- It is effective but on withdrawal,psoriasis may relapse rapidly.
5. Systemic Treatment for extensive Psoriasis include immunosuppresive drugs such as Methotrexate etc.
6. Phototherapy- Using ultraviolet light is more effective then earlier described treatments. Earlier U VB and PUVA(UVA exposure after injesting Psoralen) were most common forms of Phototherapy. But now a days Narrow Band U VB(NB-UVB) is used with fewer side effects.
Sun light has Ultra Violet(UV) rays of three types- UVA,UVB,UBC. UBA And UVB are used for Psoriasis. Phototherapy is given constantly 3 to 5 times for 2 months at least. After one month of constant phototherapy few signs of improvement starts. And after complete treatment once a week therapy is needed for a very long time.

Homeopathic Treatment


Homeopathy has more then 100 medicines for different types of Psoriasis.Psoriasis patients need a long term therapy from 1 to 3 years. 60 to 80% cases of Psoriasis are curable by homeopathic medicines.Homeopathic medicines are prescribed on patient's Individual pattern of Psoriasis lesions,Modalities according the weather and temperature changes, Personality traits,Behavioral pattern and Mental attitude of patient. General features,family history,co-existing symptoms, temperament, likings/disliking all are important for Homeopathic Prescription.

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