Psoriasis is a chronic dermatological condition characterized by the formation of flaky and scaly skin because of a dysfunctional immunological system. Individuals with the condition have an increased skin cell turnover and this accumulation of skin cells forms psoriatic patches. The condition is prevalent in adults between the age groups of 20 and 30 years and 50 and 60 years. There is no gender preference for the disease.

Psoriasis is a multifactorial and non-contagious condition. Hereditary and environmental triggers seem to play a role in the pathogenesis. If a family member is affected by the condition, the individual is more predisposed to getting the disease. However, the correlation between genetics and the pathogenesis of psoriasis is still unclear.

Dr. Shilpa Binu Thomas, MD Dermatology (Government Medical College, Thiruvananthapuram, India) says that triggers such as infections, injury to the skin, obesity, stress, toxins like alcohol and smoking, and UV radiation from sunlight contribute to the pathogenesis. She also states that certain medications like beta blockers for hypertension, lithium for bipolar disorder, and some antimalarials can cause flare-ups of psoriasis.

The clinical picture of psoriasis can vary from minor distress in an individual to causing severe damage to the quality of life. It is a long-standing condition that includes an asymptomatic period followed by symptomatic periods. The skin forms red patches and scales that can be white or silvery or grey and are most commonly found on elbows, knees, back, scalp and nails. It can be itchy and can form painful fissures and cracks that can cause bleeding and disable the person. Psoriasis can affect the joints known as psoriatic arthritis, which is characterized by swelling, stiffness, and pain in multiple joints, especially in the morning.

Psoriasis is diagnosed by the pattern and appearance of the patches and scales on the skin. In addition, there should be an assessment of the psychological profile to see how the disease is affecting the daily life of an individual. For instance, in the UK, several score charts are used to assess the severity of the condition such as the Psoriatic Arthritis Severity Index (PASI) and Dermatology Life Quality Index (DLQI).

As for the treatment of psoriasis, there is no confirmed cure, however, there are treatment strategies to control the disease. The treatment varies from individual to individual depending on the severity. In most patients, topical medications such as ointments consisting of vitamin D analogs and corticosteroids are sufficient to clear the lesions. However, in severe scenarios, phototherapy is performed which involves exposing the skin to UV radiation and, oral medications such as acitretin, ciclosporin, methotrexate, and injections made of biological components such as etanercept, adalimumab are also prescribed.

Psoriasis can cause a significant social, physical, and psychological impact on the life of the individual. Therefore, it is always best to consult a physician regarding any asymptomatic changes in the appearance of the skin instead of ignoring them so that treatment can be obtained at an earlier stage rather than at a late stage.

References:

NHS (2022). Psoriasis. Available at: https://www.nhs.uk/conditions/psoriasis/

British Skin Foundation. Psoriasis. British Association of Dermatologists. Available at: https://knowyourskin.britishskinfoundation.org.uk/condition/psoriasis/

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