Psoriasis

                             Psoriasis

             (An autoimmune skin disorder, Kalanjagapadai, विचर्चिका, चम्बल या अपरस रोग)

                                                  

                  

                                                             "Fight Psoriasis naturally."

Are you a psoriasis patient or do you know someone who is suffering from this embarrassingly painful skin condition? Do you know that it is a lifelong condition, and it is important to take an active role in managing it. Learning more about psoriasis, seeing a dermatologist to discuss treatment options, and developing a healthy lifestyle.

Psoriasis is non infectious, inflammatory disease of the skin, charecterized by well defined erythromatous plaques with large, adherent, silvery scales.

A chronic, recurrent, inflammatory disease of the skin of unknown origin characterized by well circumscribed erythematous dry plaques of various sizes, covered with mica like scales. 

It causes itchy, flaky, red patches of skin that may be painful or even bleed. Psoriasis may affect your nails  and even your joints as well. Psoriasis is a metabolic disease. Psoriasis is not contagious. You cannot get psoriasis by touching someone who has psoriasis, swimming in the same pool, even intimate contact.

People worldwide develop psoriasis. A family history of psoriasis seems to increase the risk of developing psoriasis. It is important to know that a family history of psoriasis does not guarantee that someone will develop psoriasis.

Eczema and Psoriasis are used interchangeably. Of course, there are some similarities but are different chronic diseases and so should be the treatment. Both the skin conditions are known as twins because of identical symptoms, yet the management may differ. So, if your skin is dry, red, itchy and causing persistent scratching.

Urgent medical attention is usually recommended in severe cases by healthcare providers'

Introduction

Psoriasis is a medical condition that occurs when skin cells grow too quickly .Faulty signals in the immune system cause new skin cells grow too quickly and new skin cells to form in days rather than weeks. The body does not shed these excess skin cells, so the cells pile up on the surface of the skin and lesions form.

 

Eruption

Onset and character - The initial lesion is a papule covered with silvery scales. The papules gradually enlarges peripherally and scales increased to a mass. The removal of scales exposes pinpoint bleeding points (Auspitz sign)

Psoriasis at Elbow

Psoriasis at occiput

Psoriasis at Saccrum

Sites -The lesion occurs predominantly on the elbows, knees, sacrum and occiput, but may occur anywhere on the body. The lesions are prone to occur at sites of trauma (Koebner phenomenon)

The reaction activates a series of events, causing new skin cells to form in days rather than weeks. The reason T cell trigger this reaction seems to lie in our DNA. Psoriasis is one of the most stubborn skin diseases. It is a chronic disease characterized by thick, red, silvery, scaled, patches of skin. It is however rare in infancy and old age.

Factors The factors that aggravate and precipitate the outbreak of psoriasis are injury to the skin in the form of cuts, burns, minor, abrasions, changes in the seasons, physical and emotional stress, infections and use of certain medicines for the treatment of other diseases.

When do people get psoriasis?

Psoriasis can begin at any age, from infancy through the golden years. Most people first see psoriasis between 15 and 30 years of age. About 75% develop psoriasis before they turn 40 . Another common time for psoriasis to begin is between 50 and 60 years of age.

Does psoriasis affect quality of life?

For some people,  psoriasis is a nuisance. Others find that psoriasis affects every aspect of their daily life. The unpredictable nature of psoriasis  may be the reason. Psoriasis is a chronic (lifelong) medical condition. Some people have frequent flare- up that occur weekly or monthly others have occasional flare ups

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When psoriasis flares up it can cause severe itching and pain. Sometimes the skin cracks and bleeds. When trying to sleep, cracking and bleeding skin can wake a person frequently and cause sleep deprivation. A lack of sleep can make it difficult to focus at school or work.. Sometimes a flare up requires a visit to a dermatologist for additional treatment. The cycle of flare  up and remissions often lead to feelings of sadness, despair, guilt and anger as well as low self esteem. Depression is higher in people who have psoriasis than in the general population. Feelings of embarrassment are also common.

                                                    

The main abnormality  in the disease is increased epidermal proliferation due to excessive division of cells in the basal layers. Clinical feature includes well demarcated lesions ranging from a  few millimeters to several centimeters in diameters, The lesions are red with dry silvery, white scaling which may be obvious only after scrapping the surface.

“Patients are advised to follow seasonal regimen or restrictions / kaala ozhukkam specially in winter” (The seasonal conduct called kaala ozhukkam structures out the guidelines to be followed in different seasons to prevent illnesses)                                    

Sign & symptoms

Morphological varieties

Guttate psoriasis

The lesion varies in size (drop size) from minute papules only just visible to sheets covering large parts of the body.. Quite often  they are discs from 1.5cm to several centimeters in size. The lesions of psoriasis are always dry. And rarely become infected.

                                       

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Nummular psoriasis / Coin shaped lesion

                                                                                                                

Annular psoriasis

With central clearing like ring

Annular Psoriasis on Abdomen

Gyrate psoriasis

Annular lesions merging with one another.

Pustular psoriasis Sterile  pustules on an erythematous base. These appear in crops.

Regional variety of psoriasis affect some parts of the body only.

Pustular Psoriasis

Flexural psoriasis The intertriginous areas are affected like  the axillae, groins ,under the breasts cubital and popliteal region

Flexural psoriasis

Palmer and plantar psoriasis Involving the palms and soles with hyperkeratotic scale patches.

Scalp Discrete areas of scaling often thicker than elsewhere. Beneath this scaling the scalp has the typical psoriatic red hue.

Arthropathic psoriasis Joints of the fingers, feet, knees  and ankles are affected. The involvement of the interphalangeal joint is typical. Eventually the joints are deformed.

Arthropathic psoriasis Joints

Arthropathic psoriasis Joints

Arthropathic psoriasis Joints

Psoriasis of the nails It is associated with pitting  and transverse ridging of the nail plate. There is subungual hyper-keratoses as well as onycholysis.

Psoriasis of Nail

Erythrodermic psoriasis Almost the entire skin becomes inflamed and scaly. It can be a serious condition   particularly in the elderly, generally requiring hospitalization.

Erythrodermic psoriasis

Generally, the skin of the person suffering from psoriasis appears red and irritated and may be covered with bright silvery scales

                                          

Sometimes there  is also little itching. Areas involved are elbows, knees, the skin behind the ears, trunk and scalp                                          

There are five types of Psoriasis: Plaque, guttate, pustular, inverse and erythrodermic.

About 80% of people living with psoriasis have plaque (plak) psoriasis also called Psoriasis vulgaris

                                                                                           

                                                                         

Plaque psoriasis causes patches of thick, scaly skin  that may be white, silvery or red called plaques. These patches can develop anywhere on the skin. The most common areas to find plaques are the elbows, knees, lower back and scalp.

Psoriasis also affects nails. About 50% of people who develop psoriasis see changes in their fingernails and /or toenails. If the nails begin to pull away from the nail bed or develop pitting, ridges, or a yellow-orange color, this could be sign of psoriatic arthritis. Without treatment, psoriatic arthritis can progress and become debilitating. It is important to see a dermatologist if nail changes begin or joint pain develops. Early treatment can prevent joint deterioration.

The disease also affects the under arms and genital areas.                                         

"Consult a doctor / Skin specialist for a diagnosis."                               

Complications : Deterioration. If the disease is untreated ,may lead to joint affection causing the destruction of bones, diminishing joint space and deformity.

                                     

Causes

The modern medical system has not been able to establish the exact cause of psoriasis.

Psoriasis involves the abnormality in the mechanism in which the skin grows and replaces itself. The abnormality is related to the metabolism of amino acids, the proteins chemicals which are natures basic building blocks for the reproduction of cell tissues.

• Hereditary also plays a role in the development of psoriasis. As it tends to occur in families. About 30% of the patients have a family history of the disease.
• Immune system : The T cell ( a type of white blood cell that fights unwanted invaders such as bacteria and viruses) mistakenly trigger  a reaction in the skin cells. This is why you hear psoriasis is referred to as a “T cell mediated disease.”
• Genetic : Genes play a key role. Unlike autoimmune many genes are involved in psoriasis. One of the genes that have been identified is called PSORS1.This is one of   several genes that regulate how the immune system fights infections. It is also true that not every one who inherits genes for psoriasis gets psoriasis. For Psoriasis to appear  it seems that a person must inherit the “right “ mix of genes and be exposed to a trigger.
• Trigger: Some common triggers are:  a stressful life event, skin injury and having strep throat infection. 

Precipitating or aggravating factors :

• Septic focus
• Psychological / emotional stress
• Hot weather and sunlight are beneficial. Cold may be an aggravating factor.
• Koebner positive- Injury and trauma are trigger factors
• Drugs
• A. Steroids After stopping results in severe flare up.
• B. Lithium
• C. Antimalarial
• Beta adrenergic blockers
• Ibuprofen

Diagnosis 

To diagnose psoriasis, a dermatologist will examine your skin, nails, and scalp for signs of this condition. Your dermatologist will also ask if you have any: 

• Symptoms, such as itchy skin

• Joint problems, such as pain and swelling or stiffness when you wake up

• Blood relatives who have psoriasis

• Recent changes in your life, such as an illness or increased stress

Sometimes, a dermatologist also removes a bit of skin. By looking at the removed skin under a microscope, a doctor can confirm whether you have psoriasis. 

Lifestyle

• He should avoid all nervous tensions and should have adequate rest.
• Too frequent baths should be avoided.
• Soap should not be used.
• Regular sea water baths and application of sea water  externally over the affected parts once a day are beneficial..
• The hot Epsom salt-bath has proved valuable in psoriasis.
• Three full baths should be taken weekly until the trouble begins to subside.
• After the bath ,a little olive oil may be applied.
• Skin should be kept absolutely clean by daily dry friction or sponge.
• In many cases  psoriasis responds well to sunlight. The affected part should be frequently exposed to sun. The daily use of a sunlamp or ultra-violet light  are also beneficial.

Water

The best way to get glowing with less effort and time is drinking water. Drinking less amount of water can under hydrate your skin, reducing the level of oxygen on the skin and tissues. Your skin cannot function at its best without water. This result in dry, rough and dull looking skin. So, to avoid that, drink an adequate amount of water daily. You need to drink at least8-10 full glasses of water a day. It keeps your skin clear, soft and glowing and helps combat many skin issues like Psoriasis and Eczema.

Exercise

The patient should undertake plenty of exercise in fresh air ,especially exploring the affected parts.

Pranayama 

Bhastrika Deep breathing exercises

breathing exercises purifies the 72000 nadi channels and reduce the stress also.

Mudra

Varuna Mudra 

                                          

Apana mudra

                                           

Prana Mudra

                                        

Counselling Spiritual approach

It helps the patients to provide mental and emotional strength.

Family support Plays an important role in it.

Healthy diet can improve your psoriatic symptoms by supporting your general health and well being.

Diet

Your diet influences your psoriatic symptoms.

• Banana

Banana in your diet are usually positive for your overall health and psoriatic symptoms.

Vegetables. lean meats, fish. low fat diet dairy products and whole grains.

• Avocado

1. Biotin source
2. Control dermatitis and Psoriasis.

Avoid 

Limit or eliminate your intake of alcohol to help reduce your psoriasis symptoms.

Food allergies : Psoriasis is triggered by food allergies.

Follow a hypoallergenic diet and eliminate gluten  to improve your psoriasis. Gluten is found in many whole grains like barley, wheat and rye. Other common food allergens like citrus. milk and dairy products, corn ,soy and eggs may worsen psoriasis symptoms. As well. To determine whether food allergies are triggering your psoriasis flareup, keep a food notebook that tracks the foods you eat and your daily psoriasis symptoms.

Treatment
Injection Itolizumab (Anti-Psoriatic injection) Biocon's.

Management

Although there are many therapies for the control of psoriasis there is no way to predict or prevent re-occurrences.

General

1. Remove trigger factor if possible.
2. A warm climate  may help to control relapses.
3. Topical applications-
4. 2-5% Tar cream or ointment.  
5. Salicylic acid with or without benzoic acid as in Whitfield ointment
6. Dithranol 0.5%  to start with messy but effective especially  stubborn patches
7. Topical corticosteroids:  Good for initial control to be used judicially and intermittently.
8. UVB radiation with or without tar creams or long wave ultra- violet light with psoralen (PUVA)
9. Systemic therapy: Corticosteroids : To be used only for erythrodermic psoriasis. Tan Prednisolone 60-80mg daily to be tapered gradually.
10. Avoid systemic steroids in all other types of psoriasis risk of severe  rebound flare-up of psoriasis after stopping steroids(which is resistant to treatment,)
11. Antimitotic : Methotrexate 5 mg/week initially or Cyclosporin in erythrodermic or generalized pustular psoriasis and exceptionally in chronic plaque psoriasis which has not responded to other forms of treatment. Useful but toxic. Frequent blood counts are necessary.

The goal of treatment is to control the symptoms and prevent infections. In general, three treatment options  are used for patients with psoriasis:

• Topical medications such as lotion, ointments, creams and shampoos.
• Body wise ( systemic) medications which are pills or injections that affect the whole body ,not just the skin.
• Phototherapy, which uses light to treat psoriasis.
• Most cases of psoriasis are treated with medications that are placed directly on the skin or scalp. If you have an infection, your doctor will prescribe antibiotics. You may try the following care techniques at home.
• Oatmeal baths may be soothing and may help to  loosen scales. You can use over the counter oatmeal bath products. Or, you can mix one cup of oatmeal into a tub of warm water.
• Sunlight may help your Symptoms go away. Be careful not to get sunburned.
• Relaxation and anti stress technique may be helpful. The link between stress and flares of psoriasis is not well understood, however.

Acute Psoriasis ( Erythematous - scaly Disorders)

( threatening to exfoliate dermatitis) 

Rx. Cap Doxycycline 100 mg twice a day.

Rx.  Aloederm cream

Rx. Moisturex cream

Rx. Propygenta cream

Rx. Cotaryl cream

Apply Twice a day for 14 days.

Subacute and Chronic Psoriasis

Rx  Acid Salicylic Acid

Rx Acid Benzoic

Rx Emulsifying ointment

Rx To be applied on lesion twice a day for 10 days

Whitfield’s ointment. Apply at night

Diprovate or sterotop cream or Elocon ointment. To be applied once a month for 1 month.

Rx Lococid cream

Tacrolimus ointment 0.1% for adult patients with chronic moderate to severe plaque Psoriasis.

Inj Etanercept induction dose: 50 mg twice weekly for three months subcutaneously. Maintenance dose 50 mg subcutaneously.

Rx Flutivate cream

Rx Eumosone cream

Moisturex cream

Calcipatriol skin cream along with steroid ointments.

Antihistamine tablets to prevent scratching.

Plaque Psoriasis

Tazarotene skin cream 0.05 to0.1%.

1% prepared coal tar topical (Esoro lotion) produces significant reduction in erythema, scaling and plaque thickness,

Note Phototherapy (UVA) and systemic agents Acitrecin cyclosporin methotrecxate ( should only be used when topical treatment are inadequate.

Liposomal anthralin / coaltar preparation

Calcipotrol 0.05% ointment

Biologicals ; Infiximab,Etanercept

Psoriasis with few localized lesions:

Inj Hydrocortisone (roussel)25mg/ml as for chronic eczema.

A high concentration of Dithranol (2-4%) is applied to the skin lesion for about 11/2 hours and then washed off. It can be used for outpatients and is associated with less staining.

Ayurvedic 

Therapeutic Vomiting : Vaman

Purging or Laxative : Virechana

Blood letting :Raktamokshana. 

Vtakaphara chikitsa, 

Sarvanga Takra dhara

Do's (Pathya)

• Diet such as vegan, high protein
• Products that can included in every day diet : turmeric, neem, garlic and onion.
• Jasmine flower paste and guggul to control inflammation.
• Black night shade and Aloe vera juice.
• Breathing Exercises :Pranayama
• Lifestyle improvements like 
• Inducing Sweating :  Swedana
• Consuming medicated Ghee, bitter vegetables, green gram, barley, old rice.
• Keeping the surroundings clean.
• Yoga
• Meditation
• Controlling weight
• Oil massage : (Abyayanga)
• Healthy foods
• Exercise every day.
• Smiling without any reason.
• Starting and ending the day with expressing gratitude to the  Almighty.

Don'ts (Apathya)

• Foods that contain high amount of carbohydrates and sugar.
• Food that are too salty, too acidic or too sour, sea foods, non-veg 
• Alcohol and Tobacco

Nature cure

• Since psoriasis is a metabolic disease, a cleansing juice, fast for a week is desirable in the beginning of the treatment. Carrots, beets, cucumbers and grapes may be used for juices.
• Juices of citrus fruits  should be avoided.
• All animal fats including milk, butter and eggs should be avoided.
• Refined or processed foods and foods containing hydrogenated fats or white sugar, all condiments, tea and coffee should be avoided.
• The warm water enema should be used daily to cleanse the bowels during the fast.

After the fast patient should adapt the diet of  three basic food groups, namely:

Seeds, nuts and grains.
Vegetables
Fruits.
With emphasis on raw seeds and nuts especially sesame seeds, pumpkin seeds, sunflower seeds and plenty of organically grown raw vegetables and fruits.
After noticeable improvement goat milk yogurt and homemade cottage cheese may be added to the diet. Cabbage leaves have been successfully used in the form of compresses in the treatment of psoriasis. The thickest and  greenest outer leaves are most effective for use as compresses.. They should be thoroughly washed in warm water and dried with a towel. The leave should be made flat soft and smooth by rolling them with a rolling pin after removing a thick vein. They should be warmed and then applied smoothly to the affected part in the overlapping manner. A pad of soft woolen cloth should be put over it. The whole compress should  then be secured with an elastic bandage.

Mud Pack :The use of mud packs in the treatment of psoriasis has also been found highly beneficial. The pack are made by mixing the clay with a little water and applying to the affected areas. After the clay has dried  it is removed and fresh pack applied . Mud packs are eliminative in their action. They absorb and remove the toxins from the diseased area.

Vitamin E therapy has been found effective in the treatment of psoriasis. Dose 200 to 800 I. U. a day It will help reduce itching and scabs.

Lecithin is considered a remarkable remedy for psoriasis. 6 to 9 caps a day 2-3 cap before and after each meal. In form of granules. It may be taken four tbsps. daily for two months. It may therefore be reduced to two teaspoonfuls.

Siddha

• Shamana oushadi Patients has to undergo one sitting of 
• Shodhana (Purificatory therapy) such as virechana (purgation), vamana (emesis).
• Vetpalai or Wrightia tinctoria (indigo). The oil is prepared from its leaves and coconut oil
• 777 OIL Drug of choice : It’s a wonder medicine for psoriasis. Easily available in all ayurvedic medical stores. It is a single herbal formulation prepared by lipid extraction procedure. Used for external use : Application after bath  as a thin coating over affected surface. Exposure to morning sun for 15 minutes after application. Use finger -tips for application over scalp. Use natural cleansing agents like Shikakai powder for washing hair and body.

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