What are Psoriasis and its treatments? 

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What is the meaning of Psoriasis?

Psoriasis is a chronic (long-term) skin disorder causing red, itchy, scaly patches usually covered by silvery or white scales. This condition is most often seen in the elbows, knees, lower back, legs, soles of the feet, palms, and scalp region.m Psoriasis usually begins in early adulthood, although it can start later in life as well.  In this article, we will be discussing in detail psoriasis and its treatment.

• What are the different types of Psoriasis?
• What are the causes of Psoriasis?
• What are the risk factors for Psoriasis?
• What are the symptoms of Psoriasis?
• How to diagnose Psoriasis?
• What is the treatment for Psoriasis?
• What are the complications of Psoriasis?
• How to prevent Psoriasis?
• What is the cost of Psoriasis treatment in India?

What are the different types of Psoriasis?

The different types of Psoriasis include:

Plaque psoriasis: 

• Plaque psoriasis is the most common type of psoriasis.
• It causes dry, red, raised skin patches that are covered by silvery scales.
• The plaques may be tender or itchy and maybe few or many in number.
• This type of psoriasis usually appears on the knees, elbows, scalp, and lower back.

Nail psoriasis:

• Nail psoriasis usually affects the toenails and fingernails.
• It causes abnormal nail growth, pitting, and discoloration of the nails.
• The affected nails may loosen and separate from the nail bed. This condition is known as onycholysis.
• In severe cases, the nails may crumble.

Guttate psoriasis:

• This type of psoriasis is usually seen in children and young adults.
• It is usually triggered by a bacterial infection like strep throat (sore and scratchy throat).
• It results in small, drop-shaped, scaling lesions on the arms, legs, or trunk.

Pustular psoriasis:

• This is a rare form of psoriasis.
• It leads to the formation of pus-filled lesions that are maybe widespread (known as generalized pustular psoriasis) or in the smaller areas of the soles of the feet or the palms of the hand.

Inverse psoriasis:

• This type of psoriasis mainly affects the skin folds of the buttocks, breasts, and groin area.
• It leads to the formation of smooth patches of red skin that worsen with sweating and friction.
• This type of psoriasis may occur due to fungal infections.

Erythrodermic psoriasis:

• This type is considered to be the least common type of psoriasis.
• It can lead to red, peeling rashes that burn or itch intensely, and can cover the entire body.

Psoriatic arthritis:

• Psoriatic arthritis causes painful, swollen joints.
• The joint symptoms may sometimes be the only symptom of psoriasis.
• This kind of psoriasis can affect any joint.
• It can lead to stiffness and joint damage, which may be permanent.

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What are the causes of Psoriasis?

• Psoriasis is an immune system (disease-fighting system of the body) problem.
• The immune system overreacts leading to inflammation and skin regeneration at faster than normal rates.
• In normal circumstances, the new skin cells grow every 28 to 30 days. But, in the case of psoriasis, the new cells grow and move to the surface of the skin every three to four days.
• The buildup of the new cells replacing the old cells leads to the formation of silvery scales and red patches.
• Genetics and other environmental factors are believed to play a role in the immune system not working properly.
• Psoriasis is not contagious.

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What are the risk factors for Psoriasis?

Some factors may trigger the risk of developing psoriasis. These factors include:

• Skin infections
• Infections like strep throat
• Stress
• Injury to the skin, like a scrape or cut
• Bug bite
• Severe sunburn
• Cold, dry climate
• Smoking
• Excessive alcohol consumption
• Certain medicines like antimalarial medications, high blood pressure medicines, lithium
• Rapid withdrawal of corticosteroid medications
• Family history
• Obesity
• Diabetes
• Hypertension (high blood pressure)

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What are the symptoms of Psoriasis?

Psoriasis commonly affects the elbows, knees, legs, lower back, palms, soles of the feet, scalp, and face. 

Most types of psoriasis flare for a couple of weeks or months, then subside for some time or may go into remission.

The symptoms of psoriasis vary in different individuals and may include:

• Red patches of skin covered by silvery, thick scales
• Small scaling spots
• Itching of skin
• Burning sensation
• Soreness of skin
• Dry and cracked skin that may itch or bleed
• Swollen, stiff joints
• Pitted, thickened, or ridged nails

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How to diagnose Psoriasis?

• Physical examination: Psoriasis can usually be diagnosed by the doctor by physical examination. The doctor will examine your scalp, skin, and nails. The patient’s symptoms are noted, along with the medical history and family history of the patient.
• Biopsy: The doctor will remove a small skin sample and send it to the laboratory for examination under the microscope. This helps in diagnosing the type of psoriasis and ruling out other disorders.

What is the treatment for Psoriasis?

The goal of psoriasis treatment is to stop the skin cells from growing rapidly and to remove the scales.

There are several treatment options for psoriasis. The type of treatment done for you depends on how severe is psoriasis, and how responsive it has been to a previous treatment.

The different types of treatments done for psoriasis include:

Topical therapy: This includes the topical application (applied to the skin) of certain medications.

Corticosteroids:

• These are the most commonly prescribed medicines for the treatment of mild to moderate psoriasis.
• Corticosteroids may be available in the form of creams, ointments, gels, lotions, foams, shampoos, and sprays.
• Examples of corticosteroids include hydrocortisone, triamcinolone, and clobetasol.

Vitamin D analogues:

• The synthetic forms of vitamin D such as calcitriol and calcipotriol slow the growth of cells.
• These drugs can be used alone, or in combination with the corticosteroids.

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Retinoids:

• Tazarotene is a type of retinoid that is available in the form of a cream or gel.
• It can be applied one or two times a day.

Calcineurin inhibitors:

• They help in reducing the inflammation and buildup of plaque.
• Examples include pimecrolimus and tacrolimus.

Coal tar:

• It helps in reducing itching, scaling, and inflammation.

Salicylic acid:

• Salicylic acid present in shampoos and scalp solutions reduces the scaling of the scalp psoriasis.

Anthralin:

It is a tar product in the form of a cream.

• It is used to slow skin cell growth. It also removes the scales to make the skin smoother.

Goeckerman therapy:

• Coal tar may be combined with light therapy for the treatment of psoriasis. This is known as Goeckerman therapy.
• These two therapies when combined are more effective than when used alone.
• Light therapy: Light therapy is the preferred treatment for moderate to severe psoriasis. It can be used alone, or in combination with other medications. The skin is exposed to controlled amounts of artificial or natural light for the treatment of psoriasis. Repeated treatments would be required. The different types of light therapies include:

Sunlight: 

• Daily exposure to sunlight for a brief time is known as heliotherapy. This may help in improving psoriasis.

UVB broadband:

• An artificial source of light emitting controlled doses of UVB broadband light can help in the treatment of single patches, widespread psoriasis, and psoriasis that does not improve with topical therapy.

UVB narrowband:

• It is generally more effective than UVB broadband treatment.
• It is usually given twice or thrice a week till the skin improves, and later less frequently for maintenance therapy.

Psoralen plus ultraviolet A (PUVA):

• A light sensitizing medicine known as psoralen is given before being exposed to UVA light.
• The UVA light can penetrate deep into the skin, and psoralen will make the skin more responsive to the exposure of UVA light.
• This is an aggressive form of treatment that is mostly used for severe cases of psoriasis.

Excimer laser:

• In this form of treatment, a strong UVB light is targeted at the affected skin only.
• Excimer laser therapy will require less sessions than traditional phototherapy since The UVB light used is more powerful.

Oral and injected medications: In case of moderate to severe psoriasis, when other forms of treatments have not worked the doctor prescribes certain oral or injected medicines.

Steroids:

• In case of a few small, persistent psoriasis patches the doctor may inject triamcinolone into the lesions.

Retinoids:

• Retinoids like acitretin can be given in the form of pills for reducing the production of skin cells.

Methotrexate:

• It is a medicine usually administered as a single oral dose, once a week.
• It decreases the production of skin cells and reduces inflammation.

Cyclosporine:

• It is a drug taken orally for severe types of psoriasis.
• It suppresses the immune system.

Biologics:

• These medications are usually given in the form of injections.
• These drugs alter the immune system, disrupt the cycle of psoriasis, and improve the symptoms of the disease in a few weeks.
• Examples of biologics are etanercept, adalimumab, infliximab, secukinumab, ustekinumab, and ixekizumab.

Other medications:

• Thioguanine, hydroxyurea, and apremilast are some of the other drugs that can be used for the treatment of psoriasis.

Alternative medicine: Several alternative therapies are considered safe and effective in reducing itching and scaling in people with mild to moderate psoriasis.

Aloe extract cream:

• This is a cream obtained from the leaves of the aloe vera plant.
• It may help in reducing the redness, itching, scaling, and inflammation.

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Oregon grape:

• It is also known as barberry. It is applied to the skin to reduce the severity of psoriasis.

Fish oil supplements:

• Oral fish oil therapy when used in combination with UVB therapy helps in reducing the amount of skin that is affected by psoriasis.

Essential oils:

• Essential oils can help in reducing stress and anxiety.

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What are the complications of Psoriasis?

Psoriasis can lead to the following conditions:

• Psoriatic arthritis, causing pain, swelling, and stiffness in the joints
• Obesity
• Diabetes
• Eye conditions like conjunctivitis
• High blood pressure
• Cardiovascular (heart-related) diseases

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• Other autoimmune diseases like celiac disease (immune reaction triggered on eating gluten) and sclerosis (nerve damage disrupting the communication between the brain and the body)
• Inflammatory bowel diseases like Crohn’s disease (inflammation of the digestive tract)
• Depression and low self-esteem

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How to prevent Psoriasis?

Although psoriasis cannot be prevented, the following lifestyle changes can reduce your risk of developing psoriasis:

• Eat a balanced diet
• Increase intake of protein
• Avoid gluten intake in case of a gluten allergy
• Avoid foods like simple carbohydrates and saturated fats, as they may cause inflammation
• Take a bath daily
• Avoid excessive exposure to sunlight. Use sunscreen with a sun protection factor of SPF 30 or more when you step out in the sun
• Quit smoking
• Limit alcohol consumption
• Reduce stress by yoga, meditation, and exercise
• Avoid prolonged hot showers
• Keep your skin well moisturized
• Maintain a healthy weight

What is the cost of Psoriasis treatment in India?

The total cost of psoriasis treatment in India can range from around INR 5,000 to INR 95,000 depending on the type of treatment done. However, the cost of the procedure may vary across different hospitals. There are many big hospitals and specialized doctors in India for psoriasis treatment. The cost varies across different hospitals. 

If you are coming from abroad, in addition to the expenses of psoriasis treatment, there will be a cost of staying in a hotel, cost of living, and cost of local travel. So, the total cost of psoriasis treatment in India will be around INR 2,600 to INR 1,25,000. 

We hope that we were able to answer all your questions regarding psoriasis and psoriasis treatment through this article.

If you want more information and treatment for psoriasis, you can contact a Dermatologist.

We only aim to give you information through the article and do not recommend medication or treatment in any way. Only a doctor can give you the best advice and correct treatment plan.