What is psoriasis?
Psoriasis is an inflammatory skin condition. The obvious sign is the colour change associated with the plaques (the raised patches in the skin), although this is more obvious where there is little scale. In fair-skinned people, the plaque will look red (sometimes referred to as salmon pink), whereas in dark-skinned individuals the plaque tends to look a darker shade of the normal skin. Often, however, the white scaling is thick and hides the redness, so psoriasis looks thick, white and, crusty on exposed surfaces regardless of the underlying skin colour. The thickening is caused by the greatly increased ‘turnover’ of the skin cells. Normally, a living skin cell moves upward from the bottom layer of skin, loses its nucleus and dies. It is then largely made up of a protein called keratin and is shed from the surface of the skin as new cells go through the same process and replace it from underneath. The whole process takes around 28 days, but in psoriasis it is greatly speeded up to 3-4 day cycle. Living cells are then much closer to the surface, and as they still need a blood supply, the vessels lie closer to the surface, leading to the redness and heat that many people with psoriasis complain of. The fact that the surface cells are being replaced before they are shed results in a thick layer of scale, which, as everyone with the condition knows, flakes off readily and abundantly.
It is essentially important to understand what psoriasis is not. This can be summarized by saying that it is:
- Not contagious
- Not cancer
- Not related to diet
- Not allergic
Clinical features of psoriasis
Sites of predilection
Include scalp, retro auricular area, knees, elbows, sacrum, and nails.
Lesion morphology – sharply bordered erythematous patches and plaques with silvery scale
- Psoriasis vulgaris
Chronic plaque type psoriasis
v Small papules evolve through confluence in to large irregular, well-circumscribed plaques, 3-20 cm.
v Silvery scale is extremely typical
v Sites of predilection include knees, elbow, sacrum, scalp, retinoauricular area
v Untreated, the plaques can remain stable for months or years.
v May be less distinct in dark skin
v Appears as exanthema over 2-3 weeks; starting with small macules and papules that evolve into 1-2 cm plaques with silvery scale
v Favor the trunk, less often extremities or face
v Most patients are children or young adults, usually after streptococcal pharyngitis; sometimes following treatment or tonsillectomy, the psoriasis resolves completely and never returns
v Involves axillae and groin; often misdiagnosed.
v Macerated and fissured; thick plaques and silvery scale usually missing
v Requires less aggressive therapy
v Inverse psoriasis
v Overlaps with intertrginious; form where involvement is flexural and classical sites such as knees and elbows are spared
- Psoriatic erythroderma
v Involves the entire integument: can develop suddenly out of a Guttate psoriasis or from long standing psoriasis following too aggressive therapy or abrupt discontinuation of medications.
- Pustular psoriasis
v Numerous pustules on palms and soles
- Drug induced psoriasis
v Medications are common triggers for psoriasis
How psoriasis is diagnosed?
Psoriasis is often diagnosed by a dermatological or primary care physician by its characteristic appearance and locations on the body. If a person has the skin changes typical of psoriasis, a diagnosis can be made clinically by examination alone, based on the skin’s appearance due to psoriasis, a physician will usually be able to diagnose psoriasis and being treating the skin immediately.
If person looks different than most cases, appears in an unusual location, further test may be needed. The definitive test when a clinical diagnosis of skin disease is a skin biopsy. Usually one test is required, but it may be repeated if the results are not clear or the disease changes over time. No blood test exists to diagnose psoriasis, and psoriasis does not cause abnormal blood tests for most people. The most common reason to draw blood when treating people for psoriasis is to make sure it is safe to begin a new medication or to watch for a medicine’s possible side effects.
The evaluation of psoriatic arthritis may include X-ray, joint tests, and blood panels to look for other causes of arthritis.
Patient should be encouraged to expose maximum to sunlight and avoid trauma during the active phase.
Homeopathic treatment of psoriasis – Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach.
This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat psoriasis but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned; several well-proved remedies are available for psoriasis treatment that can be selected on the basis of cause, location, sensation, modalities and extension of the psoriasis. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. Few important remedies for the homeopathic treatment of psoriasis are given below:
- Arsenic Album – excellent psoriasis remedy in which psoriasis, worse by cold application and wetness, better by warmth.
- Sulphur – great psoriasis remedy helpful in so many other skin manifestations also
- Kali Brom – remarkable psoriasis remedy in which there is syphilitic psoriasis. Skin cold, blue, spotted corrugated, large, indolent, painful pustules.
- Kali Ars – Kali Ars is a very well proved psoriasis remedy with patches on back, arms and spreading from elbows; scaly itches, scaling off leaves behind red skin.
- Thyrodinum – one of the best psoriasis remedy for chilly and anemic subjects. Dry impoverished skin; cold hands and feet
- Radium Brom – psoriasis of penis, itching eruptions on face oozing, Patchy erythema on forehead
Other important psoriasis remedies are:
Arsenic alb, Aurum Met, Psorinum, Selenium, Hydrocotyle, Mezarium, Petrolium, Ars Iod, Puls, Sepia, Silicea. Rhus Tox, Thuja, Tuberculinum, Graph, Calcaria Carb, Lycopodium, Merc Sol, Petrolium and many other medicines.
Allopathic treatment – mainly include corticosteroid, tar, vitamin D analogues, retinoides etc.
Other natural and alternative modes for psoriasis treatment – Include Naturopathy, Herbal medicine, Yoga, Ayurveda, Acupressure etc…
1. Tim Mitchell, Rebecca Penzer; Psoriasis 2005; 1-2.
2. Wolfarm Sterry, Ralf Paus, Walter H. C. Burgdof; Dermatology; 265-266.
3. Kendra Gail Bergstorm, Alexa Boer Kimball; 100 Questions & answers about Psoriasis 2009; 13-14.