Psoriasis

Psoriasis

1. Definition Psoriasis is a chronic autoimmune skin disorder characterized by thick, scaly, and inflamed skin patches. It occurs when the immune system mistakenly attacks healthy skin cells, leading to an overproduction of skin cells.

2. Causes / Etiology The exact cause of psoriasis is not known, but it is believed to be a combination of genetic, environmental, and immune system factors. Some common triggers include:

• Stress
• Infections (viral or bacterial)
• Injury to the skin
• Certain medications
• Hormonal changes
• Family history

3. Types or Classification There are several types of psoriasis, including:

• Plaque Psoriasis: The most common type, characterized by raised, red, and scaly patches on the skin.
• Guttate Psoriasis: Small, pink spots that appear on the skin, often in children and young adults.
• Inverse Psoriasis: Smooth, red patches that appear in skin folds.
• Pustular Psoriasis: Small, pus-filled blisters that appear on the skin.
• Erythrodermic Psoriasis: A rare and severe form of psoriasis that covers most of the skin.
• Psoriatic Arthritis: A type of psoriasis that affects the joints.

4. Pathology The pathophysiology of psoriasis involves a complex interplay of immune cells and skin cells. The process can be summarized as follows: Step 1 → The immune system releases pro-inflammatory cytokines (e.g., TNF-alpha) that stimulate the production of skin cells. Step 2 → The skin cells multiply rapidly, leading to an accumulation of cells in the epidermis. Step 3 → The accumulated skin cells form thick, scaly patches. Step 4 → The scaly patches can crack and bleed, leading to infection and further inflammation.

5. Clinical Features General features:

• Thick, scaly, and inflamed skin patches
• Redness and swelling
• Fingernails and toenails may become thick and brittle
• Joint pain and stiffness (in psoriatic arthritis)

Specific features:

• Plaque psoriasis: raised, red, and scaly patches
• Guttate psoriasis: small, pink spots
• Inverse psoriasis: smooth, red patches in skin folds
• Pustular psoriasis: small, pus-filled blisters
• Erythrodermic psoriasis: widespread redness and scaly patches
• Psoriatic arthritis: joint pain and stiffness

6. Complications Acute complications:

• Infection (bacterial or fungal)
• Bleeding and scarring
• Joint damage (in psoriatic arthritis)

Chronic complications:

• Skin cancer
• Osteoporosis (due to long-term use of corticosteroids)
• Cardiovascular disease
• Depression and anxiety

7. Diagnosis / Investigations Routine tests:

• Physical examination
• Skin biopsy

Special tests:

• Blood tests (e.g., CBC, liver function tests)
• Imaging studies (e.g., X-rays, MRI)
• Patch testing (to identify allergens)

8. Management General management:

• Topical corticosteroids
• Moisturizers
• Sunlight therapy (PUVA or UVB)

Modern treatment:

• Biologics (e.g., etanercept, adalimumab)
• Systemic corticosteroids
• Phototherapy (e.g., narrowband UVB)

Dietary advice:

• Eat a balanced diet rich in fruits, vegetables, and whole grains
• Maintain a healthy weight
• Avoid triggers (e.g., spicy foods, stress)

9. Homeopathic Therapeutics

• Arsenicum album: for psoriasis with itching and burning sensations

  • Itching and burning sensations
  • Skin is dry and scaly
  • Eruptions are accompanied by a feeling of heat
  • Sleep is disturbed due to itching
  • Worse at night and in warm weather

• Graphites: for psoriasis with thick, hard scales

  • Skin is thick and hard
  • Scales are black and oily
  • Eruptions are accompanied by a feeling of dryness
  • Better with warm weather and exercise

• Sulphur: for psoriasis with itching and burning sensations

  • Skin is dry and scaly
  • Eruptions are accompanied by a feeling of heat
  • Better with cold weather and exercise

• Calcarea carbonica: for psoriasis with thick, hard scales

  • Skin is thick and hard
  • Scales are black and oily
  • Eruptions are accompanied by a feeling of dryness
  • Better with warm weather and exercise

• Kali sulphuricum: for psoriasis with itching and burning sensations

  • Skin is dry and scaly
  • Eruptions are accompanied by a feeling of heat
  • Better with cold weather and exercise