Psoriasis is an inflammatory skin disease, which occasionally also affects the joints and causes redness, scaling, pain and swelling. It can occur with varying intensity throughout life and is not contagious.
It affects about 2 percent of the population and mainly occurs between 15 and 35 years, although it can occur in children and the elderly.
Psoriasis starts in the immune system, specifically when these cells are activated inappropriately and results in different cellular responses such as proliferation and dilatation of blood vessels.
In normal people cell turnover of the epidermis lasts 30 days. However, in psoriatic patients, it lasts four days. This causes the accumulation of scaly and itchy red skin on the surface causing thick plates, .
Causes of Psoriasis
Although the specific origin of the disease is unknown, it is known that it is a genetic disease. In fact, scientists have located the gene whose alteration influences the appearance of the pathology.
It is also known to be a hereditary disease. If one of the two parents is psoriatic, one in eight children may suffer; if both parents are affected, the probability rises to one in four.
It can also happen that the genetic alteration is inherited, but the person does not go on to develop the disease.
Among the external factors that can trigger Psoriasis include: • Chronic infections. • Nervous stress. • Obesity . • Alcohol consumption. • Diseases such as rheumatoid arthritis . • Changes in hormone . • Trauma (wounds, bruises, sunburn, etc.).
SYMPTOMS OF PSORIASIS
Psoriasis can occur slowly or appear suddenly. In addition, symptoms may disappear for a period of time and come back.
The most common manifestations are skin lesions as plaques whose size vary and are characterized be reddish and covered with whitish scales of different shapes and sizes. Some can be the size of the nail of the little finger, but others can be extended to cover large areas of the body, adopting a ring-shaped or spiral.
The most common locations are the elbows, knees, scalp, back and buttocks.
The scaling can be confused with severe dandruff, but the plaques characteristic of psoriasis distinguish it from dandruff. Psoriasis may also occur around and under the nails, which thicken and become deformed. The eyebrows, armpit and navel may also be affected.
Other less common symptoms are: • Pain. • Genital lesions in men. • Nail changes ranging from color (shades between yellow and brown), thick (thicker and detachment and separation of the skin). • Dandruff.
Prevention of Psoriasis
At present no method is unknown to help prevent the onset of this disease .
Experts advise keeping the skin clean and moist and avoiding your specific triggers.
Types of Psoriasis
There are many types of psoriasis. It can be classified according to the severity, shape and pattern of the scales.
• Mild psoriasis covers 2 percent or less of the body skin. Isolated plaques are usually located in the knees, elbows, scalp, hands and feet. The treatment is topical (creams, lotions, shampoos).
• Moderate psoriasis covers between 2 and 10 percent of the body surface. It may appear on the arms, legs, trunk, scalp and other areas. The treatment given to patients is topical and phototherapy use. In some cases it can also include drug therapy.
• Severe psoriasis covers more than 10 percent of the body's skin. Usually treated with phototherapy and oral medications.
According to the shape and pattern of the scales • Plaque psoriasis: Known as 'psoriasis vulgaris'. This is the most typical form of the disease (80 percent of cases correspond to this type). Flakes forming the top of the plate are composed of dead cells, which detach from the plate. Other symptoms include pain and itchy skin and cracks.
• Psoriasis guttata or gotular: This type appears as small red droplets on the skin that occur on the trunk and limbs and sometimes on the scalp. However, these lesions are not as thick as plaque psoriasis. It can be caused by any infection and usually occurs during childhood.
• Inverse psoriasis (in folds): Appears in armpits, under the breasts and in the folds of buttocks and genitals. This usually appears on smooth and dry skin, in the form of redness and swelling, but no scales. Inverse psoriasis is particularly prone to irritation by rubbing and sweat, so obese people have more problems.
• Erythrodermic psoriasis is a rare inflammatory type of psoriasis that often affects most of the body. It is characterized by a reddening of the skin and can be quite aggressive.
• Generalized pustular psoriasis: Also called Von Zumbusch pustular psoriasis. It is very rare and occurs with large areas of red skin and painful pustules. When these pustules dry it can re-occur cyclically.
• Localized pustular psoriasis: When the pustules appear only in the hands and feet.
• Acropustulosis: In this type, the skin lesions are located at the tips of the fingers and sometimes on the feet. They are characterized because they can be painful and disabling and produce nail deformity and the most serious cases, changes in facial bones.
Psoriatic arthritis is a form of chronic joint inflammation affecting between 10 and 30 percent of patients with psoriasis. This condition, characterized by redness, pain and swelling of joints, can occur at any time, but usually triggered between 30 and 50 years.
The areas affected are mainly the fingers and feet, the lumbar and sacral spine, knees and wrists.
An early diagnosis in psoriatic arthritis plays an important role, because if not treated quickly it can lead to irreversible joint damage.
Outbreaks of psoriasis may disappear and manifest itself again after a long time.
Diagnosis of Psoriasis
The disease diagnosis is made by observing the area where peeling and skin lesions appear. As the psoriasis advances, doctors can easily recognize its characteristic pattern of peeling, so generally do not need to do diagnostic tests.
Sometimes specialists perform a biopsy of the skin to confirm the diagnosis and rule out other conditions that may share the appearance and symptoms.
Treatment of psoriasis depends on the patient and the type of disease they may have. Although No cure exists for this disease, it can be kept totally controlled and in some cases the symptoms (swelling, redness, flaking and itching) need not appear again. The different treatments applied are:
In general, the sun and is beneficial for patients. Some may require a specific reinforcement with artificial ultraviolet light (UVB) or a combination of ultraviolet light and medications called PUVA (psoralen with UVA exposure to ultraviolet light), also called photochemotherapy. The drug is taken by mouth or injected to enhance the effects of UVA route.
Usually oral, but patients may also require injections.
Topical medication (creams and lotions): • Steroids: for mild to moderate psoriasis. There are some drugs that mimic the action of certain naturally occurring organism/hormones .
• Tar: tar based preparations have been used for centuries to treat psoriasis. One of its main disadvantages is the unpleasant smell that occurs.
• Calcipotriol: is a synthetic form of vitamin D, which is used in the treatment of mild to moderate psoriasis. It does not act quickly, but long term it is effective in controlling psoriasis. It is not recommended to apply in the area of the face, where it can cause irritation.
• Retinoids are derivatives of vitamin A. They are usually used in combination with steroids.
• Anthralin: Is effective in mild to moderate psoriasis and poses no long-term side effects, but can be irritating to the skin.
• Salicylic acid: Salicylic acid is used as a complementary treatment. It is used to remove scales in psoriasis plaques and leaves the skin ready for the application of topical medications.
Systemic medication • Methotrexate: Methotrexate has been used to treat psoriasis for over 50 years – with many patients’ skin responding very well to it. Methotrexate has a number of actions that account for its helpful effects in psoriasis. It slows down the skin cells that are dividing so rapidly in psoriasis, and also reduces inflammation.. Its side effects include nausea, fatigue, loss of appetite and mouth sores.
• Oral retinoids (iostretinoina) are effective in some cases of psoriasis, but they work best in combination with other medicines. They are safe as a long term treatment.
• Cyclosporine: Controls the immune system. It is used only if all other options have failed. It is effective and can have rapid effects, but can cause hypertension and renal function damage. You can not keep this medication for more than a year.
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