What is Psoriasis?
Psoriasis is a chronic disease of the skin. It starts with red or brown colored thick spots appearing densely on the skin. The skin tissue on these spots falls off in scales and white flakes. Psoriasis may be restricted only to some parts or sometimes it may spread to the whole body. As this appears uncontrollably, it is called ‘Psoriasis Vulgaris’.
Is It a Contagious Disease?
Not at all. This does not affect others by contact. Either of the couple or both of them may have psoriasis and still they can live together without any apprehensions.
Who Fall Prey to This?
Psoriasis can affect anyone, be it a child or adult. It is found mostly in the age group of 30-50. Though it is universally present it is very common among in the Eskimos, the Red Indians and the Japanese, probably owing to their dietary habits. By and large, fish is their staple food and the ‘omega acids’ in fish are proved to act against and control Psoriasis.
Percentage of sufferers of Psoriasis in the world: An estimate reveals that 1 to 3 percent of the world population suffers from Psoriasis. There are 50,0,00 – 80,00,000 people in America alone, found to be suffering from Psoriasis. There are about 20 million (20,00,000) people suffering from Psoriasis in our country.
Aetiology: The causative factors that cause Psoriasis are not known. There are several reasons that may cause the disease, some of which are discussed here.
Psoriasis can be transmitted genetically. If one of the parents has Psoriasis, chances of genetic transmission to the children are 8 to 10 percent and if both the parents have Psoriasis, it is 30 to 50 percent.
Extreme climatic contains like a very high degree or very low degree of temperature, injuries on the skin, certain fevers, polluted atmosphere etc. can cause Psoriasis. Besides these, certain allopathic medicines may also cause Psoriasis as a side-effect. Beta blockers used to control hypertension (high B.P), certain drugs used in Psychiatry like Lithium, some anti-malarial drugs and even anti-inflammatory drugs used for joint pains can cause Psoriasis.
Emotional stress and strain can also induce or exacerbate Psoriasis
Scales/Flakes: Human skin also sheds off the epidermal cells just as a snake sheds off its outer skin. But this phenomenon takes place without our cognizance. Generally, it takes 26 days for the new cells to form under the skin and for the old cells to fall. But in a patient of Psoriasis the new cells form at a very fast pace i.e. in 3 to 4 days, and as a result, the outer dermal cells get thickened. This makes the skin appear scaly and eventually, the scales fall off.
How does this happen?
There are two reasons for this. First, it is the abnormal behavior of T-cells when triggered by some unknown antigens. The while blood corpuscles (W.B.C) that help the immune system in our body behave in an excited manner and release some chemical substances called cytokines and chemokines. These substances stimulate the cells in the epidermal layer of the skin. As a result, the epidermal cells are produced in large numbers and they mature quite fast. Secondly, the blood vessels in the ‘dermis’ (layer beneath the skin) get excited, proliferate in large numbers and pour out the inflammatory cells, chemicals and chemokine into the dermis which in turn stimulate the excessive growth of the epidermal cells of the skin. This results in the formation of scales/flakes.
Psoriasis on the scalp – How to distinguish it from Dandruff?
Psoriasis may be mistaken for dandruff. But there is a marked difference between the two. The scales in dandruff are oily and they appear all over the head. But, Psoriasis appears in patches and the scales are dry and white.
Effect of Psoriasis on nails and joints
Psoriasis can appear all over the body. When the nails of the fingers and the toes are involved, they become pitted, distorted and decayed. Psoriasis can affect not only the nails but also the joints of the fingers, the toes, elbow-joints, knee-joints and also pelvic bone. Low-back and backbone are not an exception.
Types of Psoriasis
There are two types. the type-1 occurs in children and is genetic in origin. It persists for long periods. The type-2 occurs in adults and is mostly because of environmental factors. This is not as troublesome as type-1.
Varieties of Psoriasis
The most common type of Psoriasis is ‘Plaque Psoriasis’. This is commonly found on knees, elbows, lower back and scalp. Apart from these sites any part of the body, including tongue, can be affected.
Another variety is ‘Guttate Psoriasis’. This appears as small. round to oval scaly papules on the skin. The lesions are found mainly in the trunk. This is more common in children. Infections in the body are responsible for this. Antibiotics can handle this situation effectively and quickly.
‘Palmo-plantar Psoriasis’ is restricted to palms and soles. The skin becomes thick and cracks appear in the palms and the soles. ‘Flexural Psoriasis’ appears beneath the breast, arm-pits, folds of the sin near the navel, loins, groins, in between buttocks and peri-anal region.
‘Erythrodermic Psoriasis’ affects the whole body, through this type is very rare. In this condition, the skin is fiery red and there will be abundant scales falling off the skin. A lot of proteins are lost through the shedding of the skin. The flow of blood to the skin is very high and even the heart gets enlarged. It is a very complicated and hospitalization is mandatory.
The Erythrodermic and pustular Psoriasis need emergency treatment and they are triggered by the improper use of some native medications, plant medicines, Homoeopathy medication, Ayurvedic mediation, Allopathic medication and certain infections and deficiencies like that of Calcium. In these two conditions shedding off the skin cells leads to shedding off proteins. Protein depletion in the body may lead to other problems. Scales on the skin may host bacteria, which may infect lungs, kidneys and other organs.
The common varieties like Plaque Psoriasis and Scalp Psoriasis may not be severe, but treatment should be taken lest it should lead to ‘Ertythrodermic Psoriasis’ and ‘Pustular Psoriasis’.
Is the suffering life-long?
Psoriasis may not be cured completely. It can be cured to some extent and then it can be kept under control. There is no strong evidence to say that one has to bear it life-long. 30% of the cases can be completely cured. The remaining 70% have to suffer continually. But with proper treatment, the disease can be kept well under control. There will be aggression and recession of the disease in them. They will face problems in the society and are kept at bay by others with the impression that it is contagious. This makes the patients depressed. But one should note that this is not at all infections and it will not spread from one person to the other.
Which diet is good, vegetarian or non-vegetarian?
Non-vegetarian food is not good for the patients with Psoriasis. As stated earlier, fish is good for them. Capsules of fish-oil are given to the patients as a part of the treatment. It is hard to cure Patients of Psoriasis with diabetes, obesity and high-fat levels in the blood. Consuming alcohol, smoking and chewing tobacco have deleterious effects on Psoriasis and one should quit such habits once and for all.
Try to reduce tension and keep cool
Patients of Psoriasis respond much faster when they are cool and tension free. They should avoid pressures of any kind.
Diet in Psoriasis
Fish, fresh fruits, vegetables with a lot of fiber, leafy vegetables, carrot juice, orange juice etc… are helpful for the patients. They should avoid red meat.
Linseed oil, Primosa oil, and Flax seeds, which contain Omega-3 fatty acids are good for them.
Kinds of treatment available for Psoriasis
Psoriasis is also a chronic disease like diabetes and hypertension. One should realize that it can be kept under control, proper medicines, though a complete cure is difficult. Various kinds of treatment are available for Psoriasis depending upon the type, extent, severity, body-part affected and other health problems of the patient.
There are three kinds of treatment available now.
- Medicines for external application
- Oral and Injection preparations.
Medicines for External Application: If Psoriasis appears at one or two places on the body in the form of spots, drugs like ointments of coal-tar, salicylic acid, paste of anthralline, steroidal ointments, combination of anthralline and steroids, retinoids, vitamin-D, diathranol etc. are given for external application. Simple ointments and petroleum jelly, mineral oils like liquid paraffin, vegetable oils like coconut oil, sesame oil, olive oil etc. are good emollients because they keep the Psoriasis peaches soft and supple and dissolve scales also. Ointments like coal-tar and anthralline prevent the abnormal division of the cells. Shampoo preparations of coal-tar, steroids, salicylic acid etc. are also available for Psoriasis on the head.
Phototherapy: The ultraviolet therapy is of use when the psoriasis-spots either do not respond to the external application of the above drugs or they spread to other parts. Exposure to sunlight or ultraviolet rays (PUVA therapy) effect the cytokines and prevents the abnormal growth of the cells. Excimer Lasers also have the same effect to certain extent.
Mixed therapy: A combination of external application and phototherapy or oral drugs and phototherapy is also in practice in controlling Psoriasis. If the disease spreads to a large part of the body, coal-tar is applied to the body and the patient is made to stand in the sun after bathing. This therapy is called ‘Gokerman regime’. There are ‘Psoriasis Resorts’ specially meant for this purpose in the region of the Dead Sea, near Israel. The Dead Sea contains coal-tar in its water. So, the patients take bath in the sea and expose themselves to the sun. Phototherapy can be administered along with tablets of ‘Psoralen’.
Oral drugs: Powerful drugs are given to those who are not benefitted with the phototherapy. ‘Methotrexate’, a drug used in cancer therapy, in lower doses is found to be yielding excellent results. But this drug should not be given for more than 3-4 years. Prolonged therapy with this drug affects the liver adversely, causing hepatic failure and hence this drug should be taken under the doctor’s supervision. The patients under this therapy should undergo some tests frequently i.e every two or three months to rule out any adverse effects.
In cases of emergency, Cyclosporin and Cyclophosphamide are administered as crisis busters, but only to suppress the disease. These drugs change the course of natural immune system of the body and hence a long-term use of these drugs is not advisable. Encouraging results can be obtained with combining phototherapy and medicines like vitamin A acid and Retinoic acid etc. Steroids are used in the case of wet and pus-oozing ‘Pustular Psoriasis and Erythrodermic Psoriasis’, but not without harmful side-effects when used for long periods.
Anyway, all these therapies have their own limitations. Recurrence of Psoriasis is a matter of concern in many cases. 50% of the patients are not happy with any of these therapies. Moreover, these drugs have harmful effects on vital organs like kidneys, liver, bone marrow etc. There is no drug that can be said to be universally useful and acceptable. A silver lining to the cloud is the advent of ‘Biologicals’, which provide long-time relief, but with limitations.