About psoriasis, its causes and treatment

The symptoms of psoriasis

By psoriasis there are discrete thickened areas of the skin. They are bright red and can be shaped as macules, papules or patches. They are often cowered with lamellated silvery scales. The lesions can vary in size, be round or more irregular. They can grow and float together to form greater areas. The scales or underleying skin leyers can fall off and leave sores.

Psoriasis has two main variants. By non-pustular psoriasis, the patches do not contain any fluid or semi-fuid purulent material. By pustular psoriasis the patchnes are hollow and contain purulent floating material.

The lesions or the fluid in the pustular variants are not infected with bacteria or other microorganisms at the onset, but can be infected when scaling of patches or bursting of papules leave sores.

The symptoms most often appear on the scalp, knees and elbows, but often also on the buttocks, chest and back. The condition is chronic, or recurrent.

Psoriasis also often give inflammatory reactions in the joints.

Somtimes even rheumatoid arthritis occur together with psoriasis.


The causes and mechanisms od psoriasis

The cause of psoriasis are not fully understood. There is an inheritary causal component. The core process in the disease is an increased proliferation of epidermal cells. there are two theories about this excessive cell proliferation. One theory is that it is caused by a genetic fault.

Another theory is that it is a secondary consequence of an autoimmune attack at the epidermial cells. It is thought that T cells (which normally help protect the body against infection) migrate to the dermis and trigger the release of cytokines (tumor necrosis factor-alpha TNFa, in particular) which cause inflammation and the rapid production of skin cells, especially keratinocytes, the cells that make the horny substance covering the skin. It is not known what initiates the activation of the T cells, but this can also be a genetic factor.

An inflammation will in the first place kill skin cells or damage structures around the cells. But killing of cells or damaging structures will relieve substances from the cells that stimulate other cells to divide, and the rate of the stimulated division can be greater than the rate of cell destruction so that the epidermis thickens and makes plaques. Some signal substances used by the immune system that make immune cells to proliferate also seem to give the same effect on skin cells.

The inflammation theory also explains the fact that the skin areas affected by psoriasis also can get sores where the epidermis has fallen off blended between the plaques. Those sores will then be the areas where cells are destructed but where the reactive proliferation has not yet recovered the damaged area and produced a plack formation.

The first outburst of psoriasis sometimes occur after physical or mental stress, skin injury, or streptococcal infection. Conditions that have been reported as accompanying or worsening the disease include infections, stress, and changes in season and climate. Treatment of diseases with Certain medicines, including lithium salt and beta blockers, have been reported to trigger or worsen the disease. Excessive alcohol consumption, smoking and obesity may aggarvate psoriasis or make psoriasis difficult to treat.

By bacterial infections the microbes can make substances that spread in the body, for example to the skin. These substances can the fasten at cell structures or structures between the cells. The immune system can then react against the sites that have been changed by bacterial substances stuck to them and exert destruction that in the next place can induce excessive reactive dividing of cells. In tis way infections might start a psoriatic process.

Some drugs can cause psoriasis or trigger the onset of sporiasis that also have other causal components. Such drugs are beta-blockers, lithium, antimalarials, terbinafine, calcium channel blockers, captopril, glyburide, granulocyte colony-stimulating factor, interleukins, interferons and and lipid-lowering drugs.


variants of psoriasis

There are many variants of both non-pustular and pustular psoriasis, according to the exact symptoms and possibly also to the exact causes.

PSORIASIS VULGARIS - Common psoriasis. This is the most frequent variant. It gives dry, red scaling patches of various sizes.

PSORIATIC ERYTHRODERMA - By this variant great body areas are thickened, dry, red and scaly, also the face,arms, feet and nails.

GENERALIZED PUSTULAR PSORIASIS - This variant occurs accutely. It gives fever and widespread paupules containing pus that however is not infected with microorganisms.

PUSTULOSIS PALMARIS ET PLANTARIS (Palmoplantar pustulosis) - By this variant there are chronic or recurrent pustules on the palms and soles. The pustules occur in the epidrmis, teh outer layer of the skin, and the liquid content is filled with neutrophil white blood cells.

ANULAR PUSTULAR PSORIASIS - By this variant the lesions are formed as rings filled with fluid. The rings tend to spread and enlarge.

ACRODERMATITIS CONTINUA (Dermatitis repens) - This variant gives fluid-filled plaques at the fingers and toes that later spread upwards .

IMPETIGO HERPETIIFORMIS - This is a rare variant of psoriasis occuring in the last part of pregancy. It gives red areas with pus-filled pustules at the peripheries. The lesions begin at the innet thighs or groin. Then the pustules enlarge and join to give great sores. Then the lesions spread to the trunk and extremities, and can also spread into the mouth. Usually the lesions heal after pregnancy.

INVERSE PSORIASIS - This is a kind of psoriasis that only attacks folds or semiclosed areas on the body, like the inner-side of the shoulders, the innerside of the elbows, the folds or inside of the ear, the lips, the groin, the penis, the vulva or the natal cleft.

NAPKIN PSORIASIS - This is psoriasis attacking the diapered area of infants.

SEBORRHEIC-LIKE PSORIASIS - In thsi variant of psoriasis, the plackes are overlapped or blended with an inflammation that causes excessive secretion of vaxy substances (sebhorrhea).


Generally about psoriasis treatment

There is no definite cure for psoriasis, but a clever combination of treatments can often take away most symptoms. Psoriasis has periods where the disease fleares up and periods where it retreats again. It the periods of worsening intensive treatment can drive back symptoms. In the stiller periods, more gentle treatment can be used to hinder the disease to flare up again and to lessen the symptoms when this still occur.

There are many kinds of treatment against psoriasis, and the treatment plan for psoriasis must be indiviualized.


Obsolete treatments

Many treatment methods for psoriasis are effective, but also hurt the skin so much that they by now have gone out of use. Also many treatments for psoriasis of contemporary use give dangerous side effects and must be used with caution.

In the 18th and 19th centuries, Fowlers solution, a blending containing arsenic compounds was used by dermatologists as a cure for psoriasis. It went out of use because of the toxic and cancerogenic effects.

In the middle of the 19th century ultra-soft x-rays were popular as a psoriasis treatment. Such rays kill cells, and thereby slow down the growth of plaques. However, they also cause cancer, damage the skin and accelerate the aging process of the skin. This treatment has therefore been dropped and replaced by ultraviolet rays.


Reducing psoriasis outbreaks with diet

It seems that outbreaks of Psoriasis can be alleviated or hidered by a diet with much of antioxidants, beta-carotene, folate, omega-3 fatty acids, and zinc as nutritional factors that may play a role in the prevention and management of psoriasis.

To achieve getting enough of these substances and to hinder triggering inflammatory responses, you should have a generally anti-inflammatory healthy diet with a lot of raw or gently cooked vegetables and fruit, full corn bread and cereals and fish. If you cook vegetables or fruits, use the water from the cooking too so that you do not spill nutrients.

In addition will these food types help especially much: Fat fish, shelfish, flax seeds, carrots, apricots, mangos and all types of green vegetables and the spices turmenic and black pepper. The fat you consume should come from sources as fat fish, flax oil, olive oil, rape oil and almonds.

Some spices can make some people react with outbreaks, but this probably differs very much from person to person, so you should try to watch if you react this way when you use much of some spice.

You should avoid consuming much soy oil, corn oil, palm oil and possibly sunflower oil. Also moderate your intake of diery products, red meat, citrus fruits, and alcohol. Do not add great extra quantities of fat or sugar to your food. Some people find it best to avoid food with gluten, which especially means wheat.

You should also avoid smoking. An extra supply of omega-3-fat and zink may be good.


Topical treatments for psoriasis

Coal or wood tar is a traditional treatment for psoriasis still in use. Tar is a product made by heating coal or wood. Tar slows the rapid proliferation of skin cells. when the plaques are worn away, the normal appearance of the skin will therefore be restored. Tar can also help reduce the inflammation, itching and scaling of psoriasis. Tar can be applied through creams, through shampoos, through soap or added to bath water. Tar can however irritate and redden the skin and it is to some extend cancerogenic.

Anthraline or steroid creams are used. Steroid cream can however make the skin thin and damaged in the long run.

Crams containing vitamin D3 or A-vitamin-variants called retinoids can help for psoriasis by reducing cell proliferation and inflammation.

Sulphur was a common treatment for psoriasis in the victorian age, but was dropped because more effective treatments emerged. However, these more effective treatments have shown to carry great risks for development of cancer. Sulphur treatment has therefore got modern again, and has shown to be useful without great risk of side effects.

Natural topical creams against psoriasis contain ingredients working from several angles: They contain ingredients that soften the plaques so that they more easily can be removed. Ingredients like squalane and glycerine diffuse into the plaques and make them soft so that they more easily can be scrubbed or teared away. They have ingredients that reduce cell proliferation and inflmmation. They typically contain vitamin D3 and A-vitamin variants to reduce cell proliferation and inflammation. They typically also contain herbs that stimulate the skin to repair damage, but yet do not trigger the abnormal cell proliferation, like for example Aloe vera. They furter contain herbs or oils that soothe and reduce itching.


Pharmacological treatments of psoriasis

Several types of pharmacological treatment for psoriasis are in use which are administered either orally or as shots. Cytostatica, for example methothrexate, is used in severe cases as a cure for psoriasis. Cystostatica slow the cell divisions or kill cells that are dividing and thus inhibit the growth of plaques. Cytostatica can damage structures in the body and increase the chance of getting cancer.

A new type of pharmacological treatments steadily more used, but still most in severe cases, is so called biological therapy. By this kind of tretment, one uses drugs that alter the function of specific chemical pathways in the immune system, most often blocking the function of signal substances, antibodies or cells in the immune system. Many of these drugs are themselves antibodies that block specific functional components. The number of these drugs in use or development is already great, but one still does not know which will be the best. These drugs are expensive, but seem to be very effective. Still they do not cure the disease, only help to controle it, and also these drugs can give serious side effects.


Physical treatments against psoriasis

Ultraviolet light or sun-baths are also effective treatments. Ultraviolet wavelengths are subdivided into UVA (380–315 nm), UVB (315–280 nm), and UVC (< 280 nm). The epidermis absorbes ultraviolet B (UVB) (315–280 nm) and this band works beneficial against psoriasis.

Narrowband UVB (311 to 312 nm), is that part of the UVB spectrum that is most helpful for psoriasis. Exposure to UVB several times per week, over several weeks can effect a remission from psoriasis. However this treatment can in the long run damage the skin and give cancer.


Treatment of psoriasis by surgery

Individual loclized plaques can simply be planed away surgically, and the plaque seldome come back at the same spot. Such localized surgery is a very effective treatment for strictly localized psoriasis. Localized individual spots can nearly be cured this way.