Psoriasis: Types, Symptoms, Treatment

What is psoriasis?

Psoriasis is a chronic disease where the immune system becomes overactive, leading to the rapid multiplication of skin cells. This results in patches of skin becoming scaly and inflamed, most commonly seen on the scalp, elbows, or knees, but other body parts can also be affected.

Psoriasis is not contagious; therefore, you cannot contract psoriasis from another individual.

What is the difference between eczema and psoriasis?

Eczema is characterised by red, inflamed, and itchy patches of skin, often with oozing or crusting. It commonly appears on the face, neck, inside of elbows, behind knees, and on hands and feet. The skin may become thickened and rough from scratching.

Psoriasis involves red, raised patches of skin covered with silvery-white scales. It usually appears on the scalp, elbows, knees, and lower back. Skin lesions are typically well-defined with a scaly surface.

What are the causes of psoriasis?

Psoriasis is categorised as an immune-mediated disease, meaning that the body’s own immune system has become hyperactive which then leads to health complications. If you have psoriasis, immune cells become stimulated and produce molecules that set off the rapid growth of skin cells. This results in the characteristic inflammation and scaliness of the skin linked to the condition.

The exact cause of psoriasis is not fully understood, but it is believed to involve a combination of genetic, immune system, and environmental factors. Psoriasis tends to run in families, indicating a hereditary component. Specific genes associated with the immune system are thought to play a role in making some individuals more susceptible to developing psoriasis.

If your psoriasis seems to flare for no apparent reason, one or more triggers could be the cause behind it. Here are some psoriasis triggers: 

• Stress
• Skin injury
• Drinking alcohol often or excessively
• Smoking
• Dry, cold weather
• Sunshine, warm weather
• Infection
• Medication
• Tattoos and piercings
• Shaving

What are the symptoms of psoriasis?

Psoriasis symptoms can vary depending on the type and severity of the condition, but common symptoms include:

• Patches of thick, red skin covered with silvery-white scales, usually accompanied by itching or burning sensations, typically appearing on the elbows, knees, scalp, trunk, palms, and soles of the feet.
• Dry, cracked skin that itches or bleeds.
• Nails that are thick, ridged, and pitted.

The symptoms of psoriasis can be intermittent, with periods of worsening symptoms, known as flares, alternating with periods of improvement.

Some patients have experienced a related condition called psoriatic arthritis, marked by symptoms such as stiff, swollen, or painful joints; neck or back pain; or Achilles heel pain. If you have symptoms of psoriatic arthritis, it is crucial to consult your doctor soon as untreated psoriatic arthritis can cause irreversible damage. 

How is psoriasis diagnosed?

Psoriasis is typically diagnosed through a combination of physical examination, medical history, and sometimes laboratory tests.

In some cases, a small sample of skin (biopsy) may be taken and examined under a microscope to rule out other skin conditions and confirm the diagnosis. The biopsy can show typical features of psoriasis, such as thickened epidermis, elongated rete ridges, and inflammatory cells.

While there is no specific blood test for psoriasis, blood tests may be ordered to rule out other conditions and assess overall health. Tests might include checking for markers of inflammation or other autoimmune conditions.

How is psoriasis treated?

There is no permanent cure for psoriasis. Psoriasis treatment aims to reduce inflammation, slow down the rapid skin cell turnover, and clear the skin lesions. Treatment plans are tailored to the severity and type of psoriasis, as well as the patient’s overall health and preferences.

The goal is to decrease psoriasis to 1% of your body surface area, which is approximately equivalent to the size of the front of your hand, or less within three months of the beginning of treatment. After that, it is recommended to consult your doctor regularly to assess the effectiveness of your therapy.

Treatment can result in clear skin and periods without psoriasis symptoms at times (remission). It can persist for months or years; however, the majority last from 1 to 12 months.

1. Topical treatments are often the first line of treatment for mild to moderate psoriasis and are applied directly to the skin. 
   • Corticosteroids to reduce inflammation and relieve itching.
   • Vitamin D analogues such as calcipotriene and calcitriol to help slow skin cell growth.
   • Retinoids derived from vitamin A to help normalise skin cell growth.
   • Calcineurin inhibitors to reduce inflammation and plaque buildup, especially useful in sensitive areas.
   • Coal tar to help reduce scaling, itching, and inflammation.
   • Salicylic acid to help remove scales and smooth the skin.
2. Phototherapy (light therapy) involves controlled exposure to natural or artificial ultraviolet light can help treat moderate to severe psoriasis. 
   • UVB phototherapy involves exposure to ultraviolet B light.
   • PUVA therapy combines psoralen (a light-sensitizing medication) with UVA light.
3. Systemic treatments are used for moderate to severe psoriasis or psoriatic arthritis and affect the entire body. 
   • Traditional systemic medications like methotrexate to reduce inflammation and slows skin cell growth and ciclosporin to suppress the immune system.
   • Biologic agents to target specific parts of the immune system.
4. Lifestyle and home remedies. 
   • Moisturisers to keep the skin hydrated to reduce dryness and scaling.
   • Bath solutions by adding oatmeal, Epsom salts, or Dead Sea salts to bathwater to help soothe the skin.
   • Maintain a healthy diet, exercise regularly, avoid smoking and excessive alcohol, and manage stress to improve overall health and potentially reduce flare-ups.

Can psoriasis be prevented? 

Self-care is an important part of your daily life, which involves taking responsibility for your health and well-being, along with support from those involved in your care. Self-care involves prioritising both physical and mental health, taking precautions to prevent illness or accidents, and effectively managing minor illnesses as well as long-term conditions.

Make an appointment at Pantai Hospitals

Consult your doctor if your psoriasis symptoms worsen or if you notice new symptoms. A dedicated and expert team of dermatologists at Pantai Hospitals is available for consultation to provide the best care and assistance.

Pantai Hospitals has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.