( Thirty minute read)
THIS POST IS AN ATTEMPT TO BRING TOGETHER ALL THE RELAVIANT AVAILABLE INFORMATION ON PSORIASIS, INTO ONE REFERENCE POINT. IN ORDER TO PROVIDE A BETTER SOURCE FOR THE LATEST INFORMATION ABOUT PSORIASIS.
Psoriasis is a chronic skin disorder affecting up to 2.5% of the world’s population.
Despite the myriad treatment options available, there is no uniformly accepted therapeutic approach for moderate-to-severe psoriasis.
Dealing with any skin condition can be frustrating, but psoriasis may just be one of the most problematic of the bunch.
If you do suffer from it, take heart in the fact that you’re not alone.
Psoriasis cannot be cured, but it can be managed, and—over time—you can find the strategies that help minimize symptoms and maintain the highest possible quality of life.
WHAT IS PSORIASIS:
Psoriasis is a long-lasting, noncontagious autoimmune disease (An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part characterized by raised areas of abnormal skin.] These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis is a complex chronic inflammatory skin disease caused by the dynamic interplay between multiple genetic risk foci, environmental risk factors, and excessive immunological abnormalities.
Psoriasis varies in severity, from small, localized patches, to complete body coverage.
If your family has a history of psoriasis, a viral infection such as chickenpox can be the catalyst for an outbreak especially in children. It can start at any age, but most often develops in adults between 20 and 30 years old and between 50 and 60 years old.
Skin cells are normally made and replaced every three to four weeks, but in Psoriasis this process only lasts about three to seven days. Psoriasis occurs when skin cells are replaced more quickly than usual. It’s not known exactly why this happens, but research suggests it’s caused by a problem with the immune system.
The exact role genetics plays in psoriasis is unclear. A genetic predisposition contributes to the development of psoriasis. Approximately 40% of people with psoriasis or psoriatic arthritis have an affected family member. Approximately 7–42% of people with psoriasis develop psoriatic arthritis. In most patients, arthritis appears 10 years after the first signs of skin psoriasis. The first signs of psoriatic arthritis usually occur between the ages of 30 and 50 years of age. In approximately 13–17% of cases, arthritis precedes the skin disease.
Psoriasis is not contagious, so it cannot be spread from person to person. Doctors do not know the exact cause of psoriasis.
THE DIFFERENT FORMS OF PSORIASIS:
Psoriasis often has an unpredictable clinical course. Pustular psoriasis frequently has a variable and protracted course without intervention.
Plaque psoriasis (psoriasis vulgaris) the most common form of psoriasis:
Plaque psoriasis is generally a chronic disease, with fluctuating severity over time. Its symptoms are dry skin lesions, known as plaques, covered in scales. They normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body. The plaques can be itchy or sore, or both. In severe cases, the skin around your joints may crack and bleed.
Scalp psoriasis is a type of plaque psoriasis.
It can occur on parts of your scalp or on the whole scalp. It causes patches of skin covered in thick scales.
Some people find scalp psoriasis extremely itchy, while others have no discomfort.
In extreme cases, it can cause hair loss, although this is usually only temporary.
In about half of all people with psoriasis, the condition affects the nails.
Nail Psoriasis can cause your nails to develop tiny dents or pits, become discoloured or grow abnormally. Nails can often become loose and separate from the nail bed. In severe cases, nails may crumble.
Guttate psoriasis may resolve, relapse, or develop into chronic plaque psoriasis.
Guttate psoriasis causes small (less than 1cm) drop-shaped sores on your chest, arms, legs and scalp. There’s a good chance guttate psoriasis will disappear completely after a few weeks, but some people go on to develop plaque psoriasis.
This type of psoriasis sometimes occurs after a streptococcal throat infection and is more common among children and teenagers.
Inverse (flexural) psoriasis:
This affects folds or creases in your skin, such as the armpits, groin, between the buttocks and under the breasts. It can cause large, smooth patches of skin in some or all these areas.
Inverse psoriasis is made worse by friction and sweating, so it can be particularly uncomfortable in hot weather.
Less common types of psoriasis.
Pustular psoriasis is a rarer type of psoriasis that causes pus-filled blisters (pustules) to appear on your skin.
Different types of pustular psoriasis affect different parts of the body.
Generalised pustular psoriasis or von Zumbusch psoriasis:
Generalised pustular psoriasis is a rare and serious form of psoriasis that usually needs emergency treatment.
It causes pustules that develop very quickly on a wide area of skin. The pus consists of white blood cells and is not a sign of infection. The pustules may reappear every few days or weeks in cycles. During the start of these cycles, Von Zumbusch psoriasis can cause fever, chills, weight loss and fatigue. Von Zumbusch psoriasis, also known as acute generalized pustular psoriasis, is a rare type of psoriasis characterized by white, pus-filled blisters (pustules). The pustules are not contagious but are the result of sudden and extreme autoimmune inflammation. It differs from the two other types of pustular psoriasis, which are generally limited to the hands or feet, and is considered far more serious. Von Zumbusch can develop at any age but predominately affects adults over 50. Von Zumbusch can appear abruptly on the skin. Within hours, tiny pustules appear, many of which will consolidate into larger blisters. Von Zumbusch psoriasis can be life-threatening and requires immediate medical care.
This causes pustules to appear on the palms of your hands and the soles of your feet.
The pustules gradually develop into circular, scaly spots that then peel off.
Pustules may reappear every few days or weeks.
Erythrodermic psoriasis is a rare form of psoriasis that affects nearly all the skin on the body. This can cause intense itching or burning. Erythrodermic psoriasis can come on suddenly and may need emergency medical treatment.
It can cause your body to lose proteins and fluid, leading to further problems such as infection, dehydration, heart failure, hypothermia and malnutrition.
People with Pustular or Erythrodermic psoriasis usually need to start with stronger (systemic) medications.
Severe extensive Erythrodermic and Pustular psoriasis can cause death.
Knowing your triggers may help you avoid a flare-up.
If you are not sure what they are, keep a diary of any psoriatic symptoms you experience, however minor. This can help pinpoint the conditions or substances you need to avoid.
- An injury to your skin, such as a cut, scrape, insect bite or sunburn – this is called the Koebner response
- Drinking excessive amounts of alcohol
- Hormonal changes, particularly in women – for example, during puberty and the menopause
- Certain medicines – such as lithium, some antimalarial medicines, anti-inflammatory medicines including ibuprofen, and ACE inhibitors (used to treat high blood pressure)
- Throat infections – in some people, usually children and young adults, a form of psoriasis called guttate psoriasis develops after a streptococcal throat infection, but most people who have streptococcal throat infections don’t develop psoriasis
- Other immune disorders, such as HIV, which cause psoriasis to flare up or appear for the first time. If you have an active psoriasis outbreak do not get a vaccination, this includes the flu vaccine, especially if it is a live vaccine.
- If you have psoriasis, avoid hot showers.
- Extreme climates are common triggers for psoriasis. This is especially true with respect to extremely dry cold temperatures or intense heat with high humidity.
The pathophysiology of psoriasis.
The term pathophysiology comes from three Greek words. “Pathos” means suffering.
The skin is our largest organ. It consists of three layers:
- The epidermis is the outermost layer (also called the cutaneous layer).
- The dermis is the middle layer.
- The subcutis is the inner layer (also called the hypodermis or subcutaneous layer).
A wide range of treatments are available for psoriasis, but identifying the most effective one can be difficult. There is no one-size-fits-all solution to managing psoriasis. Most people achieve remission when treatment has successfully isolated the part of the immune system that causes psoriasis .Biologic agents appear to offer a safe and effective alternative to conventional systemic therapies and phototherapy for the treatment of moderate-to-severe chronic plaque psoriasis. The biologics appear to be safer than traditional therapies, although long-term safety data still need to be established. Their use is associated with a much higher cost compared with traditional treatment options.
The type of treatment regimen that will be best for you depends on your age, the severity of psoriasis, and the location on your body. Treatment that works for one person doesn’t necessarily work for another. Because of this, treating psoriasis can be a process of trial and error, and it can be frustrating.
Psoriasis is unique to each individual, and a treatment that works for one person doesn’t necessarily work for another. Because of this, treating psoriasis can be a process of trial and error, and it can be frustrating. Options include creams and ointments (topical therapy), light therapy (phototherapy), and oral or injected medications. You might need to try different drugs or a combination of treatments before you find an approach that works. Even with successful treatment, usually the disease returns.
They are available as oils, ointments, creams, lotions, gels, foams, sprays and shampoos.
- Vitamin D analogues. Synthetic forms of vitamin D — such as calcipotriene (Dovonex, Sorilux) and calcitriol (Vectical) — slow skin cell growth. This type of drug may be used alone or with topical corticosteroids. Calcitriol may cause less irritation in sensitive areas. Calcipotriene and calcitriol are usually more expensive than topical corticosteroids.
- Retinoids. Tazarotene (Tazorac, Avage, others) is available as a gel or cream. It’s applied once or twice daily. The most common side effects are skin irritation and increased sensitivity to light. Tazarotene isn’t recommended when you’re pregnant or breastfeeding or if you intend to become pregnant.
- Calcineurin inhibitors. Calcineurin inhibitors — such as tacrolimus (Protopic) and pimecrolimus (Elidel) — calm the rash and reduce scaly buildup. They can be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are irritating or harmful. Calcineurin inhibitors aren’t recommended when you’re pregnant or breastfeeding or if you intend to become pregnant. This drug is also not intended for long-term use because of a potential increased risk of skin cancer and lymphoma.
- Salicylic acid. Salicylic acid shampoos and scalp solutions reduce the scaling of scalp psoriasis. They are available in non prescription or prescription strengths. This type of product may be used alone or with other topical therapy, as it prepares the scalp to absorb the medication more easily.
- Coal tar. Coal tar reduces scaling, itching and inflammation. It’s available in non prescription and prescription strengths. It comes in various forms, such as shampoo, cream and oil. These products can irritate the skin. They’re also messy, stain clothing and bedding, and can have a strong odour. Coal tar treatment isn’t recommended when you’re pregnant or breastfeeding.
- Anthralin. Anthralin is a tar cream that slows skin cell growth. It can also remove scales and make skin smoother. It’s not intended for use on the face or genitals. Anthralin can irritate skin, and it stains almost anything it touches. It’s usually applied for a short time and then washed off.
Mild corticosteroid ointments (hydrocortisone) are usually recommended for sensitive areas, such as the face or skin folds, and for treating widespread patches. Topical corticosteroids might be applied once a day during flares, and on alternate days or weekends during remission. Stronger corticosteroid cream or ointment — triamcinolone (Trianex) or clobetasol (Cormax, Temovate, others) — for smaller, less-sensitive or tougher-to-treat areas. Long-term use or overuse of strong corticosteroids can thin the skin. Over time, topical corticosteroids may stop working.
If you have moderate to severe psoriasis, or if other treatments haven’t worked, your health care provider may prescribe oral or injected (systemic) drugs. Some of these drugs are used for only brief periods and might be alternated with other treatments because they have potential for severe side effects.
Include special diets, vitamins, acupuncture, healers and herbal products applied to the skin. None of these approaches is backed by strong evidence, but they are generally safe and might help reduce itching and scaling in people with mild to moderate psoriasis.
- Aloe extract cream. Taken from the leaves of the aloe vera plant, aloe extract cream may reduce scaling, itching and inflammation. You might need to use the cream several times a day for a month or more to see any improvement in your skin.
- Fish oil supplements. Oral fish oil therapy used in combination with UVB therapy might reduce the extent of the rash. Applying fish oil to the affected skin and covering it with a dressing for six hours a day for four weeks might improve scaling.
- Oregon grape. Oregon grape — also known as barberry — is applied to the skin and may reduce the severity of psoriasis.
- Dead Sea salt baths work for some like healers if used early.
- Mind-body therapies are often used by people with psoriasis to overcome the daily stress of living with psoriasis. Most of the therapies involve focusing on immediate sensations—the here and now—rather than projecting into the future or fixating on anxieties or insecurities.
Pills and injections:
If you have moderate to severe psoriasis, or if other treatments don’t work, your health care provider might prescribe pills or injections. Because of severe side effects, some medicines are used for only brief periods and are alternated with other treatments.
- Retinoids. These pills, such as acitretin, might reduce the production of skin cells if you have severe psoriasis that doesn’t improve with other treatments. Symptoms usually return once therapy is discontinued. Side effects might include lip inflammation and hair loss. Acitretin isn’t recommended for people who are pregnant, breastfeeding or might become pregnant within three years.
- Methotrexate. This medicine can be taken by mouth or injected. It suppresses inflammation. Methotrexate might cause upset stomach, loss of appetite and fatigue. When used for long periods, it can cause severe liver damage and lower levels of red and white blood cells and platelets. It’s important to avoid alcohol while taking methotrexate. People need to stop taking methotrexate at least three months before attempting to conceive. This medicine is not recommended for those who are pregnant or breastfeeding.
- Cyclosporine. This medicine — usually taken by mouth for psoriasis treatment — suppresses inflammation. It’s similar to methotrexate in effectiveness. It also increases the risk of infection and other health problems, including cancer, kidney problems and high blood pressure. These medicines aren’t recommended for those who are pregnant, intend to become pregnant or are breastfeeding.
- Biologics. Several biologics are used to treat moderate to severe psoriasis. Options include infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), certolizumab (Cimzia), ustekinumab (Stelara), risankizumab-rzaa (Skyrizi), tildrakizumab (Ilumya) and ixekizumab (Taltz). Biologic medicines are injected, either by you or by a health care provider. They are for people who don’t respond to traditional therapy. Because these medicines have strong effects on the immune system, they might increase your risk of life-threatening infections, such as tuberculosis.
- Guselkumab, an interleukin (IL)-23 inhibitor, effectively treats moderate-to-severe plaque psoriasis.
There are many varieties of psoriasis cream available, so it’s a good idea to learn about the differences before you start buying and using them. The best cream for psoriasis depends on the location, type, and severity.
Steroid creams, ointments, gels and lotions are applied directly to the area of skin that’s itchy or sore, to reduce inflammation. They are designed to improve pain and soreness, but they don’t usually treat the underlying cause of your symptoms. Steroid creams should not be used on your face.
Emollients that come in cream or lotion form are less moisturising, but are also less greasy and will dry on the skin more rapidly.
- Dermalex psoriasis – moisturises the skin to help prevent flare-ups.
- Oilatum cream – relives itching while soothing and rehydrating skin.
- E45 cream – clinically proven to soothe dry skin as well as psoriasis.
The primary benefits of Emollient creams, lotions and ointments are that: They reduce dryness, scaling, itching and cracking, making you feel more comfortable. They can improve the absorption of topical medicated products.
- Emollients for psoriasis often contain liquid paraffin/white soft paraffin, anti-microbials, and lauromacrogols (which can prevent itching).
- CeraVe’s Psoriasis Moisturizing Cream has 2% salicylic acid to help treat psoriatic skin symptoms, like scaling. The niacinamide-boosted cream also moisturizes and repairs the skin barrier, helping to restore essential moisture.
- MG217 features coal tar, the resin that has been used to treat psoriasis for hundreds of years, and shows significant results in the reduction of inflammation, itching, and scaling.
- Avène’s Soothing Eye Contour Cream doesn’t contain any active treatment ingredients, like salicylic acid, the cream is perfect for those with hypersensitive skin, as it’s known for soothing, hydrating, and reducing puffiness.
- Curél Hydra Therapy oatmeal extract, vitamin E, water-activated, apply post-shower.
- Gold Bond Multi-Symptom Psoriasis Relief Cream, contains salicylic acid. Salicylic acid is a beta-hydroxy acid (BHA), which is a type of exfoliating acid. The other type is AHA, or alpha hydroxy acid, and this includes ingredients such as glycolic and lactic acid, derived from willow bark or produced synthetically, salicylic acid has anti-inflammatory and antibacterial properties. It is oil-soluble reducing the itch.
- Enspilar Form. It helps to reduce the redness, thickening, and scaling of the skin that occurs.
- Sorantinex. is a steroid-free three-step treatment regimen for the chronic form of psoriasis vulgaris (plaque psoriasis). Sorantinex has also been shown to be safer and more effective than many prescription drugs for psoriasis.
Future Psoriasis Treatments on the Horizon:
Medical researchers are working tirelessly toward new and effective medications for psoriasis. Some up-and-coming options for people with the condition include:8
- Deucravacitinib, an oral, allosteric TYK2 inhibitor that works by blocking certain immune proteins for better disease management
- Tapinarof, a steroid-free biologic topical cream that works by hindering inflammation pathways within the body
- Roflumilast, a topical PDE4 inhibitor that works by increasing the number of pro-inflammatory mediators in the body to reduce inflammation
Perhaps most importantly, deucravacitinib (Sotyktu; Bristol Myers Squibb), an oral, allosteric TYK2 inhibitor, became the first oral therapy approval in more than a decade, after Phase 3 POETYK PSO-1 and POETYK PSO-2 clinical trials proved successful.
Sotyktu has the potential to become the new standard of care oral treatment for people with moderate-to-severe plaque psoriasis, given its profile in helping patients achieve clearer skin as demonstrated in the POETYK PSO clinical program, said April Armstrong, MD, MPH, associate dean and professor of Dermatology at the University of Southern California.
The FDA also approved Tapinarof (VTAMA; Dermavant) cream 1%, a once-daily, steroid-free topical treatment for plaque psoriasis in adults regardless of disease severity, becoming the first FDA-approved steroid-free topical medication.
A third FDA approval came for roflumilast cream (ZORYVE; Arcutis Biotherapeutics) 0.3%, a topical PDE4 inhibitor of plaque psoriasis, including intertriginous areas, in patients 12 years of age and older, which clears plaques and reduces itch rapidly in all affected areas of the body, including intertriginous areas.
The fourth major FDA approval was for Boehringer Ingelheim’s Spesolimab (SPEVIG), the first major treatment of generalized Pustular psoriasis (GPP) flares in adult patients.
Bimekizumba. A monoclonal antibody the first to block both ( Interleukin 17a & 17f ,two types of special proteins called Cytokines which regulate the immune system.
Stay informed with a good source of information, so you will know if researchers identify a viral psoriasis, but more importantly, you will know when advances in the treatment of this uncomfortable medical condition are made.
- FINALLY SOME COMMON QUESTIONS.
Does having psoriasis make you more likely to have a heart attack?
To date it is still don’t completely understand what the link between psoriasis and heart disease is, and certainly not everyone with
psoriasis will get heart disease (and vice versa). Research on this topic is ongoing.
Does what I eat affect my psoriasis?
The truth is that scientific research has not yet found a definite link, or found a diet that works for everybody.
Will drinking alcohol affect my psoriasis?
People taking certain medications for psoriasis or psoriatic arthritis – such as methotrexate or acitretin – should avoid alcohol, or
limit alcohol consumption. This is because it can influence the way in which the medications are broken down in the body, or
raise the risk of potential side effects.
Will I have psoriasis forever?
Psoriasis is a long term condition, and is known to wax and wane (meaning it comes and goes – sometimes in flares. It has to be manage.
Did the Covid Vaccinations contribute to
The cutaneous side effects of COVID-19 vaccines are being studied and their immunogenicity is most likely linked to the
pathophysiology of psoriasis. Although uncommon, several cases of exacerbation and new onset of psoriasis have been reported
globally after vaccination.
It’s important to remember that the above information in this post is not a replacement for advice from a qualified health
All human comments and any verified insight much appreciated. All like clicks and abuse chucked in the bin.