Dr Sunaina Hameed's
Family Dermatalogy, Asthetic Lasers, Anti-Ageing Medicine & Plastic Surgery.

PSORIASIS

Psoriasis is a chronic, genetic, autoimmune disorder which is characterized by red, inflamed, scaly and sometimes itchy areas in the skin. It may sometimes involve the joints. Through a genetic disorder, Psoriasis begins in 80% of the people who get it after the age of 30, about 10% get it before 30 years of age and 10% after 60 years of age. There is a 14% risk of transmission to offspring if one parent is a Psoriatic and a 41% risk of transmission if both parents are sufferers.

Psoriasis is an unpredictable condition which can be treated but not cured. It tends to present several periods of remissions and relapses, that is to say it waxes and wanes. 70-80% of sufferers will have local lesions, that is to say involvement of less than 20% of the total body surface area. Once treated, Psoriasis may remain in remission for a period of a few weeks to several years, and this cannot be predicted by your dermatologist. Almost 50% of all patients experience spontaneous remissions, that is to say their lesions may clear even without treatment. However, recurrences are the rule.

The exact cause of Psoriasis is not entirely clear and it is multifactorial. Psoriasis is not 'hereditary' but there IS a genetic component. When the T-cells (immunity cells) in our circulation are genetically misguided into altering the normal skin regeneration cycle, there is an accelerated turnover of new cells in the lowermost layer of the skin.

Instead of the normal cell cycle of approximately 30 days taken to 'shed' old skin, the psoriatic skin cells mature in 2-3 days and tend to be retained and piled up at the surface instead of being shed. This creates the scaling which is visible. The T-cells also triggers the release of certain inflammatory mediators in the circulation, which make the skin red and itchy. However you are not alone. Psoriasis affects 1 in 100 Indians, irrespective of gender or social strata. Psoriasis is NOT contagious. Psoriasis does not affect fertility and does not complicate pregnancy and delivery. You can safely breast-feed your child after consulting your dermatologist who will accordingly tailor your prescription.

Psoriasis can be triggered by physical or emotional stress, certain bacterial infections and medications like pain-killers, estrogen, vaccinations or certain pills used to treat blood pressure, psychosis and malaria. Most patients note worsening of the lesions in winter. Some patients complain of aggravation following sun exposure and physical/chemical trauma to the skin. HIV infection may trigger the disease. Psoriasis is usually diagnosed by clinical appearance and medical history. Often a skin biopsy and/or joint X-rays may be needed to confirm the diagnosis.

Psoriasis is still treated with time-tested topical remedies like emollients, coal tar gels and shampoos, anthralin applications, Vitamin-D derivatives and steroid creams, which work very well for milder cases.

If topical treatments (creams) fail to achieve adequate results, the next step may be phototherapy. Here the skin is exposed to ultraviolet radiation, either using natural sunlight or in artificial chambers. You can also opt for 'Targeted' broadband Phototherapy for localized lesions, which spares the unaffected skin from unwanted radiation.

The next step involves the use of oral or injectable medications like Methotrexate, Retinoids or Cyclosporine. These work very well for Psoriatic Arthritis as well.

For those who want to side-step the messiness of creams or the side-effects of oral medications, there are several new options. Biological therapies offer the option of using intravenous or subcutaneous injections every few weeks to suppress extensive Psoriasis with minimal inconvenience to patients. Your dermatologist will help you select your treatment option based on your age, severity, financial capabilities, general health and convenience.

DIY TIPS

Soak in a bath with soothing bath oils for 10-15 minutes and then gently rub skin with a towel to take off the scales. Exposure to sun may improve the skin condition. Use a high factor sunscreen during exposure to sunlight. Maintain a healthy weight and a nutritious diet rich in fish-liver oils. Talk to coworkers and family members about the problem and let them know that it is not contagious. Organize local Psoriasis Support Groups in your city. Talk to a friend or a counselor to help cope with depression or emotional trauma that Psoriasis may cause. Refer to www.psoriasis.org for any further details beyond the scope of this brochure.

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