What is Psoriasis

 

What is Psoriasis

 Psoriasis is a chronic skin disease where the immune system becomes overactive, producing molecules that create rapid production of squamous cells, or skin cells.  Normally white blood cells called T-cells, attack and destroy bacteria preventing infections, but with psoriasis they mistakenly attack healthy cells.   A spiral of events occurs during a psoriasis outbreak, macrophages, T-cells, and dendritic cells migrate to the surface of the epidermis to release cytokines causing inflammation and the overproduction of cells on the skin (Sahi et al, 2020).  It generally takes a month for skin cells to grow, die, and shed from the body, but with psoriasis the process can only take 3-4 days.  Instead of shedding the dead cells, they pile on the epidermis creating red and irritated skin, with silvery-white scales called plaques, which causes itching and burning to the individual (About psoriasis, 2022). 

Scientists do not fully understand the condition.  They have determined the disease is linked to genetics and some environmental factors, that also include stress and mental disorders.  Diagnosing the disease can be done by physical exam, the lesions are usually easy to diagnose.  A biopsy can be performed to rule out other conditions and infections.  A primary care physician can diagnose psoriasis, but a patient may be referred to a dermatologist for further treatment.  The plaques can occur in cycles of flare-ups and remission, meaning there are no symptoms.  The condition’s severity can be ranked based on its percentage of skin area affected, characteristics of the lesions, and impact on daily life.  If the inflammation covers 3% of the body it is considered mild, inflammation that covers 3-10% of the body is called moderate, and symptoms covering more than 10% then it is considered severe (Donnelly, 2021). 

Forms of Psoriasis

Plaques are usually found in the scalp, the upper and lower extremities, as well as on the trunk of the body.  Psoriasis Vulgaris or plaque psoriasis is the most common form that affects nearly 80% of individuals with psoriasis (Locations and type, 2021).  Another common form is scalp psoriasis, which affects nearly 60% of individuals with psoriasis.  Pustular psoriasis is a condition that is characterized by having pustules, which are white or yellow pus-filled and painful bumps.  These pustules can appear quickly and generally include fever, chills, fatigue, and asthenia.  Inverse psoriasis is found in the skin folds, usually of the arm pits, under the breast, and in the groin area.  The skin can appear smooth and shiny due to the increased moisture but can become irritated by the frequent rubbing of the skin.  Guttate psoriasis is common in children and young adults.  This case is seen as small round spots called papules that develop suddenly, usually after an infection like strep throat, flu, or upper respiratory infections, they can also be stress induced (Location and type, 2021). 

Psoriatic Arthritis

Holland (2021) reports that 30-33% of individuals with psoriasis can also have psoriatic arthritis, which causes pain, swelling, and stiffness in the joints.  This disorder often resembles rheumatoid arthritis; however, it affects the body differently.  Doctors can test the patient's blood for Rheumatoid Factor (Rf) to rule out rheumatoid arthritis.  Psoriatic arthritis also resembles osteoarthritis, by also having the visible skin condition it is usually a strong diagnostic factor.  If psoriatic arthritis is not treated early, it can result in permanent joint damage.  People with psoriasis can also suffer with other comorbid conditions, meaning having additional ailments that occur because of or is related to a current health condition.  Conditions like heart attack and stroke, type 2 diabetes, high blood pressure, Crohn’s disease, osteoporosis, liver and kidney disease, and mental health problems are all common risks associated with psoriasis.  

Psoriasis and Mental Health

Psoriasis patients will likely experience depression and self-esteem issues.  Fear of social rejection and stigmatization creates a psychological strain on the individuals personal, social, and sexual lives.  “Women, younger patients, and patients with early onset of the disease, and those who self-assess their psoriasis to be severe are especially at risk of mental and behavioral changes'' (Sahi et al, 2020).  Many individuals feel that their quality of life is affected.  A survey by The National Psoriasis Foundation found “almost 75% of patients believed that psoriasis had a moderate to large negative impact on their quality of life, with alterations in their daily activities” (Bhosle et al, 2006).  Those who suffer from the negative effects of the disease often feel shame, embarrassment, and lack of control.  They also feel hopelessness because there is no current cure, their only option is to try to manage the symptoms.

Treatment Options

There are a few treatment options available to help manage the symptoms and severity of this disease.  Creams and topical ointments are more commonly used to treat the skin, followed by injections, oral therapies, and phototherapy.  Topicals typically contain corticosteroids, salic acid, and retinoids.  Corticosteroids are composed of natural hormones to help control the body’s inflammatory response and retinoids reduce skin cell production.   Biologics are given by injection or through intravenous infusion (I.V.).  Their purpose is to alter the immune system to prevent interactions between the immune system and inflammatory pathways.  Cyclosporine is designed to decrease the body's immune system responses, but also can cause you to become sick easier.  Methotrexate is a similar immune suppressant but can cause liver damage and decreased production of red and white blood cells (Holland, 2021).  Phototherapy, or light therapy, is a newly discovered treatment option.  Sunlight has shown to kill overactive white blood cells, so by using UVA and UVB lights, it can help reduce the symptoms.

Living with Psoriasis

Living with psoriasis can cause strain because there is no cure to the disease, but besides taking medications, changes to one’s lifestyle can also benefit.  Eating healthy and losing weight can help lessen the symptoms.  Eating a heart-healthy diet with reduced animal products, dairy, and highly processed foods have shown to bring improvements.  Learning to manage stress is also important because stress can cause outbreaks to occur and affect one’s mental health.  Keeping the skin moisturized and avoiding triggers like cold weather, skin injuries, and infections can also lessen the chance of having an outbreak (Psoriasis, 2020).  Although the diagnosis of psoriasis can be a shock, knowing that there are treatment options and support groups can help individuals adjust more smoothly and cope while having the disease.

Definition of Terms

Squamous cells	Thin, flat cells that form the surface of the skin
T- cells (white blood cells)	White blood cells.  Apart of the immune system that helps to protect the body from infection
Macrophage	Immune cell that plays central role in fighting bacteria
Dendritic Cell	Immune cell that activates and boost immune responses
Epidermis	Epi (above) dermis (skin)- the superficial or furthermost layer of the skin
Dermis	The deeper layer of skin, under the epidermis
Extremities	Upper refers to the arms, lower refers to the legs
Pustules	Raised spot on the skin containing pus
Papules	Small, solid, raised spot om skin that is less than 0.5cm in diameter
Asthenia	Physical weakness or lack of strength
Intravenous (I.V.)	Intra (within) ven/o (vein)- Injection into the veins.
Biopsy	Bi/o (life) opsy (view of) – Piece of tissue removed to view under a microscope to aid in diagnosis
Dermatologist	Derm/a (skin) ologist (one who studies) – Physician that diagnosis and treats conditions relating to the integumentary system
Rheumatoid Arthritis (RA)	An autoimmune and inflammatory disease that causes inflammation in affected parts of the body.
Osteoarthritis (OA)	When the protective cartilage at the end of the bones wears down over time, causing pain and inflammation.
Phototherapy	Photo (light) therapy (treatment)

 

References

About Psoriasis. (2022, June 2). National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/

Bhosle, M. J., Kulkarni, A., Feldman, S. R., & Balkrishnan, R. (2006). Quality of life in patients with psoriasis. Health and quality of life outcomes, 4, 35. https://doi.org/10.1186/1477-7525-4-35

Donnelly, C. (2021, March 4). The Severity of Your Psoriasis.  Verywell Health. https://www.verywellhealth.com/mild-psoriasis-overview-4171756

Holland, K. (2021, November 18). Everything You Need to Know About Psoriasis. Healthline. https://www.healthline.com/health/psoriasis#symptoms-of-psoriasis

Location and type. (2021, March 10). National Psoriasis Foundation. https://www.psoriasis.org/locations-and-types/

Psoriasis. (2020, September). NIH  https://www.niams.nih.gov/health-topics/psoriasis

Sahi, F. M., Masood, A., Danawar, N. A., Mekaiel, A., & Malik, B. H. (2020). Association Between Psoriasis and Depression: A Traditional Review. Cureus, 12(8), e9708. https://doi.org/10.7759/cureus.9708