PSORIASIS TREATMENT IN DELHI

Psoriasis is an autoimmune condition of the skin that has a genetic predisposition. The classical sites include areas of high friction such as knees and elbows, but it also commonly appears on the scalp, lower back, genitals, and face.
Psoriasis is also known to have a familial predisposition. It is a pro-inflammatory condition affecting the skin as well as certain body organs such as the joints, the heart, and, the tongue. So, seeking timely help from a psoriasis specialist doctor in Delhi is highly recommended.

CAUSES OF PSORIASIS

Psoriasis can be hereditary, genetic, and environmental. In India, its prevalence is around 0.44- 2.8%. 80% of patients suffer from plaque psoriasis.

Psoriasis can begin at any age. Most people get psoriasis between 15 and 30 years and another peak at around 50-60 years of age. About 75% of people will have it by 40 years of age.

Studies suggest that a person’s immune system and genes play important roles. It seems that many genes must interact to cause psoriasis working alongside the triggers that can worsen psoriasis include- infections (strept throat), stress, cold, dry weather, a cut, scratch, or bad sunburn, heavy alcohol consumption, and certain medications like lithium, or medicine to prevent malaria. It is now known that psoriasis is not contagious.

Multiple causative etiologies are thought to cause psoriasis. The main cause is defects in the immune system, more specifically – t lymphocytes. These t cells normally travel throughout the body detecting and fighting off foreign substances, such as viruses or bacteria. In the case of psoriasis, the t cells by mistake identify healthy skin cells as a foreign substance and start fighting against them. Epidermal skin cells turnover time is hugely reduced. Normally skin cells take 28 to 30 days to mature and shed while in the case of psoriasis skin cells may shed in just 4 days. So, the cells build up rapidly on the surface making it look thick, scaly and can be itchy or painful.

TYPES OF PSORIASIS

1. Plaque Psoriasis (or Psoriasis Vulgaris)

Plaques are characterized by red, raised patches on the skin. These patches usually have a silvery-white coating also known as scale.

Most patches appear on the knees, elbows, lower back, and scalp and are itchy.

Constantly scratching the patches often causes the patches to thicken.

The size of the patches can vary widely. Some may experience small scattered patches, while some may experience large patches that cover a large body part.

Nail problems – pits in the nails, crumbling nail, the nail falls off.

2. Scalp Psoriasis

The symptoms are pretty similar plaque psoriasis but it affects the scalp and can cause itching. Sometimes the skin over the forehead extending beyond the hairline is also affected known as corona psoriatica.

Guttate psoriasis: This type of psoriasis causes small spots that appear usually on the trunk, arms, and legs but can appear on the scalp, face, and ears. These may clear up in a few weeks or months without treatment.


These spots often appear after an illness, especially strep throat. Guttate psoriasis may also occur in a person having plaque psoriasis.

3. Pustular Psoriasis

Skin appears red, swollen and dotted with pus-filled, painful elevated lesions (bumps) which usually appear only on the palms and soles, which will eventually dry out, and leave behind brown dots and/or scale on the skin.

Generalized Pustular Psoriasis: when the lesions are disseminated all over the body along with fever and shows the following symptoms:

  • Chills
  • Severe itching
  • Rapid pulse
  • Loss of appetite
  • Muscle weakness

4. Psoriatic Arthritis

Small joints of hands and feet feel stiff and sore, especially on waking up early in the morning. In 10% to 30% of people with psoriasis, psoriatic arthritis also ensues. Besides causing scaly skin & inflammation this type of psoriasis causes discolored nails and swollen painful joints. Symptoms range from mild to severe, and in serious cases can lead to deformity.

5. Inverse Psoriasis (or Flexural Psoriasis or Intertriginous Psoriasis)

Raw, red patches only develop where skin touches the skin (intertriginous areas), such as the armpits, around the groin, genitals, buttocks, and undersurface of breasts. Skin feels very sore where inverse psoriasis appears and since has to be differentiated from tinea infections.

6. Nail Psoriasis

As the name indicates, this affects fingernails and toenails. The symptoms include discoloration of the nails, nail pitting, abnormal growth, and separation from the nail bed (the condition is referred to as Onycholysis).

7. Erythrodermic Psoriasis (or Exfoliative Psoriasis)

This is an emergency situation as >90% body surface area is involved and is red, inflamed, and scaly. This serves as a high cardiac output state for the patient.

Skin looks like it is burned along with intense itching/intense pain.

Temperature fluctuations can be observed as one may either feel very hot or very cold. Heart beat is also increased. It’s best to get emergency care right away.

DIAGNOSES

A dermatologist can clinically diagnose the disease right away by examining a patient’s skin, nails, and scalp for signs of psoriasis.

Your dermatologist may also ask about a family history of psoriasis, and he may be interested to learn whether a patient has been under a lot of stress, had a recent illness, or just started taking medicine, to identify the triggers.

Sometimes a dermatologist may go for dermoscopy and skin biopsy for diagnoses.

Along with this, the doctor may also order a blood workup, chest x-ray, etc. Before starting your medications. 

PSYCHOLOGICAL EFFECTS

Psychological distress is undoubtedly the worst aspect of psoriasis. Ignorance and lack of knowledge about psoriasis in the general population lead to discriminatory behavior towards the patients of psoriasis which can be very upsetting. Psoriasis is not infectious, but because of this myth that psoriasis can be contagious, many times the patients experience prejudice in the public places like swimming pools and public transport. Those with severe cases of psoriasis are observed to develop depression, anxiety, and suicidal thoughts. Counseling of patients and their peers by a dermatologist is essential, they must receive expert advice and help. Also, in some cases dermatologists may recommend consulting a psychiatrist to manage the psychological distress.

OUTCOME AND LONG-TERM RISKS

Unpredictable outcome- sometimes the condition spontaneously clears out but more often than not.

Psoriasis remains a chronic (long-lasting) disease of the immune system. It is notoriously known to have a relapsing course. most people have psoriasis for life, where it comes and goes as pleases but it doesn’t necessarily mean that It cannot be cured. A dermatologist who is expertise in treating psoriasis can help provide a treatment plan that is tailor-made to address the individual concerns.

Dermatologists encourage their patients who have psoriasis to take an active role in managing this disease and subsequently improve their quality of life.

Studies have shown that people with psoriasis have a slightly increased long-term risk of heart attack and strokes. This is seen with other conditions that cause long-term inflammation in the body and resultant metabolic syndrome, and it is through that low levels of natural inflammatory chemicals called cytokines that spill over into the blood can increase the furring up of arteries leading to cardiovascular disease. For this reason, people who have psoriasis must be extra careful to control other risk factors for these conditions, by not smoking, exercising regularly, eating well, and controlling blood pressure.

PSORIASIS TREATMENT IN DELHI

Some people choose not to treat psoriasis and it’s their personal choice!

Treatment can reduce signs and symptoms of psoriasis, which usually makes a person feel better and improve quality of life.

However, the people who decide to get treated can choose from a wide range of recently advanced medicines which are completely safe to use.

A dermatologist will offer you three main types of psoriasis skin treatment: topical treatments, light therapy, and systemic medications.

1. Topical treatments

In cases of mild to moderate psoriasis, creams and topical ointments can be effective without needing any additional treatments. Commonly suggested topical treatment includes:

  • Topical corticosteroids.
  • Anthralin.
  • Calcineurin inhibitors.
  • Salicylic acid.
  • Vitamin d analogues.
  • Topical retinoids
  • Coal tar.
  • Moisturizers.

2. Light Therapy

Natural or artificial ultraviolet light is commonly used to reduce the symptoms of Psoriasis. Many times phototherapy is suggested alongside medication to provide optimum results. 

Although one must keep in mind that excessive sun exposure or sunburn should be avoided as it can aggravate the symptoms of psoriasis.

Light therapy options include:

  • Sunlight.
  • UVB Phototherapy.
  • Narrowband UVB Therapy.
  • Goeckerman Therapy.
  • Photochemotherapy or Psoralen Plus Ultraviolet-A (PUVA).

3. Oral or Injected Medication

Severe psoriasis, or cases that are resistant to other forms of treatment, may respond to oral or injected medications. These are suggested only for a short period and alternated with other treatments.

General prescription includes:

  • Retinoids.
  • Methotrexate.
  • Cyclosporine.
  • Drugs that alter the immune system (biologics).
  • Other medications, such as thioguanine and hydroxyurea.

Each of these requires close physician supervision and blood monitoring. Side effects such as hair loss and liver dysfunction are uncommon but can occur. Female patients of childbearing age and persons who drink alcohol are not candidates for these medications.

4. Biologics

The latest treatment option for psoriasis is ‘biologics’. These are antibodies, immune proteins, that have been designed to specifically target natural immune chemical proteins (cytokines, interferons, interleukins) that we know are involved in psoriasis. Because they are specific, they tend to work powerfully and quickly and are known to provide longer disease-free periods (remissions). These medications are TNF inhibitors and are given by injection, perhaps twice a week or as infrequently as once every 3 months. However, these are quite expensive and are suggested only in cases of psoriatic arthritis that hasn’t responded to other treatments and those with moderate or severe symptoms of psoriasis.

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    FAQ's

    Psoriasis is a chronic disease. Here are some things you can do that will help you take control.

    Lifestyle modifications like eating a healthy diet- rich in proteins, calcium, and omega 3 fatty acids, – ask your doctor about ‘leaky gut protocol’. Regular exercise, quitting smoking and drinking alcohol is highly recommended. Smoking, drinking, and being overweight can make treatment less effective. Those who have psoriasis are also more prone to diseases like diabetes and heart disease. So, maintaining good overall health becomes necessary.

    Be aware and notice if there are any changes in the joints. The joints may feel sore and stiff mostly in the morning. This can be the first symptom of psoriatic arthritis.

    Also, notice if there are any changes in your nails.

    As it is a known fact that psoriasis can affect one psychologically, please do not hesitate to seek expert help. Various research studies prove that patients with psoriasis can suffer from depression, anxiety, and suicidal tendencies. So do not shy away from getting professional help. All these concerns can be overcome with the right guidance and treatment.

    Just be consistent with your follow-ups, keep your blood work up to date (if on medications), and leave the rest on your trusted dermatologist.

    Treatment of psoriasis will help bring down the itchiness, soreness, and flaking skin.

    When you visit a dermatology clinic, your doctor will take all the time to inform you about the nature of the disease, frequent flares, and treatment options available.

    So, learn about psoriasis treatment. The condition may get controlled altogether with occasional flares in between. However, talk with your dermatologist before you stop taking medicine for psoriasis. Never stop a medicine immediately, go as per the dermatologist’s guidance.

    A dermatologist Aims to get you the best possible treatment plan which will leave you feeling confident that you have your psoriasis under control. However much like life, psoriasis course is unpredictable. In most cases, flare-ups are mild and limited to a few body areas and clear quickly. For patients with persistent or itchy psoriatic lesions, many medications are available including-

    Steroids: Topical steroids have been proven to be effective in controlling redness and itching caused by psoriasis. They should not be used more than 3-4 weeks at a time without taking a 1-week break. Patients need to be aware of the strength of their steroids because high potency steroids should not be used on the face, on children, or in large body areas as it may lead to systemic absorption. Sometimes, oral or injected steroids are used as they have quick effects but they might last only for a short period. Side effects such as weight gain, osteoporosis, glaucoma, and diabetes may occur with long-term systemic steroid use.

    Vitamin D Creams: cacipotriene or calcipotriol are available by prescription and have been shown to help control psoriasis. Many patients will use them in combination with topical steroids, or alone as a steroid-sparing agent. Vitamin d₃ will not cause thinning of the skin. Combination vit d and steroid cream products can be used once a day, for up to 4 weeks at a time.

    Topical Retinoids: A specific vitamin derivative that has been shown to reduce the scaling and redness of psoriasis is suggested. It also can be used in combination with steroids or alone. Irritation is the main side effect, and it should not be used on thin or sensitive skin, such as the groin.

    Medicated Shampoos: for patients with scalp psoriasis, daily hair washing is helpful. Range of medicated shampoos that can control the flaking and itching on the scalp: tar, salicylic or glycolic acid, selenium sulfide, zinc pyrithione, and clobetasol. Prescription clobetasol shampoo (a steroid) can be applied for 5 minutes then lathered and rinsed. Patients may use any preferred conditioner afterward.

    Oral medications:

    Omega 3 fatty acids: this potent anti-inflammatory nutraceutical can help to improve psoriatic skin, as well as benefit your overall health. Omega 3’s (fish oil or algae-based) are taken daily (2000mg a day).

    Please keep in mind – not everything works for everyone. It is crucial to discuss your problem, concerns and expectations with a dermatologist in Delhi to understand the right course of action to relieve your skin from psoriasis.