What is Psoriasis?
In the Name of Allah, Most Gracious, Most Merciful;
All praise and thanks are due to Allah, May Allah blessings and peace be upon His Messenger.
Psoriasis is a chronic skin disorder that affects 1% to 3% of the world's population. It is characterized by periodic flare-ups of well defined, red patches covered by a silvery, flaky scale on the extensor surfaces and the scalp. There are several variations of psoriasis but the most common type is chronic plaque psoriasis.
Normally a skin cell matures in 21 to 28 days during its passage to the surface where a constant shedding of dead cells, as scales, takes place. Psoriatic cells, however, are believed to turn over in two - three days and in such profusion that even live cells reach the surface and accumulate with the dead cells in visible layers.
Psoriasis appears as raised red patches of skin covered with silvery scales. It can occur on any part of the body although elbows, knees and the scalp are usual sites. There is often accompanying itching. Psoriasis affects women and men equally. It may appear for the first time at any age, but is more likely to appear between the ages of 11 and 45.
Widespread ignorance about the nature of psoriasis and the real or imagined reactions of others may lead to a withdrawal from society and to feelings of isolation, depression and defensive shyness.
A. What Causes Psoriasis
By Heather Brannon, MD,
The exact cause of psoriasis is unknown, but it is believed that a combination of several factors contributes to the development of this disease.
1. Genetic Causes of Psoriasis
Researchers have found 9 gene mutations that may be involved in causing psoriasis. One of these mutations on chromosome 6, called PSORS-1, appears to be a major factor that can lead to psoriasis. Mutations on genes cause certain cells to function differently. With psoriasis, these mutations seem to largely affect T-helper cells.
2. Immune System Causes of Psoriasis
In a normally functioning immune system, white blood cells produce antibodies to foreign invaders such as bacteria and viruses. These white blood cells also produce chemicals that aid in healing and fighting infective agents. But with psoriasis, special white blood cells called T-cells become overactive.
These T-cells "attack" the skin and set off a cascade of events that make the skin cells multiply so fast they start to stack up on the surface of the skin. Normal skin cells form, mature, then are sloughed off every 30 days. But in plaque psoriasis the skin goes through this whole process in 3-6 days.
Normally T-cells produce chemicals that help heal the skin. In psoriasis, T-cells produce an abnormally large amount of these chemicals and actually cause more inflammation in the skin and joints.
3. Environmental Causes of Psoriasis
Not everyone who has these gene mutations gets psoriasis and there are several forms of psoriasis that people can develop. Certain environmental triggers play a role in causing psoriasis in people who have these gene mutations. Learn more about other psoriasis triggers.
Environmental Factors that Trigger Psoriasis
By Heather Brannon, MD
By Heather Brannon, MD
Psoriasis is a complicated, chronic skin disorder. We are still struggling to understand what goes on at the molecular level in this frustrating disease. Psoriasis is caused by one or more mutations in certain genes that then trigger cells in the immune system to attack the skin. But not everyone with these mutations gets psoriasis. The following are environmental factors that can trigger a psoriasis flare.
1. Skin Injury
Sometimes an injury to the skin can cause the formation of a psoriasis patch. This is known as the Koebner Phenomenon, and it can occur in other skin diseases, such as eczema and lichen planus. It can take 2 to 6 weeks for a psoriasis lesion to develop after an injury. Types of injuries that can trigger a flare include:
• Abrasion - even mild abrasion
• Increased friction from clothing or skin rubbing against skin in folds, such as armpits or under breasts
• Viral rashes
• Drug rashes
Weather is a strong factor in triggering psoriasis. Exposure to direct sunlight, which usually occurs in the warmer months, often improves the rash. On the other hand, cold, short days seen in the winter months can trigger the rash to worsen.
Psychological stress has long been understood as a trigger for psoriasis flares, but scientists are still unclear about exactly how this occurs. Studies do show that not only can a sudden, stressful event trigger a rash to worsen; daily hassles of life can also trigger a flare. In addition, one study showed that people who were categorized as "high worriers" were almost two times less likely to respond to treatment compared to "low worriers."
Infections caused by bacteria or viruses can cause a psoriasis flare. Streptococcal infections that cause tonsillitis, or strep throat, tooth abscesses, cellulites, and impetigo can cause a flare of guttate psoriasis in children. The human immunodeficiency virus (HIV) does not increase the frequency of psoriasis, but it does increase the severity of the disease.
5. Low Vitamins
Low levels of calcium have been reported as a trigger for psoriasis. Oddly enough, even though medications made from vitamin D are used to treat psoriasis, low levels of vitamin D do not trigger a flare-up.
6. Drug Triggers
The following drugs are known to either worsen psoriasis or induce a flare-up:
• Chloroquine -- used to treat or prevent malaria
• ACE inhibitors -- used to treat high blood pressure. Examples include monopril, captopril, and lisinopril.
• Beta blockers - also used to treat high blood pressure. Examples include lopressor and atenolol.
• Lithium -- a medication used to treat bipolar disorder
• Indocin -- an anti-inflammatory medication used to treat a variety of conditions, including gout and arthritis
• Corticosteroids, such as prednisone or solumedrol, can actually dramatically improve psoriasis. However, abruptly stopping the drug or rapidly tapering off of it can trigger a flare-up.
B. What to do about your Psoriasis:
1. Moisturize your skin regularly:
Psoriasis symptoms get worse when your skin is dry, so keep it moist with creams and lotions. Thick and oily moisturizers are often the best, since they are good at trapping moisture beneath the skin. Moisturizers are also useful for removing scales, especially if you wrap the area with plastic after applying moisturizer.
2. Avoid dry, cold weather:
Climate can have a big effect on psoriasis. For a lot of people, cold and dry weather can make the symptoms of psoriasis worse. In general, hot weather is better for people with psoriasis, although some have worsening symptoms when the heat and humidity rise.
3. Use a humidifier:
Keeping your skin moist is important, so use a humidifier during dry seasons of the year.
4. Avoid scrapes, cuts, bruises and infections:
It is very important for people with psoriasis to avoid bruises and cuts. Trauma to the skin can cause a flare-up of psoriasis, either at the site of the injury or elsewhere, a condition called "Koebner's phenomenon." Infections can also cause psoriasis to appear. Be especially careful when shaving. Avoid insect bites, chafing, acupuncture, and tattoos.
5. Get some sun, but not too much:
Because ultraviolet rays in sunlight slow the growth of skin cells, getting moderate doses of sun is a good idea. However, make sure they're brief -- about 20 minutes or so. Use sunscreen if you're out in the sun for any longer period of time.
6. Decrease stress:
Although it hasn't been proven, a lot of people feel that their psoriasis tends to flare up during stressful times. So try to reduce your stress levels. That's easier said than done, but there are some things you can do: practice relaxation techniques or give yoga a try.
7. Exercise, eat right, and maintain a healthy weight:
Although no studies have proven a connection between diet and psoriasis, experts recommend that people with the condition should eat a well-balanced diet, high in fruits and vegetables. Fish oils (the omega-3's) in supplement form have been helpful in doses of 6 g. daily. Exercise may also help, and will improve your mood. Excess weight can worsen psoriasis symptoms, so maintaining a healthy weight may help prevent flare-ups.