Psoriasis is a chronic, non-contagious skin disorder that is seen as scaly plaques on the skin. It appears as an elevated red plaque that is covered by a silvery dry scale. It affects 1-2% of the world population.

A normal skin cell matures in 28 – 30 days. In Psoriasis, cells move to the top of the skin in three days. The excessive skin cells that are produced “stacks up” and form the elevated red, scaly plaques that characterize Psoriasis. The white scale that covers the red plaque is composed of dead cells that are continually being cast off. The redness of the plaques is caused by the increased blood supply necessary to feed this area of dividing skin cells.

Different Types of Psoriasis

Discoid or Plaque Psoriasis
This is the most common type of Psoriasis. Well defined, coin-shaped patches of skin that are usually red and covered in white, waxy scales that appear on the knees and elbows but plaques can appear anywhere on your body. They can be itchy and may bleed if scratched.

Guttate Psoriasis (Latin gutta, meaning drop)

Guttate Psoriasis usually develops 7-14 days after a severe throat infection or bout of tonsillitis caused by streptococcal infection. The “drop-like” patches are mostly found on the trunk and limbs. It generally occurs in children or young adults and often disappears by itself after several weeks/months.

Flexural (inverse) Psoriasis
Flexural Psoriasis is found in “skin folds” of sites such as the armpits, groin, buttocks or beneath the breast. The skin is red and covered with thin plaque but not scaly.

Napkin PsoriasisWell defined glazed areas in nappy area of babies

Scalp Psoriasis

Scalp Psoriasis is common in Psoriatic patients. About 50% of all Psoriasis patients suffer from scalp Psoriasis. It is clearly defined, infiltrated, very thick, white and scaly plaques over the scalp, especially in occiput and above the ears. Masses of sticky grey-ish white asbestos-like scales on scalp. It can look like dandruff.

Sebopsoriasis

Sebopsoriasis is usually seen on the scalp and the face (glabella, eyebrows and nasolabial folds), postauricular and pre-auricular areas and sometimes on the central chest. It overlaps with seborrhoeic dermatitis but is distinguished by having more well-demarcated plaques. The face is usually not affected when it comes to psoriasis. Psoriasis of the scalp can extend down over the forehead, temples and sometimes over the eyebrows and ears.

Palmoplantar Psoriasis

May only effect palms and or soles. Well-demarcated plaques on the palms of hands or soles of feet. More hyperkeratotic types (thickening of skin) tend to form painful fissures. It can be difficult to distinguish palmoplantar Psoriasis from:

• Tinea (scrapings for fungal culture should be routinely ordered)
• Dermatitis e.g. Allergic contact dermatitis

Pustular Psoriasis

Pustular Psoriasis usually exists as a large red area covered with green, tender pustules (blisters), despite their colour the pustules are not infected (the green colour is caused by masses of white blood cells-these cells flood into any part of the skin that is inflamed). After 7-10 days pustules become dispersed and brown scales appear and later fall off. Pustular Psoriasis on the palms and soles tend to be sore rather than itchy. It is uncomfortable, unsightly and can make writing and walking difficult.

The rarest and most severe form is Generalised Pustular Psoriasis. A patient becomes ill, feverish and a sudden onset of tiny pustules all over the skin, within a few hours or days. The pustular change is induced by the overuse of strong cortisteroid application.

Palmoplantar Pustulosis-PPP
This is an independent disorder. Around the pustules the skin becomes red, thickened and painful fissures will form with a distressing itch. It is most common in middle aged females. People with this condition can benefit from UVB treatment.

Nail Psoriasis

In 50% of patients with Psoriasis, the nails are affected. Pitting, discolouration and thickening of the nail may occur

Psoriatic Arthritis

It is an inflammatory form of Arthritis which may affect only a few or multiple joints.

Erythroderma
90% Or more of skin is inflamed. It may be a slow worsening of chronic plaque Psoriasis or an explosive form of unstable psoriasis. The skin becomes red, hot and continually scales. They lose the ability to control their body temperature and experience the loss of fluids and proteins. Psoriatic Erythroderma may be provoked by too intense topical treatment, by infections, the sudden withdrawal of topical corticosteroid therapy as well as anti-malarial therapy.

Treatment Options

 

Topical Therapy

Emollients

Psoriatic skin tends to be very dry, and this dryness can lead to a worsening of the psoriasis if it is not treated. Emollients smoothen, soothes and hydrates the skin by sealing in moisture. Long term use of emollients is safe and have no side effects

Coal Tar
Medical Tar ointments are highly effective in treatment of Psoriasis and help reduce scaling and inflammation. It has been used as a treatment for Psoriasis for over 100 years and can be used on the whole body and scalp.

Topical corticosteroids
For thick plaques of Psoriasis fairly potent corticosteroids are needed. These, however, suppress the plaques rather than clearing them. Lower strength steroids are used for more sensitive areas like the face, groin, armpits and breasts

Precautions

• If potent corticosteroids are used over a widespread area of the body for prolonged periods, it can cause severe systemic side-effects for example: thinning of the skin with severe stretch marks or Telangiectasia
• Steroids are only a short-term solution (up to 3 months maximum). The product will stop working and the Psoriasis may rebound.
• Taper off gradually to prevent rebound psoriasis.

Salicylic acid
Salicylic acid acts as a scale lifter, helping to soften and remove psoriasis scales and enhances the effectiveness of other emollients

Dithranol (Anthralin)
Dithranol is a highly effective prescription only treatment of chronic plaque Psoriasis. It works by inhibiting the synthesis of DNA, preventing rapid cell turnover. Side effects include skin irritation of normal skin, staining or discoloration of skin (not permanent) and staining of clothes (permanent).

UV Therapy (Phototherapy)

UVB Narrowband (311nm) slows the abnormal growth of normal skin cells which is associated with Psoriasis. Ultra violet light is defined as short wave light energy (311nm) (ultra violet B light). Phototherapy works by a combination of anti-proliferative effects and local immune suppression. It is generally the treatment most physicians will begin with as it is most effective and less risky. The combination of Phototherapy and topical treatments is highly effective.

DEKA Excilite-µ: A complete treatment system for targeted and selective phototherapy from a MEL@308nm source.

Advantages

• Quick sessions, less often
• reduces the need for medication
• It enables treatment in more delicate areas
• Targeted treatment minimizes side effects such as erythema, burns and unwanted darkening of normal skin
• Repetitive treatments with Excilite-µ cause stabilization of results with prolonged times between relapses
• Excilite-µ can also treat Vitiligo, Psoriasis, Atopic dermatitis, Alopecia Areata and Mycosis Fungoides

Natural sunlight
Multiple short exposures to natural sunlight can temporary clear Psoriasis. A slow and gradual tan is recommended for the best results. Up to 95% of people will improve with regular exposure to sunlight. Sunburns should be avoided at all costs as it can trigger the Psoriasis. Be sure to apply sunscreen before sun exposure to your normal skin. After 15-30 minutes exposure of Psoriasis lesions, apply sunblock on lesions as well.

General Guidelines during Psoriasis therapy

Rotate therapies over the long term to minimize side effects from any one therapy and to prevent resistance to a certain therapy.

Results can take a long time to achieve. Persevere with treatments. It can only take 12 treatments to clear for one person while another may require 60 – 80 treatments.

Sometimes psoriasis can get worse before it gets better.

Be sure to discuss the variation of your treatments with your therapist at Advanced Dermatology. A commitment to lengthy treatment may be necessary to achieve clearance.

Try to avoid trigger factors

• Ear, nose, throat infections, teeth and gums, bladder infections
• Drugs – lithium (a drug used to treat manic depression)
• Hydroxychloroquine or choloroquine – Malaria medicine
• Betablockers
• Aspirin, voltaren, brufen, Coxflam, Myprodol
• Stress – precipitating and exacerbating factor
• Smoking – nicotine
• High Alcohol Intake
• HIV Infection
• Excessive Sun Exposure
• Diet
• Gluten-free diet

Treatment of Vitiligo
Most advanced treatment with DEKA Excilite-µ. Vitiligo is among the most psychologically devastating diseases with dramatic effects on the patient’s social life.

The advantages of using DEKA Excilite-µ:

• Targeted treatment; treats only the lesions
• Less side- effects of erythema, burns and hyperpigmentation
• Fewer sessions needed
• Targeted Phototherapy with MEL@308nm is revolutionary. Excilite-µ combines the advantages of laser phototherapy and broad-spectrum lasers while eliminating their disadvantages.

UVB Narrowband therapy
UVB Narrowband (311 nm). Ultra violet light is defined as short wave light energy (311nm) (ultra violet B light). Phototherapy works by a combination of anti-proliferative effects and local immune suppression.

For mild forms of Vitiligo, topical corticosteroids may be used to restore small patches of non-pigmented skin. This can only be prescribed for a short period of time as it has some side effects.

The term Eczema is derived from the Greek word “Ekzein” meaning “to boil over”, referring to the spongiostic vesicles characteristic of the early stages of the disease.

Eczema is an endogenic chronic, recurring, itching skin condition with genetic predisposition. It is not contagious.  

 The symptoms of eczema include dry, inflamed skin and intense itching which can flare up at times.

Chromosome 11 and 5 predicts the tendency and is part of the atopic syndrome eczema, hay fever, sinusitis, asthma, keratosis pilarus and allergies of ear, nose and throat conjunctivitis and urticaria. Eczema flares happen because the immune cells in an eczema sufferer’s skin overreact to certain triggers. Therefore, it is very helpful to identify and avoid exposure to those triggers.