A Nagging Scratchiness (Psoriasis)

Psoriasis is a mysterious skin disease that affects around 5 per cent of the population. It usually starts between the ages of 16 and 25 years or after the age of 55 as disfiguring, scaly, itchy, eruptions anywhere on the body. It can occur on the elbows and knees, in flexures and folds or on the face and scalp. About 10 per cent of patients may develop psoriatic arthritis, with joint pains that make mobility difficult. The nails may be affected, becoming yellow and disfigured or eventually falling off.

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Psoriasis occurs because there is an imbalance between the rate of formation and the rate of shedding of the skin in certain areas of the body. Normally new skin forms in the lowermost skin layer and gradually moves upwards. Eventually the topmost layer falls off. In most people this process takes about a month. It is a uniform, asymptomatic process and occurs unnoticed. In those with psoriasis the entire process is accelerated, uncoordinated and happens within just a few days. The skin piles up, producing the thickened silvery appearance.

Psoriasis may be precipitated by environmental factors like a bacterial (streptococcal) infection, exposure to medication like anti-malarials, some anti-hypertensives, pain killers such as indomethacin, or anti-depressants like lithium. It may appear with prolonged exposure to certain chemicals like disinfectants and paint thinners. It can also be aggravated by stress and alcoholism. There may be a genetic predisposition. Most often, no real cause is found.

The diagnosis is usually made from the typical appearance of the lesions. A scraping or biopsy may be needed if the manifestation or history is not typical. The lesions tend to wax and wane, sometimes mysteriously disappearing all together. This makes evaluation of any treatment regimen difficult. Also, unlike in the case of other chronic illness, there is no standard treatment regimen.
Bathing in tepid water to which a few drops of coconut oil has been added may bring relief

In mild cases, simple home remedies may be sufficient. Adding coconut oil to the bath water and avoiding harsh soaps and detergents is helpful. At night, a moisturising emollient like paraffin wax, petroleum jelly or baby oil may be locally applied. The hair on the scalp has to be parted and the oil applied with a brush. Sometimes the scales (particularly on the scalp) can be quite thick. Regular use of a salicylic acid shampoo alternating with a coal tar shampoo can be quite effective.

If these simple measures are not effective, a dermatologist can recommend stronger topical applications of other chemicals or steroids. These ointments may have side effects and should be used only under medical supervision. Steroid creams cause the lesions to disappear rapidly. They are most effective when applied at night and the area is sealed off under a piece of polyethylene. The creams have to be chosen carefully, as significant quantities of some of the molecules can be absorbed through the skin, causing inadvertent steroid side effects. Sometimes, it can cause thinning and atrophy of the treated area. The use of steroid creams should be tapered off, and not stopped abruptly, to prevent rebound reactivity in the psoriatic patches.

Light therapy is effective. Treatment using light becomes more efficient if a photosensitising medicine is taken prior to exposure. Natural early morning sunlight or artificial light with ultra violet (UV) lamps can be used. UV light, used unsupervised for prolonged periods (more than 200 hours), increases the risk of skin cancer.

Oral medication that can be used are methotrexate or the newer retinoids. However, they can cause gene mutations. Women who have taken retinoids should not become pregnant while on treatment and for least two years afterwards.

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Psoriasis follows a frustrating, remitting, relapsing course over a lifetime. The number of relapses and their severity can be reduced if patients follow a few simple, disease-modifying, lifestyle guidelines.

• Eat a nutritionally balanced diet with plenty of vitamins, minerals and antioxidants

• Exercise regularly. Aerobic exercise like walking, jogging or swimming releases disease-modulating chemicals from the muscles

• Try to maintain ideal body weight. Psoriasis often occurs in skin creases or folds, which are commoner in the obese

• Bathe daily so that the scales get washed off. Use tepid water and a moisturising soap. Pat the skin dry after a bath instead of harshly rubbing it with a rough towel

• Apply a non-medicated moisturising cream soon after a bath when the skin is still soft

• Expose your skin to a moderate amount of sunlight.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Sources: The Telegraph (Kolkata, India)

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