Psoriasis Treatment

Overview

Psoriasis is a chronic autoimmune skin condition characterized by red, scaly patches on the skin. It's caused by an overactive immune system that speeds up the growth of skin cells, leading to the formation of thick, inflamed areas, often with silvery scales. While there's no cure, various treatments can help manage the symptoms and improve quality of life.

About Psoriasis

Psoriasis is a chronic skin condition characterized by the rapid growth of skin cells, leading to thick, red, scaly patches that can appear on various parts of the body. It's an autoimmune disease, which means that the body's immune system mistakenly attacks healthy skin cells.

What is psoriasis?

Psoriasis is a chronic autoimmune skin disorder that significantly impacts an individual’s quality of life. It manifests as red, inflamed, and scaly patches on the skin, commonly found on the elbows, knees, scalp, and lower back. These patches, often referred to as plaques, are the result of an accelerated skin cell production process. Typically, skin cells grow and shed over the course of a month, but in psoriasis, this cycle is shortened to just a few days. As a consequence, the excess skin cells build up on the surface, forming the characteristic thick, silver scales and red patches.

The exact cause of psoriasis remains elusive, though it is widely accepted that both genetic and environmental factors play crucial roles. People with a family history of the condition are more likely to develop it, suggesting a genetic predisposition. Additionally, certain environmental triggers can exacerbate or initiate flare-ups. Common triggers include infections, such as strep throat, skin injuries, stress, smoking, and certain medications like lithium and beta-blockers. The involvement of the immune system is a hallmark of psoriasis. In an autoimmune response, the immune system mistakenly targets healthy skin cells, leading to inflammation and rapid skin cell turnover.

There are several types of psoriasis, each with distinct characteristics. Psoriasis is not contagious, meaning it cannot be transmitted from person to person. However, it can have a profound psychological and emotional impact on those affected, leading to feelings of embarrassment, frustration, and even depression. The visible nature of the condition can result in social stigma and isolation. Currently, there is no cure for psoriasis, but various treatments can help manage symptoms and improve the quality of life for those affected. 

What are the types of psoriasis?

Psoriasis is a complex and multifaceted condition, and understanding its various types is essential for effective management and treatment. There are several distinct types of psoriasis, each with its own unique characteristics and manifestations.

• Plaque Psoriasis (Psoriasis Vulgaris): This is the most common form of psoriasis, accounting for about 80-90% of all cases. It is characterized by raised; red patches covered with a silvery white buildup of dead skin cells. These patches, or plaques, are often itchy and can be painful. They typically appear on the elbows, knees, scalp, and lower back, but can occur anywhere on the body.

• Guttate Psoriasis: This type often starts in childhood or young adulthood and is typically triggered by bacterial infections, such as strep throat. Guttate psoriasis appears as small, drop-shaped lesions on the trunk, limbs, and scalp. The lesions are usually covered by a fine scale and are not as thick as the plaques seen in plaque psoriasis.

• Inverse Psoriasis: Inverse psoriasis affects skin folds, such as under the breasts, around the groin, and buttocks, and in other areas where skin touches skin. The lesions are usually smooth and shiny and are aggravated by friction and sweating. Inverse psoriasis can be particularly uncomfortable due to its location in sensitive areas.

• Pustular Psoriasis: This type is characterized by white pustules (blisters of noninfectious pus) surrounded by red skin. It can be localized, often on the hands and feet (palmoplantar pustulosis), or generalized, affecting large areas of the body. The generalized form can cause severe systemic symptoms, such as fever and chills, and requires immediate medical attention.

• Erythrodermic Psoriasis: This is the rarest and most severe form of psoriasis. It leads to widespread redness, inflammation, and scaling of the skin, which can cover large areas of the body. Erythrodermic psoriasis can be life-threatening as it disrupts the body’s ability to regulate temperature and protect against infections. It often requires hospitalization and intensive medical treatment.

• Nail Psoriasis: Psoriasis can also affect the nails, leading to changes such as pitting, discoloration, and thickening. Nails may also become loose and separate from the nail bed (onycholysis) or crumble.

• Psoriatic Arthritis: About 30% of people with psoriasis also develop psoriatic arthritis, which causes joint pain, stiffness, and swelling. It can affect any joint in the body and can range from mild to severe. Early diagnosis and treatment are crucial to prevent joint damage.

Understanding these different types of psoriasis is important for tailoring treatment to individual needs and managing the condition effectively. Each type may require different therapeutic approaches, and recognizing the specific characteristics can help healthcare providers develop personalized treatment plans.

What parts of the body does psoriasis affect?

Psoriasis is a chronic skin condition that can affect various parts of the body, manifesting in different ways depending on the type and severity of the disease. While psoriasis can occur almost anywhere on the body, certain areas are more commonly affected. 

• Scalp: One of the most frequent sites for psoriasis is the scalp. Scalp psoriasis can cause thick, crusted plaques on the skin, which may extend beyond the hairline. These plaques can be itchy, painful, and may cause hair loss due to scratching or the severity of the condition.

• Elbows and Knees: The extensor surfaces of the elbows and knees are classic locations for plaque psoriasis. The plaques in these areas are typically well-defined, red, and covered with silvery scales. These regions are prone to friction and pressure, which can exacerbate the condition and make it particularly uncomfortable.

• Lower Back: The lower back is another common site for psoriasis plaques. Similar to the plaques on the elbows and knees, those on the lower back are often red, raised, and covered with scales. The location can make sitting or lying down uncomfortable for individuals with severe psoriasis in this area.

• Nails: Psoriasis can also affect the nails, leading to changes such as pitting (small depressions on the nail surface), discoloration, thickening, and separation from the nail bed (onycholysis). Nail psoriasis can be a sign of more severe disease and is often associated with psoriatic arthritis.

• Face: Though less common, psoriasis can affect the face, including the eyebrows, upper forehead, hairline, and the skin around the mouth and nose. Facial psoriasis can be particularly distressing due to its visible nature, impacting an individual's self-esteem and quality of life.

• Palms and Soles: Palmar-plantar psoriasis affects the palms of the hands and the soles of the feet. It can cause thick, painful plaques that may crack and bleed, making it difficult to perform daily activities or walk comfortably.

• Skin Folds: Inverse psoriasis occurs in skin folds, such as under the breasts, in the armpits, around the groin, and buttocks. These areas are more prone to friction and sweating, which can aggravate the condition. The lesions are usually smooth, red, and shiny, lacking the typical scaling seen in plaque psoriasis.

• Joints: In addition to the skin, psoriasis can affect the joints, a condition known as psoriatic arthritis. Psoriatic arthritis causes pain, stiffness, and swelling in the joints, which can lead to long-term joint damage if not treated promptly. It commonly affects the fingers, toes, wrists, and spine.

• Ears and Genital Area: Psoriasis can also affect the ears and the genital area, causing discomfort and impacting sexual health. In the ears, psoriasis can lead to scaling and irritation in the ear canal. In the genital area, it can cause red, itchy lesions that may be mistaken for other conditions.

What are the symptoms of psoriasis?

Psoriasis is a chronic autoimmune skin condition with a wide range of symptoms that can vary in severity and presentation. The hallmark symptom of psoriasis is the development of red, inflamed skin lesions that are often covered with silvery white scales. These plaques, as they are commonly called, can appear anywhere on the body but are most frequently found on the elbows, knees, scalp, and lower back. The size and shape of the plaques can vary, from small, localized patches to larger, more extensive areas.

• One of the primary symptoms of psoriasis is intense itching, which can be particularly distressing for those affected. The itching can range from mild to severe and can lead to scratching, which may further irritate the skin and cause bleeding. In addition to itching, individuals with psoriasis often experience a burning or stinging sensation in the affected areas, contributing to their discomfort.

• In some cases, psoriasis can affect the nails, leading to a variety of changes collectively referred to as nail psoriasis. Symptoms of nail psoriasis include pitting (small depressions on the nail surface), discoloration (yellow-brown spots), thickening of the nails, and onycholysis (separation of the nail from the nail bed). These nail changes can be painful and can affect the functionality of the nails.

• Psoriasis can also manifest in the form of pustules, as seen in pustular psoriasis. This type is characterized by the presence of white pustules filled with non-infectious pus, surrounded by red skin. The pustules can be localized or widespread and are often accompanied by symptoms such as fever, chills, and fatigue.

• Erythrodermic psoriasis is a rare and severe form of the disease that leads to widespread redness and inflammation of the skin. The entire body can be affected, resulting in extensive shedding of the skin. This form of psoriasis can disrupt the body's ability to regulate temperature and can be life-threatening, requiring immediate medical attention.

• Individuals with inverse psoriasis experience smooth, red lesions in skin folds, such as the armpits, groin, and under the breasts. These areas are prone to friction and moisture, which can exacerbate the condition and cause discomfort.

• For those with psoriatic arthritis, joint symptoms are a significant aspect of the condition. Psoriatic arthritis causes joint pain, stiffness, and swelling, which can affect any joint in the body. The severity of joint symptoms can vary, from mild discomfort to severe pain and disability. Early diagnosis and treatment are crucial to prevent joint damage and improve quality of life.

What causes psoriasis?

The precise cause of psoriasis remains a topic of extensive research, but it is understood to be a multifactorial disease involving a combination of genetic, immunological, and environmental factors. At its core, psoriasis is an autoimmune disorder where the body's immune system mistakenly attacks healthy skin cells. This abnormal immune response leads to the rapid production and accumulation of skin cells, resulting in the characteristic red, scaly patches seen in psoriasis.

• Genetics play a crucial role in the development of psoriasis. Individuals with a family history of the condition are more likely to develop it, indicating a hereditary component. Researchers have identified several genes associated with psoriasis, including those involved in the regulation of the immune system. Specific genetic variations can predispose individuals to the abnormal immune response that triggers psoriasis. However, having these genetic markers does not guarantee the development of the disease; it merely increases the susceptibility.

• The immune system is central to the pathogenesis of psoriasis. In individuals with psoriasis, T-cells—a type of white blood cell that normally helps protect the body from infections—become overactive and mistakenly target healthy skin cells. This misguided attack prompts an inflammatory response, leading to the rapid turnover of skin cells. Normally, skin cells take about a month to cycle through the layers of the skin, but in psoriasis, this process is accelerated to just a few days. The excess skin cells build up on the surface, forming the thick, scaly plaques characteristic of the condition.

• Environmental triggers also play a significant role in the manifestation and exacerbation of psoriasis. While genetics and immune system dysfunction provide the underlying framework, certain external factors can trigger the onset or worsening of symptoms. Common triggers include infections, particularly streptococcal throat infections, which can provoke guttate psoriasis. Skin injuries, such as cuts, burns, or insect bites, can lead to a phenomenon known as the Koebner response, where new lesions develop at the site of injury. Stress is another well-documented trigger, as it can exacerbate the immune system's response and worsen psoriasis symptoms. Additionally, lifestyle factors such as smoking, excessive alcohol consumption, and obesity can contribute to the severity of the disease.

• Certain medications are also known to trigger or worsen psoriasis. Drugs such as lithium, beta-blockers, and antimalarials have been linked to the onset or exacerbation of the condition. Hormonal changes, such as those occurring during puberty or menopause, can also influence the severity of psoriasis.

Psoriasis Treatment Process

How is psoriasis diagnosed?

Diagnosing psoriasis involves a combination of clinical evaluation, patient history, and, in some cases, diagnostic tests. The process begins with a thorough examination by a healthcare provider, typically a dermatologist, who specializes in skin conditions. During the clinical evaluation, the dermatologist closely examines the skin, nails, and scalp for characteristic signs of psoriasis, such as red, inflamed patches covered with silvery scales. The distribution and appearance of the lesions, along with their location on the body, are key indicators that help differentiate psoriasis from other skin disorders.

• A detailed patient history is an essential component of the diagnostic process. The healthcare provider will inquire about the patient's symptoms, including the duration, severity, and any associated itching or discomfort. They will also ask about any family history of psoriasis or other autoimmune diseases, as genetics play a significant role in the condition's development. Additionally, the provider will review the patient's medical history, including any previous diagnoses, treatments, and responses to therapies. Information about potential triggers, such as recent infections, stress, medications, or skin injuries, can also provide valuable insights.

• In some cases, a skin biopsy may be necessary to confirm the diagnosis. A biopsy involves taking a small sample of the affected skin and examining it under a microscope. This procedure helps rule out other skin conditions that may present with similar symptoms, such as eczema, fungal infections, or lichen planus. The presence of certain histopathological features, such as thickened epidermis, elongated rete ridges, and a dense inflammatory infiltrate, can confirm the diagnosis of psoriasis.

• Laboratory tests may also be conducted to support the diagnosis, particularly when psoriasis is suspected to have systemic involvement or when differentiating it from other conditions. Blood tests can help detect markers of inflammation, such as elevated C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). If psoriatic arthritis is suspected, imaging studies, such as X-rays, ultrasound, or MRI, may be performed to assess joint involvement and damage.

• Differential diagnosis is an important aspect of diagnosing psoriasis, as several other skin conditions can mimic its appearance. Conditions such as seborrheic dermatitis, pityriasis rosea, and nummular dermatitis may present with overlapping symptoms. A comprehensive evaluation by an experienced healthcare provider is crucial to accurately diagnose psoriasis and distinguish it from these other disorders.

Once a diagnosis is confirmed, the healthcare provider will work with the patient to develop an individualized treatment plan. The plan may include topical treatments, phototherapy, systemic medications, or biologics, depending on the type and severity of psoriasis. Regular follow-up visits are essential to monitor the condition, assess treatment efficacy, and make any necessary adjustments.

How is psoriasis treated?

Treating psoriasis involves a multi-faceted approach tailored to the individual's specific needs, taking into account the type, location, and severity of the condition, as well as the patient's overall health and lifestyle. While there is no cure for psoriasis, various treatments can help manage symptoms, reduce inflammation, and improve the quality of life for those affected. 

• Topical treatments are often the first line of defense, especially for mild to moderate cases of psoriasis. These include corticosteroids, which help reduce inflammation and slow the rapid growth of skin cells. Other topical medications, such as vitamin D analogs, retinoids, calcineurin inhibitors, and salicylic acid, work by normalizing skin cell production, reducing scaling, and alleviating itching. Moisturizers are also essential for keeping the skin hydrated and reducing dryness and irritation.

• Phototherapy is another effective treatment option for psoriasis, particularly for those with widespread or difficult-to-treat plaques. This approach involves exposing the skin to controlled amounts of natural or artificial ultraviolet (UV) light. Narrowband UVB therapy, broadband UVB therapy, and PUVA (psoralen plus UVA) are common forms of phototherapy. These treatments help slow down the rapid growth of skin cells and reduce inflammation. Phototherapy is usually administered under medical supervision to minimize potential risks, such as skin damage or an increased risk of skin cancer.

• For individuals with moderate to severe psoriasis or those who do not respond to topical treatments and phototherapy, systemic medications may be prescribed. These medications work throughout the body to target the underlying immune response responsible for psoriasis. Traditional systemic treatments include methotrexate, cyclosporine, and acitretin, which suppress the immune system and help reduce inflammation. These medications can have significant side effects and require careful monitoring by a healthcare provider.

• In recent years, biologic therapies have revolutionized the treatment of psoriasis. Biologics are targeted therapies derived from living cells that specifically target certain components of the immune system. These medications, including tumor necrosis factor (TNF) inhibitors, interleukin (IL) inhibitors, and T-cell inhibitors, work by blocking specific pathways involved in the inflammatory process. Biologics are usually administered by injection or intravenous infusion and are reserved for individuals with moderate to severe psoriasis who have not responded to other treatments.

• Lifestyle modifications also play a crucial role in managing psoriasis. Maintaining a healthy weight, avoiding smoking and excessive alcohol consumption, and managing stress can help reduce flare-ups and improve overall health. Regular exercise and a balanced diet rich in anti-inflammatory foods can support the immune system and promote skin health.

• In addition to medical treatments, supportive therapies such as counseling, support groups, and educational resources can help individuals cope with the psychological and emotional impact of psoriasis. These resources provide valuable information, emotional support, and practical strategies for managing the condition.

Psoriasis complications

Psoriasis is a chronic autoimmune condition that not only affects the skin but can also lead to several complications impacting overall health and quality of life. 

• One of the most significant complications is psoriatic arthritis (PsA), a form of inflammatory arthritis that occurs in up to 30% of people with psoriasis. PsA causes joint pain, stiffness, and swelling, which can lead to joint damage and loss of function if not treated promptly. Early diagnosis and appropriate management are crucial to prevent long-term disability and improve the quality of life for those affected.

• Individuals with psoriasis are also at an increased risk for cardiovascular diseases. Research has shown that the chronic inflammation associated with psoriasis can contribute to the development of conditions such as hypertension, heart attacks, and strokes. This heightened risk is partly due to the systemic nature of the inflammation, which can affect blood vessels and the heart. Maintaining a healthy lifestyle, including regular exercise, a balanced diet, and smoking cessation, can help mitigate these risks.

• Metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke, and diabetes, is more common in people with psoriasis. Components of metabolic syndrome include obesity, insulin resistance, high blood pressure, and abnormal cholesterol levels. The chronic inflammation seen in psoriasis is believed to contribute to the development of metabolic syndrome, further increasing the risk of cardiovascular complications. Managing these risk factors through lifestyle changes and medical interventions is essential for individuals with psoriasis.

• Another significant complication is the impact of psoriasis on mental health. The visible and often painful nature of the condition can lead to feelings of embarrassment, low self-esteem, and social isolation. Depression and anxiety are more prevalent in people with psoriasis, and the psychological burden can be substantial. It is important for healthcare providers to address the mental health needs of individuals with psoriasis, offering support, counseling, and appropriate treatments to improve their overall well-being.

• Psoriasis can also affect the eyes, leading to conditions such as uveitis and conjunctivitis. Uveitis is an inflammation of the middle layer of the eye, which can cause pain, redness, and vision changes. If left untreated, uveitis can result in permanent vision loss. Regular eye examinations and prompt treatment of eye symptoms are essential to prevent complications.

• Additionally, nail psoriasis can cause significant discomfort and functional impairment. Changes in the nails, such as pitting, discoloration, and separation from the nail bed, can make daily activities difficult and increase the risk of secondary infections.

Finally, individuals with psoriasis may experience complications related to their treatments. Long-term use of systemic medications, such as methotrexate and cyclosporine, can lead to liver and kidney damage, increased susceptibility to infections, and other adverse effects. Biologic therapies, while effective, can also pose risks such as increased susceptibility to infections and potential immunogenicity.

How to prevent psoriasis

Preventing psoriasis entirely is currently not possible due to its genetic and autoimmune nature. However, managing and reducing the frequency and severity of flare-ups is achievable through a combination of lifestyle changes, trigger avoidance, and medical intervention. Understanding and implementing these strategies can significantly improve the quality of life for individuals with psoriasis and help maintain skin health.

• Identify and Avoid Triggers: Recognizing and avoiding triggers that can exacerbate psoriasis is crucial. Common triggers include stress, infections, skin injuries, certain medications, and lifestyle factors such as smoking and excessive alcohol consumption. Managing stress through relaxation techniques, such as yoga, meditation, and deep breathing exercises, can help reduce flare-ups. Avoiding skin injuries, such as cuts, burns, and insect bites, can also prevent new lesions from developing. It is essential to inform healthcare providers about psoriasis before starting any new medications to avoid those that may trigger or worsen the condition.

• Maintain a Healthy Lifestyle: Adopting a healthy lifestyle can have a positive impact on psoriasis management. Maintaining a healthy weight is important, as obesity is associated with increased severity of psoriasis and a higher risk of comorbid conditions, such as cardiovascular disease and metabolic syndrome. A balanced diet rich in anti-inflammatory foods, such as fruits, vegetables, whole grains, and lean proteins, can support overall health and reduce inflammation. Regular exercise can also help manage weight, reduce stress, and improve cardiovascular health.

• Skincare Routine: Establishing a gentle skincare routine can help manage psoriasis symptoms and prevent flare-ups. Keeping the skin moisturized is essential to reduce dryness and scaling. Using fragrance-free, hypoallergenic moisturizers can help maintain skin hydration. Avoiding harsh soaps and hot water can prevent skin irritation. Gently patting the skin dry with a soft towel after bathing and applying moisturizer while the skin is still damp can lock in moisture. Additionally, using a humidifier during dry weather can help maintain skin hydration.

• Sun Exposure: Controlled exposure to sunlight can benefit individuals with psoriasis, as ultraviolet (UV) rays can help slow down the rapid growth of skin cells. However, it is essential to avoid excessive sun exposure, which can lead to sunburn and increase the risk of skin cancer. Using sunscreen and seeking shade during peak sun hours can protect the skin while still gaining the benefits of sunlight.

• Regular Medical Check-Ups: Regular check-ups with a healthcare provider, particularly a dermatologist, are essential for managing psoriasis. These visits allow for monitoring the condition, assessing treatment efficacy, and making necessary adjustments to the treatment plan. Early intervention and prompt treatment of flare-ups can help prevent complications and maintain better control over the condition.

Psoriasis Treatment in Iran

Equipped hospitals, and advanced specialized centers with experienced doctors and specialists are available in all medical treatment areas in Iran. Also, good hotels and entertainment centers have made Iran an appropriate choice for patients who need Psoriasis Treatment.

Psoriasis Treatment cost in Iran

The cost of treating psoriasis in Iran can be substantial, reflecting the chronic nature of the disease and the need for ongoing management. The cost of psoriasis treatment in Iran can go up to 500 USD. This cost encompasses various components, including direct medical costs, direct non-medical costs, and indirect costs.