Psoriasis

Psoriasis

Q) What is Psoriasis?
Psoriasis is a common, genetically determined, inflammatory and hyperproliferative skin disease. It presents thick plaques with silvery scales.

Q) Is there any genetic basis of Psoriasis?
Although specific abnormality is not detected but certain genes determine the inheritance. Not all patients have a family history but the clinical expression depends on the external factors.

Q) If one of my relatives have Psoriasis, how much chance do I have to get Psoriasis?
5% of the patients have an affected first-degree relative. There is a 16% incidence of a sibling having Psoriasis or a single parent is affected. If both parents are affected, then the risk increases to 50%.

Q) What are the different types of Psoriasis?
The types can be divided into morphological or locational variants.

(A) Morphological variants are

a) Chronic plaque psoriasis
b) Guttate Psoraisis
c) Pustular Psoriasis
d) Erythrodermic Psoriasis
e) Psoriatic arthritis

(B) Locational variants are

a) Scalp Psoriasis
b) Palmoplantar Psoriasis
c) Inverse Psoriasis
d) Nail Psoriasis

Q) What triggers psoriasis?
Psoriasis triggers are not universal. Established psoriasis triggers include:

1. Stress
Stress can cause psoriasis to wake away for the first time or aggravate existing psoriasis.
Injury to skin
Psoriasis can be seen in areas of the skin that have been injured or traumatized. This is called the Koebner phenomenon.

2. Drugs
Certain medications can trigger or exacerbate psoriasis
a) Lithium
b) Antimalarials
c) Quinidine: This heart medication has been reported to worsen some cases of psoriasis.
d) NSAIDS
e) Oral Corticosteroids

Q) Are there any non- skin related changes in Psoriasis?
Psoriasis is associated with other medical and psychiatric comorbidities. Patients with Psoriasis have a higher incidence of Diabetes, cholesterol and heart disease. Emotional distress may have a further negative impact and may sometimes lead to depression.

Q) What are the nail findings in Psoriasis?
They are found in 25 to 50% of the patients include pitting, onycholysis, subungual hyperkeratosis, and nail deformity.

Q) Is psoriasis curable?
There is no cure for psoriasis but the condition can be improved with the use of treatment. Psoriasis can relapse if treatment is stopped.

Q) What are the main topical treatments used for psoriasis?
A) Emollients work by moisturizing dry skin, reducing scaling and relieving itching. They soften cracked areas and help the topical treatment to penetrate the skin and work more effectively.
b) Topical steroids reduce skin inflammation and are of varying potency. The strength of ointment is decided by the site involved. Mild topical steroids are preferred on the face or in skin folds for short courses. Stronger topical steroids are used on thickened plaques of psoriasis such as the palms and soles.

Tar preparations have been used to treat psoriasis for many years. They help in reducing scaling and slow the skin overgrowth that occurs in psoriasis. Tar preparations include bath oils, creams, ointment, and shampoos.


Vitamin D analogs help regulate the immune system in the skin and reduce the hyperproliferation of skin in psoriasis. They are not usually prescribed during pregnancy, breastfeeding and can irritate sensitive skin areas such as the face and skin folds.

Q) What are the main topical treatments used for scalp psoriasis?
People with chronic plaque psoriasis often have lesions on the scale ranging from mild scaling to extensive plaques with thick adherent scaling. This could be difficult to treat and usually needs a lot of combination of different topical agents. Medicated shampoo which contains coal tar derivatives and ingredients to remove skin scales can be helpful to manage scalp scaling in mild psoriasis. Topical steroids are often used to manage scalp psoriasis. Vitamin D analogs are helpful.

Q) What systemic drugs are used in the treatment?
Methotrexate – It inhibits dihydrofolate reductase and suppresses DNA synthesis. Side effects include hepatotoxicity, bone marrow suppression.
Cyclosporine- It has a rapid onset of action but long term side effects limit their usage. Systemic retinoids suppress epidermal hyperproliferation and don't suppress immunity. Last but not the least biologicals can be used and the latter is promising longer remission period.

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