One

Sunday, 25 May 2025

PSORIASIS - UNDERSTANDING AND MANAGING SYMPTOMS

 


Psoriasis is a chronic autoimmune skin condition that causes your skin cells to multiply too quickly, resulting in a buildup of red, scaly patches. These patches can be itchy, painful, and sometimes even bleed. The good news? It’s not contagious—you can’t catch it from someone else. It often shows up on areas like your elbows, knees, scalp, or lower back, but it can appear anywhere on your body.

 

---

 

*Types of Psoriasis -

 

There are several types of psoriasis, each with its own unique symptoms:

 

- **Plaque Psoriasis**: The most common type, featuring raised, inflamed patches covered with silvery-white scales.

- **Guttate Psoriasis**: Small, dot-like spots, often triggered by infections like strep throat.

- **Inverse Psoriasis**: Red, shiny lesions in skin folds (like armpits or under the breasts).

- **Pustular Psoriasis**: White, pus-filled blisters surrounded by red skin.

- **Erythrodermic Psoriasis**: A rare, severe form causing widespread redness and shedding of the skin.

 

---

 

What Causes It?

 

Psoriasis happens when your immune system goes haywire and attacks healthy skin cells by mistake. While the exact cause isn’t fully understood, a few factors play a role:

 

- **Genetics**: If it runs in your family, you’re more likely to develop it.

- **Triggers**: Stress, skin injuries (like cuts or sunburn), infections, and certain medications (like beta-blockers) can set it off or make it worse.

 

---

 

*Treatment Options -

 

There’s no cure for psoriasis, but plenty of treatments can help manage it:

 

- **Topical Treatments**: Creams and ointments like corticosteroids or vitamin D analogs to reduce inflammation and slow skin cell growth.

- **Phototherapy**: Controlled exposure to UV light to calm the immune response.

- **Systemic Treatments**: Pills or injections (like methotrexate or biologics) for more severe cases.

 

The right treatment depends on the type and severity of your psoriasis, so it’s best to work with a dermatologist to figure out what works for you.

 

---

 

*Living with Psoriasis -

 

Psoriasis isn’t just a skin problem—it can affect your whole life. Physically, it can cause discomfort or pain. Emotionally, it might lead to embarrassment, anxiety, or depression. It’s also linked to other health issues like:

 

- **Psoriatic Arthritis**: Joint pain and stiffness.

- **Heart Disease** and **Diabetes**: Increased risk in some cases.

 

*Tips to Manage It:

- Keep your skin moisturized to reduce irritation.

- Avoid triggers like stress, smoking, or harsh soaps.

- Maintain a healthy weight—extra pounds can worsen symptoms.

 

Psoriasis is a lifelong condition, but with the right approach, you can keep it under control. It’s more than skin deep, so don’t hesitate to seek support from a healthcare provider to improve both your skin and your quality of life.

 

*Key Points -

- Psoriasis is a chronic skin condition causing red, scaly patches, likely due to an overactive immune system.

- It seems likely that genetics and triggers like stress or infections play a role, though research is ongoing.

- Treatment options include creams, light therapy, and medications, with new options like roflumilast foam approved in 2025.

- The evidence leans toward psoriasis being manageable but not curable, with varying severity and impact on quality of life.

 

---

 

*What is Psoriasis?

Psoriasis is a long-term skin condition where the immune system causes skin cells to multiply too quickly, leading to thick, red, and scaly patches. These patches can be itchy or sore and often appear on the elbows, knees, scalp, or lower back. It’s not contagious, and while it can affect anyone, it’s most common in adults aged 20–30 or 50–60.

 

---

 

*Causes and Triggers -

Research suggests psoriasis is an autoimmune disease, where the body’s immune system attacks healthy skin cells. Genetics seem to play a role, as it often runs in families, and triggers like stress, skin injuries, infections (e.g., strep throat), or certain medications can worsen symptoms.

 

---

 

*Treatment Options -

Treatments aim to manage symptoms and include:

- **Topical treatments**: Creams like corticosteroids to reduce inflammation.

- **Phototherapy**: UV light exposure to calm the immune system.

- **Systemic treatments**: Pills or injections for severe cases, such as biologics.

- In 2025, new treatments like roflumilast foam were approved for plaque psoriasis, offering more options for patients.

 

---

 

---

 

Comprehensive Overview of Psoriasis -

 

Psoriasis is a chronic, non-contagious autoimmune skin condition characterized by the rapid buildup of skin cells, leading to the formation of thick, red, and scaly patches. These patches, often covered with silvery-white or gray scales, can appear on various parts of the body, most commonly the elbows, knees, scalp, and lower back. The condition affects approximately 2% of people in the UK and 7.5 million adults in the US, with symptoms typically starting between ages 15 and 25, though it can begin at any age. It impacts men and women equally and varies in severity, from minor irritation to significant quality-of-life challenges.

 

*Types of Psoriasis -

Psoriasis manifests in several forms, each with distinct features:

 

- **Plaque Psoriasis**: The most prevalent type, accounting for about 90% of cases, presents as raised, red patches with silvery-white scales. On lighter skin, these appear red with white scales; on medium skin tones, they may be coral or salmon-colored with silvery-white scales; and on darker skin tones, they can be dark brown or purplish with gray scales.

- **Guttate Psoriasis**: Characterized by small, drop-shaped lesions, often triggered by infections like strep throat.

- **Inverse Psoriasis**: Appears as smooth, red patches in skin folds, such as the armpits or groin, without the typical scaling.

- **Pustular Psoriasis**: Features white, pus-filled blisters surrounded by red skin, commonly on the hands and feet, and is non-infectious.

- **Erythrodermic Psoriasis**: A rare, severe form causing widespread redness and shedding of the skin, which can be life-threatening.

 

It’s possible to have more than one type simultaneously or experience different types over a lifetime, with treatment varying based on the type and location.

 

*Causes and Triggers -

Psoriasis is classified as an immune-mediated disease, where the immune system mistakenly attacks healthy skin cells, causing inflammation. The underlying mechanism involves the immune system reacting to skin cells, leading to their rapid multiplication and shedding every 3–4 days, compared to the normal 10–30 days. While the exact cause is not fully understood, research suggests a combination of genetic and environmental factors:

 

- **Genetics**: If one identical twin has psoriasis, the other is three times more likely to be affected than if they were non-identical, indicating a strong genetic predisposition. It often runs in families, with studies showing a hereditary component.

- **Triggers**: Various factors can exacerbate or trigger psoriasis, including:

  - Stress, which can worsen symptoms due to its impact on the immune system.

  - Skin injuries, such as cuts, burns, or sunburn, known as the Koebner phenomenon, where psoriatic changes appear at the injury site.

  - Infections, particularly streptococcal infections, which can trigger guttate psoriasis.

  - Medications like beta-blockers, NSAIDs, and lithium, which may worsen the condition.

  - Lifestyle factors, such as smoking, obesity, and excessive alcohol consumption, are also linked to increased severity.

 

Symptoms often worsen during winter, possibly due to reduced sunlight exposure, and can fluctuate, with periods of flare-ups followed by remission.

 

*Symptoms and Impact -

The symptoms of psoriasis can vary widely but commonly include:

- Red, pink, or purple patches of skin, depending on skin tone, covered with scales that may be silvery-white, gray, or darker brown.

- Dry, cracked skin that may bleed, especially if scratched.

- Itching, burning, or soreness, which can be particularly distressing.

- Thickened, pitted, or ridged nails, affecting most people at some point.

- In severe cases, joint pain and stiffness, indicative of psoriatic arthritis, which affects about 30% of psoriasis patients.

 

Psoriasis is more than a skin condition; it can significantly impact emotional well-being, leading to embarrassment, anxiety, or depression. It’s also associated with increased risks of other health issues, such as heart disease, diabetes, and inflammatory bowel disease, due to chronic inflammation.

 

*Diagnosis -

Diagnosis is typically based on the appearance of the skin and medical history, with no specific tests required. Dermatologists may perform a biopsy in unclear cases to rule out other conditions like eczema. The Psoriasis Area and Severity Index (PASI) is often used to assess severity, considering the extent of redness, thickness, and scaling.

 

*Treatment Options -

While there is no cure for psoriasis, a range of treatments can manage symptoms and improve quality of life. The choice depends on the type, severity, and individual patient factors:

 

- **Topical Treatments**: These are often first-line for mild psoriasis and include:

  - Corticosteroids, such as hydrocortisone, to reduce inflammation and itching.

  - Vitamin D analogs, like calcipotriol, to slow skin cell growth.

  - Retinoids, derived from vitamin A, to normalize skin cell production.

  - Salicylic acid to remove scales and smooth the skin.

 

- **Phototherapy**: Involves controlled exposure to UV light, either UVB or UVA, often combined with psoralen (PUVA therapy). It helps calm the immune response and is effective for moderate psoriasis.

 

- **Systemic Treatments**: Used for moderate to severe cases, these include:

  - Oral medications like methotrexate, which suppresses the immune system, or cyclosporine, an immunosuppressant.

  - Biologics, such as adalimumab (Humira) or etanercept (Enbrel), which target specific parts of the immune system, particularly TNF-alpha or IL-17/IL-23 pathways. As of recent reports, there are over 13 FDA-approved biologic options for moderate to severe psoriasis.

 

- **Emerging Treatments in 2025**: The landscape of psoriasis treatment is evolving, with several new options showing promise:

  - **Roflumilast Foam (Zoryve)**: Approved by the FDA on May 22, 2025, for plaque psoriasis in adults and adolescents aged 12 and older, particularly for scalp and body psoriasis. It’s a topical foam already approved for other uses, offering a new option for topical treatment.

  - **Icotrokinra**: A first-in-class oral peptide that selectively blocks the IL-23 receptor, showing potential to set a new standard in plaque psoriasis treatment, with positive results reported in early 2025.

  - **AC-201**: A selective TYK2/JAK1 inhibitor from Accropeutics, with phase 2 results showing 74% of patients achieving PASI-75 at 50 mg twice daily, indicating strong efficacy.

  - **AX-158**: Artax Biopharma’s phase 2a results for plaque psoriasis were presented at SID2025, suggesting another potential treatment option.

  - **Tildrakizumab**: Demonstrated efficacy for nail psoriasis, with significant improvements in clinical scores at week 28, as reported at AAD 2025.

  - **Imsidolimab**: Vanda Pharmaceuticals added this anti-IL-36 antibody to its late-stage portfolio for Generalized Pustular Psoriasis (GPP), with plans for marketing approval.

  - Additionally, a light-activated drug, MRS7787, showed promise in modulating the immune system for psoriasis treatment, with studies published in early 2025.

 

These advancements, particularly in biologics, small molecules, and personalized medicine, are reshaping psoriasis management, offering patients more tailored and effective options.

 

*Living with Psoriasis -

Managing psoriasis involves more than medical treatment; lifestyle adjustments can significantly impact symptom control:

- **Skin Care**: Regular moisturizing helps reduce dryness and irritation. Avoid harsh soaps and hot water, which can exacerbate symptoms.

- **Trigger Management**: Identifying and avoiding triggers, such as stress (e.g., through mindfulness or therapy) or smoking, can help prevent flare-ups.

- **Healthy Lifestyle**: Maintaining a healthy weight is crucial, as obesity can worsen psoriasis. A balanced diet rich in anti-inflammatory foods, like omega-3 fatty acids, may also help.

- **Support and Mental Health**: The emotional toll of psoriasis can be significant, with many experiencing embarrassment or anxiety. Support groups, counseling, or connecting with others via platforms like the National Psoriasis Foundation can provide relief.

 

Psoriasis is also linked to comorbidities, such as psoriatic arthritis (affecting joints), cardiovascular disease, and diabetes, necessitating regular health check-ups to monitor for related conditions.

 

*Research and Future Directions -

The field of psoriasis research is active, with ongoing studies exploring the role of the microbiome, epigenetics, and novel therapeutic targets. The 2025 advancements, such as the approval of roflumilast foam and promising results for Icotrokinra and AC-201, indicate a trend toward more targeted and patient-friendly treatments. Patient-reported outcomes and long-term safety data, like the five-year results for Sotyktu (deucravacitinib), are also shaping treatment guidelines.

In summary, psoriasis is a complex, chronic condition with a range of treatment options, from traditional topicals to cutting-edge biologics and new approvals in 2025. While it remains incurable, the evolving landscape offers hope for better management and improved quality of life for those affected.

 

---

 

No comments:

Post a Comment