Psoriasis is an inflammatory skin condition with abnormal epidermal cell proliferation and differentiation. The lesions of psoriasis result from an increase in the cell proliferation of the skin. Usually, new cells develop and reach the surface area in 28 days. In psoriasis, this time is reduced to 3-4 days. These rapid growing cells accumulate at the surface and account for the appearance of a white or silver colored scale since the rapid kinetics does not allow time to shed.
Psoriasis is considered an auto immune disease. There is currently no cure.
Psoriasis is not infectious from person to person.
Psoriasis is an erratic condition with unpredictable flare ups and remissions.
Psoriasis tends to improve during the summer months. This is felt to be due to the positive influence of the sunlight on the skin.
Factors that adversely influence psoriasis;
- Alcohol- Overindulgence has been reported the cause flare ups of this disease.
- Physical trauma-Burns, surgery and infections can cause flare ups.
- Sunlight- Although the vast majority of patients find sunlight to be of benefit, it can cause flare ups in others.
- Drugs- Beta blockers, angiotensin converting enzyme inhibitors, antimalarials, lithium.
(NSAIDs can also exacerbate psoriasis.)
Psychosocial problems
Because of the poor self -image patients with psoriasis can exhibit, there can be social isolation, depression, drug use, alcoholism and suicidal ideation.
Common Symptoms
- Plaques of red silvery skin that are scale like in nature. They can be extremely itchy and painful.
- Plaques can grow and merge into large areas of disease.
- Plaques can fissure and bleed.
- When nails are involved, there can be discoloration, crumbling and often nails can detach from the nail bed.
- The scalp will get crusty patches.
The National Psoriasis Foundation estimates that 10% to 30% of patients with psoriasis develop an arthritis called Psoriatic Arthritis
Other types of psoriasis include:
- Guttate psoriasis- which causes small tear drop shaped red lesions starting on the trunk. Often seen in childhood and thought to be triggered by strep infections and tonsilitis. This can also be seen in stress, and use of medications such as beta- blockers and anti-malaria medicines.
- Pustular psoriasis- pustules appear on the soles of the feet and palms of the hand.
- Inverse psoriasis- seen in the skin folds with bright red lesions commonly armpits, groin and under breasts.
- Erythrodermic psoriasis- causes shedding of the fiery red skin in sheets. This is severe and can develop into severe illness.
Common Triggers for flare up
- Infections such as strep throat or other skin infections B. Weather especially cold dry winter like conditions.
- Smoking or exposure to second hand smoke.
- Injury to the skin such as a bite, cut, scrape or sunburn E. Rapid withdrawal of corticosteroids
Risk Factors
- Anyone can develop this condition.
- About 33% start in childhood.
- Although not genetic this condition runs in families High Stress increases the risk.
- Smoking increases the risk of psoriasis.
Diseases associated with psoriasis
- Obesity
- Type 2 Diabetes
- High Blood Pressure
- Eye conditions such as conjunctivitis, blepharitis
- Other auto-immune diseases such as Crohns Disease and Inflammatory Bowel Diseases F. Mental Health problems
Treatments
The type and severity of psoriasis dictates the treatment. Usually ,topicals and ultra violet light treatments are the traditional starting therapies. However, Pustular and Erythrodermic Psoriasis or Psoriatic Arthritis need stronger systemic therapies.
Topical Therapies
- Corticosteroid topicals- Topicals are usually the primary starting therapy for treatment. Corticosteroids can thin the skin and over time may stop working altogether.
- Retinoids- Most common problem is skin irritation and light sensitivity ,cannot be used in pregnancy.
- Vit D- synthetic forms used to slow growth of the skin.
- Coal Tar- can irritate the skin also smelly and can stain clothes. Cannot be used in pregnancy.
- Salicylic Acid- used to reduce the scaling.
- Calcineurin inhibitors- cannot be used in pregnancy.
- Anthralin- another coal tar product can irritate, cannot be used on the face or genital area.
(Above products can be used alone or in combination.)
Light Therapy
This involves exposing the skin to controlled amounts of natural and artificial light.
- Sunlight
- UVA
- UVB
- Laser therapy
Orals
These medicines have significant side effects and usually cannot be taken in pregnancy, breast feeding or intent to become pregnant.
- Steroids- usually injected into the lesion.
- Methotrexate- Can cause liver or blood problems loss of appetite fatigue and stomach upset common, must be stopped for both men and women 3 months before attempting to conceive.
- Retinoids- side effects dryness and muscle soreness.
- Cyclosporine- this suppresses the immune system increases risk of infection and multiple health problems including cancer. Problems with kidneys and blood pressure E. Biologics- these drugs are extremely expensive and suppress the immune system increasing risk of infections.
Platelet Rich Plasma
Platelet Rich Plasma is an autologous concentration of blood derived products. It contains growth factors that promote healing and tissue repair.
Three recently published articles;
- Progress in the Use Of Platelet Rich Plasma in Aesthetic and Medical Dermatology
J Clin Aesthet Derm 2020Aug: 13(6) 28-35 PMID 33178379
Patients with chronic plaque psoriasis treated with intra dermal PRP and methotrexate showed significant improvement in erythema, induration and desquamation at each visit compared to patients treated with methotrexate alone. At week 16 of this study all patients in the combination group achieved a Psoriasis Area Severity Index or greater than 50 up to 90. None of the patients in the methotrexate monotherapy group achieved a 50. - Can Platelet-Rich-Plasma Reduce the Burden of Inflammatory Skin Diseases Such as Psoriasis and Atopic Dermatitis?
Cureus 2021 Oct 4;13(10):e18472 PMID 3454637
A total of 30 patients were treated for plaque psoriasis. At follow up 12 weeks after trteatment 80% achieved complete remission and 20% reached a Psoriasis Area Severity Index of 70%. In all cases the lesion size decreased. No adverse events were reported and the conclusion revealed encouraging results.
- Clinical Efficacy of Platelet Rich Plasma in combination with Methotrexate in Chronic Plaque Psoriasis Patients
Dermatol Ther 2016 Nov;29(6): 446-450 PMID 27418241
Patients treated with PRP/Mtx showed substantial improvement and cleared off psoriasis at week 16.
Juventix Regenerative Medical produces a FDA approved plasma harvesting kit that is economical and is proven to provide reproducible results. Since Platelet Rich Plasma is an autologous product there are no side effects, no allergic reactions. Platelet Rich Plasma can be used with confidence in almost all patients with few exclusions. In the world, 125 million people are suffering with psoriasis, Juventix can provide a safe effective alternative to the treatment of these patients.
Restore, Revive Regenerate, Juventix Regenerative Medical.
Regenerative Regards,
Dr. Robert McGrath
