1) What is psoriasis? What causes psoriasis? Is it hereditary or an outcome of
Psoriasis is a chronic, disfiguring, inflammatory and proliferative condition of
the skin in which both genetic and environmental influences are present and is
characterized by red, scaly, sharply demarcated, indurated plaques, present
particularly over the back of the elbows and front of the knees and scalp.
Type 1 psoriasis appears to have a strong hereditary element given its
association with early onset and positive family history (41% if both parents are
affected, 14% if one parent is affected, 6% if one sibling is affected and 2% if no
sibling or parent is affected).
However environmental factors such as sunlight, trauma, drug intake,
infections, emotional stress, alcohol and smoking do act as aggravating factors.
2) How can one prevent psoriasis?
Psoriasis is an autoimmune disease caused by multiple factors. There are no
specific vaccines to prevent this disease and it is also difficult to predict who
can develop psoriasis. However at the earliest development of symptoms of
the disease, timely intervention could prevent progression and development of
other medical conditions.
3) What can a psoriatic patient do to prevent the condition from flaring up?
Psoriasis is a chronic condition with remissions and exacerbations. However,
prolonged remission can be obtained by:
Taking adequate steps to avoid physical, chemical, electrical, surgical
trauma, streptococcal infections (for guttate psoriasis), Metabolichypocalcemia (calcium deficiency), sunlight, drugs (antihypertensives like
beta blockers, anti-malarials like chloroquine, pain killers,
antipsychotics), alcohol, smoking, emotional stress, obesity
Regular use of moisturisers
4) Can psoriasis spread through touch? Is it lifelong?
Psoriasis does not spread through touch or sharing of clothes, food and bed.
It is a life-long condition. Guttate psoriasis (a type of psoriasis), however, has
good prognosis and often runs a self-limited course. Other types of psoriasis
like erythrodermic and pustular psoriasis typically have a bad prognosis. Early
onset and a family history of psoriasis are also considered bad prognostic
5) What are the available treatment options for psoriasis?
A. Depending on the severity of the condition:
B. Topical – Coaltar, Keratolytics (salicylic acid), Corticosteroids, Vitamin D
C. Systemic –Methotrexate, Retinoids, Mycophenolic Acid
D. Phototherapy – Narrow band 311 nm, 308 nm excimer laser
E. Biologicals – The use of biologicals like Etanercept, Infliximab,
Adalimumab is finding greater acceptance over other systemics as it
ensures better efficacy and longer remission without significant systemic
side effects. If you qualify for this treatment, a doctor would do the
necessary investigations to put you on this therapy. Biologics find its use
among chronic patients with psoriasis affecting their bones and nails.
However, at present these drugs are expensive. More recently an Indian
company has launched a new biologic, Itolizumab, which is a ‘first-inclass’ novel antibody therapy and claims to have an excellent safety and
efficacy profile with much longer remission periods. This could be a
promising therapy for patients suffering from Chronic Plaque Psoriasis.
6) Allopathy, Homeopathy, Ayurveda, Biologics – which among these offer
the best treatment for psoriasis?
Biologics are specifically tailored to inhibit only a targeted portion of the
immune system and are believed to result in a more favorable side-effects
profile, thus providing an effective and safe alternative choice for treatment.
However the disadvantage is the cost involved. Any system of medicine –
Homeopathy, Ayurveda, Unani – could work for psoriasis, provided a patient
responds to that particular treatment and the treatment is genuine,
authenticated and properly administered. Caution should be exercised as these
medicines could be fortified with corticosteroids which are known to flare up
and worsen psoriasis.
The responses are from Dr. B.S. Chandrashekhar, Chief Dermatologist, Cutis
Address: 5/1, Behind Godrej Interior, Near Veeresh Theatre, 4th Main, MRCR
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