Why Skin Gets Psoriasis? Dr. Badran Answers

Psoriasis is a genetic skin disease associated with the immune system. Psoriasis is not contagious, according to Dr. Magdy Badran.

It is characterized by itchy scales, inflammation, and redness. It usually occurs on the scalp, knees, elbows, hands, and feet.

Psoriasis is an Autoimmune Disease

Your immune system causes your skin cells to reproduce too quickly. A normal skin cell matures and falls off the body's surface in 28 to 30 days.

However, skin affected by psoriasis takes only three to four days to mature and move to the surface. Instead of falling off (shedding), the cells pile up and form lesions. The skin also becomes very red due to increased blood flow.

Psoriasis is an autoimmune disease. Immune cells in the blood mistakenly recognize newly produced skin cells as foreign invaders and attack them.

This can cause the overproduction of new skin cells beneath the surface of the skin. The new cells migrate to the surface and force out existing skin cells. That causes the scales, itching, and inflammation of psoriasis.

Genetics

Psoriasis, a chronic and inflammatory skin disease, is considered a hereditary condition. Genetics almost certainly plays a role. Having a family member with the disease increases the risk.

Around 10% of the population inherit one or more of the genes that increase the chance of developing psoriasis. However, only 2–3% of the population will develop it.

If one of your parents has psoriasis, you have about a 10 % chance of getting it. If both of your parents have psoriasis, your risk is 50 percent. About one-third of people diagnosed with psoriasis have a relative with psoriasis.

The reason that some people with the genetic features do not develop psoriasis is that: they may not have the right collection of genetic features or they may not have had exposure to specific environmental triggers.

This suggests that both environmental triggers and genes play a role in whether a person will develop psoriasis.

Environmental Factors

Many genes must interact for psoriasis to develop. In addition to genes, a person’s immune system plays a role in psoriasis risk. If you have the genes for psoriasis, you need to be exposed to a trigger for it to develop.

Environmental factors that may trigger a psoriasis onset or flare-up include stress, cold and dry weather, a severe sunburn, HIV infection, drugs such as lithium, beta-blockers, and antimalarials or withdrawal of corticosteroids. Infections, especially strep throat in young people, is reported as a trigger for psoriasis onset.

Injury or trauma to a portion of the skin may sometimes become the site of a psoriasis flare-up.

In one study of women with psoriasis, about 10% of the participants had also developed an inflammatory bowel disease like Crohn’s disease or ulcerative colitis.

Psoriasis and Obesity

Evidence is strongly suggestive that obesity through pro-inflammatory pathways predisposes to the development of psoriasis and that obesity aggravates existing psoriasis.

In recent decades, the prevalence of immune-mediated diseases in industrialized nations has been increasing and also there is evidence that the epidemiology of psoriasis seems to be changing.

A 2009 US study demonstrated that the incidence of psoriasis among adults had almost doubled between the 1970s and 2000. Given the fact that the genetic basis has remained constant, awareness is increasing that factors in the environment including the Western lifestyle play a major role in this growing prevalence.

The dietary habits in industrialized nations promote high-fat, high-salt, high-sugar diets with excess caloric intake resulting in an obesity epidemic.

The possible link between autoimmunity and obesity has become even more relevant since the discovery that white adipose tissue is not just an inert energy storage tissue.

It is now known that adipose tissue is an essential endocrine organ secreting a wide range of soluble mediators involved in immunity, inflammation, and metabolic and appetite regulation.

The soluble mediators released from white adipose tissue possess pro-inflammatory actions and contribute to the low-grade inflammatory state in obese inpiduals.

This pro-inflammatory state, generated by obesity, may be a key factor in the association between adiposity and inflammatory/autoimmune.

In psoriasis, epidemiological evidence is increasing and suggests that patients may be more adipose compared to inpiduals without psoriasis. The immunological mechanisms in psoriasis and obesity show considerable overlap.

Numerous mechanisms may be involved in explaining the link between psoriasis and obesity. Patients with psoriasis may have a higher risk of social isolation, poor eating habits, depression, decreased physical activity and increased alcohol consumption.

Cigarettes and Alcohol Affect Psoriasis

Smokers with a family history of psoriasis increase their risk as much as nine times. Smoking and alcohol use increase the risk of developing psoriasis and may make the disease significantly worse.

Smoking affects the onset of psoriasis and its clinical appearance. Smoking doubles a person's risk of getting psoriasis; the risk increases with the number of cigarettes smoked per day and is higher in women than men.

The risk for women who smoke more than 20 cigarettes per day is about 2.5 times greater than the rate of nonsmokers, and in men, the risk is about 1.7 times greater than the rate of nonsmokers.

Studies have also found a very strong association between smoking and palmoplantar pustulosis. Smoking and alcohol may also be associated with the same psychosocial factors that may drive psoriases, such as stress, worry, and poor coping skills.

Alcohol can have dangerous side effects when combined with certain psoriasis medications, such as methotrexate or acitretin in women of child-bearing potential.

Psoriasis Symptoms

Dry, thick, and raised patches on the skin are the most common sign of psoriasis. These patches are often covered with a silvery-white coating called scale, and they tend to itch.

The cracked skin may bleed. Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission.

These symptoms can have a physical and emotional impact on a person and affect their quality of life.

Types of Psoriasis

Plaque psoriasis is the most common form. It causes dry, raised, red skin lesions (plaques) covered with silvery scales.

The plaques might be itchy or painful and there may be few or many. They can occur anywhere on the body, including genitals and the soft tissue inside the mouth.

Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth, and discoloration. Psoriatic nails might loosen and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble. Around 80% of people with psoriatic arthritis develop nail changes.

Guttate psoriasis, this type primarily affects young adults and children. It's usually triggered by a bacterial infection such as strep throat. It's marked by small, water-drop-shaped, scaling lesions on your trunk, arms, legs, and scalp.

Inverse psoriasis, this mainly affects the skin in the armpits, in the groin, under the breasts, and around the genitals.

Inverse psoriasis causes smooth patches of red, inflamed skin that worsen with friction and sweating. Fungal infections may trigger this type of psoriasis.

Pustular psoriasis, this uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or smaller areas on your hands, feet or fingertips. It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently.

Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.

Psoriatic arthritis, in addition to inflamed, scaly skin, psoriatic arthritis causes swollen, painful joints that are typical of arthritis. Symptoms range from mild to severe, and psoriatic arthritis can affect any joint.

Sometimes the joint symptoms are the first or only manifestation of psoriasis or at times only nail changes are seen.

Tips for Psoriasis Skin Care

If you don't smoke, don't start. If you do smoke, consider stopping—you may have a higher likelihood of remission. Don't drink. Psoriasis may improve with weight loss.

Focus on positive, healthy ways to cope with stress and anxiety—try meditation, counseling, adequate sleep, healthy diet, and exercise.

Keep your skin moist. It can help your skin heal and reduce dryness, itching, redness, soreness, and scaling.

Avoid harsh products like lotions with alcohol, deodorant soaps, acids, and some laundry soaps. Choose your moisturizer based on how dry your skin is.

Ointments are thick, heavy, and good at locking in moisture. Lotions are thinner and get absorbed more easily. Or, you can pick a cream that falls somewhere in between.

After your bath or shower is a good time to gently pat on the lotion. Reapply throughout the day and when you change clothes. Use more on cold or dry days.

Try not to scratch and pick. Keep your nails short. Take an antihistamine if you are itchy. A daily warm bath using a mild soap can help soothe itchy spots and remove dry skin.

Hot temperatures and harsh soaps can be hard on the skin that's already sensitive. Take 15 minutes to soak in the warm water. Try not to rub your skin with the towel as you dry off.

The ultraviolet light in sunlight can slow the growth of skin cells, so small doses of the sun can be a good way to soothe, improve, and even heal psoriasis lesions.