Introduction
Psoriasis is a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales. These patches normally appear on elbows, knees, scalp and lower back, but can appear anywhere in the body. Most people are only affected with small patches. In some cases, the patches can be itchy or sore. Psoriasis affects around 2% of people in the UK. It can start at any age, but most often develops in adults under 35 years old, and affects men and women equally. The severity of psoriasis varies greatly from person to person. For some it’s just a minor irritation, but for others it can majorly affect their quality of life. Psoriasis is a long-lasting (chronic) disease that usually involves periods when you have no symptoms or mild symptoms, followed by periods when symptoms are more severe. It is considered as an auto-immune disease by a majority of experts.
Signs and symptoms
Chronic erythematous scaly rashes on skin
Sudden onset of many small areas of scaly redness
Pain (especially in erythrodermic psoriasis and in some cases of traumatized plaques or in the joints affected by psoriatic arthritis)
Pruritus (especially in eruptive, guttate psoriasis)
Afebrile (except in pustular or erythrodermic psoriasis, in which the patient may have high fever)
Dystrophic nails, which may resemble onychomycosis
Long-term, steroid-responsive rash with recent presentation of joint pain
Joint pain (psoriatic arthritis) without any visible skin findings
Conjunctivitis or blepharitis
Causes
Psoriasis involves hyperproliferation of the keratinocytes in the epidermis, with an increase in the epidermal cell turnover rate. The cause of the loss of control of keratinocyte turnover is unknown. However, environmental, genetic, and immunologic factors appear to play a role.
- Environmental factors – Many factors besides stress have also been observed to trigger exacerbations, including cold, trauma, infections (eg, streptococcal, staphylococcal, human immunodeficiency virus), alcohol, and drugs (eg, iodides, steroid withdrawal, aspirin, lithium, beta-blockers, botulinum A, antimalarials).
- Genetic factors – Patients with psoriasis have a genetic predisposition for the disease. The gene locus is determined. Psoriasis is associated with certain human leukocyte antigen (HLA) alleles.
- Immunologic factors – Evidence suggests that psoriasis is an autoimmune disease. Studies show high levels of dermal and circulating TNF-α.
Pathophysiology
People with psoriasis have an increased production of skin cells. Skin cells are normally made and replaced every 3 to 4 weeks, but in psoriasis this process only takes about 3 to 7 days. The resulting build-up of skin cells is what creates the patches associated with psoriasis. Although the process is not fully understood, it’s thought to be related to a problem with the immune system. The immune system is body’s defence against disease and infection, but it attacks healthy skin cells by mistake in people with psoriasis. Psoriasis can run in families, although the exact role genetics plays in causing psoriasis is unclear. Many people’s psoriasis symptoms start or become worse because of a certain event, known as a trigger. Possible triggers of psoriasis include an injury to skin, throat infections and using certain medicines.
Diagnosis
Clinical examination
Skin biopsy
Routine blood tests
X-Rays
Treatments
Topical treatment, such as vitamin D analogues or topical corticosteroids in the form of creams and ointments.
If these are not effective, or condition is more severe, a treatment called phototherapy may be used. Phototherapy involves exposing skin to certain types of ultraviolet light.
In severe cases, where the above treatments are ineffective, systemic treatments may be used. These are oral or injected medicines that work throughout the whole body.
Prognosis
There’s no cure for psoriasis, but a range of treatments can improve symptoms and the appearance of skin patches.
Complications
- Secondary infections
- Possible increased risk of lymphoma
- Possible increased risk of cardiovascular and ischemic heart disease
- Psoriatic arthritis
- Mitral valve prolapse
- Possibly inflammatory bowel disease
Disease & Ayurveda
Ekakushtha/ ekakushtha
Nidana
Unwholesome diet with opposite potency
Improper routine and behaviour
Teasing and humiliating other good people
Theft
Bad deeds which cause emotional stress factors like repentance/fear/anxiety
Kapha- Vaatadoshakopanidana – causes for vitiation of the kapha dosha and Vaatadosha
Purvaaroopa
Absence of sweating
Loss of tactile sensation
Samprapti
Due to the causative factors, vitiated doshas (mainly kapha) vitiate rasadhatu and reaches skin and develop into scaly rashes.
Lakshana
Absence of sweating
Big lesions resembling scales of fish
Lesions are scattered all over the body or head
Skin resembles the skin of elephant
Itching may be present
Divisions
Not mentioned
Prognosis
Yaapya in most cases
Asaadhya in chronic & complicated cases
Chikithsa
Treatment of eka/charmakushtha is alleviating the vitiated Kapha and Vaata doshas. It should be done accordingly in each case. If the lesions are wet/oily and swelling is present, kaphadoshahara treatment should be done. If the lesions are dry & flaky, with dark discolouration, Vaatadoshahara treatment should be administered. Other factors like body constitution, age, physical and mental strength of patient, digestion, season etc. also should be considered while treating the kushtha.
Samana
kshalana – washing with kashayas like aragwadhadikwatha or triphalakwatha
lepana – applying external medicines like kasamardalepa, chakramardadi lepa, aragwadhadi lepa etc.
Sodhana
Vamana with madanaphalakwatha
Virechana with erandatailam, or avipathi choornam
Kashayavasti
Snehavasti
(Vasti is especially beneficial in psoriatic arthritis)
Commonly used medicines
Aragwadhadi kwatham
Amrutavrishapatoladi kwatham
Avipathi choornam
Nimbamruthadi erandam
Manjishtadi Kashayam
Gandhak Rasayan
Rasasindhooram
Rasagandhi Mezhu
Arogyavardhini Vati
Brands available
AVS Kottakal
SNA Oushadhasala
Vaidyaratnam oushadhasala
AVP Coimbatore
Home remedies
No home remedy is there to completely cure psoriasis. But herbs that can help the discomforts of the disease includes the following:
Turmeric
Aloe vera
Neem
Apple cider vinegar
Baking soda
Tea tree oil
Epsom salt
Oatmeal
Diet
Pathya
Light meals and easily digestible foods
Green gram, soups, buttermilk boiled with ginger, turmeric, curry leaves etc.
Freshly cooked and warm food processed with cumin seeds, ginger, ajwain etc
Apathya
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products other than buttermilk- Cause indigestion, increase Kaphadosha, can lead to obstruction in channels and respiratory problems.
Curd – causes vidaaha and thereby many other diseases
Red chilli and other pungent, hot and spicy food items.
Vihaara
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid stress.
Maintain a regular food and sleep schedule.
Avoid sedentary lifestyle as it is one of the main causes of many diseases.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Yoga
Psoriasis, like many of skin diseases, gets worse with stress & lack of proper circulation. A regular exercise routine and yoga therapy is recommended in psoriasis cases for proper destressing & improved circulation.
Salabhasana
vajrasana
Nadisudhi pranayama
Bhujangasana
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
- PMID: 30508547
Psoriasis increases the risk of cardiovascular (CV) disease. Secukinumab, a fully human monoclonal antibody against IL-17A, shows significant efficacy in psoriasis, but effects on CV markers are unknown. CARIMA (Evaluation of Cardiovascular Risk Markers in Psoriasis Patients Treated with Secukinumab) was a 52-week, randomized, double-blind, placebo-controlled, exploratory trial in patients with moderate to severe plaque psoriasis without clinical CV disease. Patients were randomly assigned to receive 300 mg or 150 mg secukinumab until week 52 or to receive placebo until week 12 and then 300 mg or 150 mg secukinumab until week 52. The primary outcome was endothelial function measured by flow-mediated dilation (FMD). Baseline FMD was significantly lower in psoriasis patients than healthy volunteers (4.4 ± 3.9% vs. 6.1 ± 3.3%, P = 0.01). At week 12, baseline-adjusted mean FMD was numerically higher in patients receiving secukinumab versus those receiving placebo, but this difference (300-mg group, +1.2%; 150-mg group, +0.76%; P = 0.223 and P = 0.403 by analysis of covariance) did not reach significance. At week 52, FMD increased across groups. FMD was significantly higher than baseline in patients receiving the label dose of 300 mg secukinumab for 52 weeks (+2.1%, 95% confidence interval = 0.8-3.3; P = 0.0022). Other relevant CV markers were unchanged. CARIMA indicates that secukinumab might have a beneficial effect on CV risk by improving the endothelial function of patients with plaque psoriasis.
- PMID: 31453631
The aim of this 12-week randomized, double-blind, placebo-controlled trial was to determine the efficacy and safety of a probiotic mixture in the reduction of psoriasis severity. Ninety 18-70-year-old adults with plaque psoriasis were randomized into probiotic and placebo groups. At 12-week follow-up, 66.7% of patients in the probiotic group and 41.9% in the placebo group showed a reduction in Psoriasis Area and Severity Index of up to 75% (p < 0.05). A clinically relevant difference was observed in Physician Global Assessment index: 48.9% in the probiotic group achieved a score of 0 or 1, compared with 30.2% in the placebo group. The results of follow-up 6 months after the end of the study showed a lower risk of relapse after the intake of the probiotic mixture. Analysis of gut microbiota confirmed the efficacy of the probiotic in modulation of the microbiota composition.
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
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