Psoriasis is a common, chronic relapsing immune mediated skin disease characterized by dry, thick and raised patches, papules, and plaques. These patches are often covered with a silvery-white coating called scale which usually itches. Psoriasis mainly affects the skin and joints. Various sites of the body such as scalp, face, trunk, limbs, palms and soles involve in psoriasis.
Types of psoriasis:
- Plaque psoriasis/Psoriasis vulgaris :-
The most common form typically appears as raised areas of inflamed skin covered with silvery white scaly skin. These areas are called plaques and are most commonly found on the knees, elbows, scalps and back
- Inverse psoriasis :-
It appears as smooth inflamed patches of skin that affect skin folds of abdomen, intergluteal cleft and under the breasts.
- Guttate psoriasis :-
It is characterized by numerous small, scaly, red, teardrop-shaped lesions which appears primarily on the trunk, but also the limbs and scalp. It is preceded by a streptococcal infection.
- Pustular psoriasis :-
It appears as raised bumps filled with noninfectious pus. It can be localized or generalized, the skin under and surrounding the pustules is red and tender.
- Erythrodermic psoriasis:-
It involves widespread inflammation and exfoliation of the skin accompanied by severe itching, swelling and pain. This form can be fatal as the extreme inflammation and exfoliation disrupt the body’s ability to regulate temperature and perform barrier functions.
Causes of Psoriasis:
It is not purely a skin disorder and can have a negative impact on many organ systems. It is considered as a genetic disease thought to be triggered by environmental factors. It develops when the immune system mistakes anormal skin cell for a pathogen and sends out faulty signals that cause overproduction of new skin cells. It is difficult to treat due to its chronic recurrent nature but various treatments can help to control the symptoms.
- Skin changes: -usually based on appearance of the skin. Characteristics are scaly, red, plaques, papules, or patches of skin that may be painful and itch.
- Nail changes: - includes pitting of nails(pinhead sized depressions in the nails), whitening of the nails, small areas of bleeding from capillaries under the nails, thickening of skin under the nail, yellow reddish discoloration of nail and crumbling of nails.
- Auspitz’s sign :- pinpoint bleeding when scale is removed.
- Koebner phenomenon: - psoriatic skin lesions induced by trauma to the skin.If the clinical diagnosis is uncertain skin biopsy may be performed it will show clubbed epidermal projections and epidermal thickening on microscopy.
- Psoriatic arthritis (red or swollen joints such as figures, elbows etc, stiffness and pain on joints right after waking up in the morning)
- Cardiovascular disease (the psoriasis medicines may increase heart rate and cholesterol levels)
- Depression (due to social anxiety may feel sad or guilty for missing out on activities with others.)
- Eye diseases (leads to complications such as blepharitis, conjunctivitis etc)
- The treatment options are topical agents (corticosteroid preparation) are used for mild disease, phototherapy (form of sunlight eg:-UVB lamps) for moderate disease and systemic agents(oral medications or injectable treatments) for severe disease.
- In Ayurveda skin diseases have collectively considered under a common term of kushta. According to Ayurveda psoriasis is correlated to sidhmam.
- “sidhmam ruksham bahi snigdhamantharghrishtam raja kireth gandai kanduyuthaischitham” [asht hr]
In Sidhmam type of skin disease patches on skin are dry outside and moist inside,gives out small scales when scratched, smooth to touch, thin, whitish coppery colored resembling flower of dugdhika plant, usually common in upper parts of the body.
- The multimodal treatment approach that has been adopted for sidhma includes jirnajwara chikitsa, vatarakta chikitsa, rasayana chikitsa along with kushta chikitsa. These include sodhana and samana therapy. The first line of treatment is snehapana means intake of ghee or oil medicated with dasamoola, amrutha, eranda, thikthaka gana dravyas, aragwadha etc according to the predominant doas. External oleation includes application of oil or ghee prepared with drugs namely pathya, bhallathaka, arushkara, sarshapa, aragwadha etc.
- snigdhasya sodhanam yojyam
After proper oleation sodhana(panchakarma) should be done. Rakthamokshana(blood letting), vamana(emesis), virechana(emesis) has to be done based on the predominance of dosha involved in the disease.
After sodhana therapies samana chikitsa has to be done which includes application of pastes, oils or ghee made up of drugs like bhallathaka, krimijith etc, internal medications that includes Kashaya, arishta, vati etc.
Rasayana therapies is done in order to nourish the body as the body is weak after the sodhana therapies. It pacifies doshas, acts on raktha dhathu, cures agnimandhya etc. the medicines include gandhaka rasayana, tuvaraka rasayana etc.