Psoriasis is a chronic inflammatory skin disease that affects millions of people worldwide. It manifests in a variety of forms and can severely impact patients’ quality of life . Understanding the causes of psoriasis and the factors that trigger the disease is crucial to better manage and treat it. This article explores the triggers, types of psoriasis, and management strategies.
What is psoriasis?
Psoriasis is a chronic disease characterized by an acceleration of skin cell renewal, leading to the appearance of red patches covered with white scales. It is a chronic inflammatory disease in which the immune system plays a central role. This dysregulation of the immune system leads to excessive inflammation, which accelerates the life cycle of skin cells.
Acceleration of the cell cycle
Accelerated cell turnover in psoriasis is at the heart of the formation of the red plaques characteristic of this disease. Here's why this happens:
1. Normal Cell Cycle vs. Psoriasis
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Normal cycle : Normally, skin cells (keratinocytes) renew themselves approximately every 28 to 30 days. Old, dead cells are shed from the surface of the skin and replaced by new cells formed in deeper layers.
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Cycle in psoriasis : In psoriasis patients, this cycle is significantly accelerated. Skin cells renew themselves in just 3 to 6 days. This means that new skin cells reach the surface much faster than they should.
2. Accumulation of Skin Cells
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Accumulation : Due to this acceleration, skin cells do not have time to shed normally. They therefore accumulate on the surface of the skin, forming thick layers of immature cells.
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Red patches and scales : This rapid buildup of cells results in thick, raised, reddish patches, often covered in silvery or white scales. These scales are actually dead cells that were not properly removed.
3. Inflammation
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Inflammatory response : The accumulation of skin cells triggers an inflammatory response in the skin. The immune system, which is out of whack in psoriasis, sends out defense signals, mistakenly believing it is fighting an infection or attack.
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Redness : This inflammation causes blood vessels in the skin to dilate, which causes the characteristic redness of the plaques. Immune cells also release pro-inflammatory substances, such as TNF-alpha and interleukins, which worsen the inflammation and further accelerate the cell cycle.
4. Thickening of the Skin
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Hyperproliferation : In addition to the accumulation of dead cells, new cells that quickly rise to the surface do not have time to mature properly. They accumulate in thick layers, creating dense, rough plaques.
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Plaque texture : This hyperproliferation and chronic inflammation leads to thick, rough, raised plaques that are often itchy and sometimes painful.
Causes of psoriasis
The exact causes of psoriasis are not completely understood, but several factors are involved:
- Genetic predisposition : Patients with psoriasis often have a genetic predisposition . If a parent has psoriasis, there is an increased risk for children to develop the disease.
- Immune system : Psoriasis is largely caused by a dysfunctional immune response. T cells, a type of white blood cell, mistakenly attack healthy skin cells, causing inflammation and the rapid production of new skin cells.
- Triggers : Various factors can trigger or worsen psoriasis, such as stress, infections (especially streptococcal infections which can trigger guttate psoriasis ), skin trauma (Koebner phenomenon), certain medications, alcohol, and tobacco.
The different forms of psoriasis
There are several types of psoriasis , each with specific characteristics:
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Plaque psoriasis : This is the most common form, characterized by thick red patches covered with white or silvery scales. These patches often appear on the elbows, knees, scalp, and lower back.
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Guttate psoriasis : Appears as small, teardrop-shaped lesions on the skin, often triggered by a bacterial infection such as strep throat.
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Inverse psoriasis : This type develops in folds of skin, such as under the armpits, under the breasts, or in the groin area. The patches are often smooth and shiny.
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Pustular psoriasis : Characterized by noninfectious pustules surrounded by red skin, often located on the hands and feet.
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Erythrodermic psoriasis : This rare but serious form causes intense inflammation over a large area of the body, requiring urgent medical attention .
Psoriasis and psoriatic arthritis
About 30% of people with psoriasis develop psoriatic arthritis , a form of inflammatory arthritis that can cause joint pain, stiffness, and swelling. This complication highlights the importance of proactive disease management to prevent severe complications.
Psoriasis management
Management of psoriasis depends on the severity of the disease and its impact on patients' quality of life . Treatments aim to reduce inflammation, slow the excess production of skin cells, and relieve symptoms.
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Local treatments : These include creams and ointments containing corticosteroids, vitamin D, or salicylic acid to reduce inflammation and thickening of the skin.
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Phototherapy : Controlled exposure to ultraviolet B (UVB) rays may help reduce symptoms of psoriasis, especially in moderate to severe cases.
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Systemic medications : For severe psoriasis , systemic treatments such as immunosuppressants or biotherapies may be prescribed to modulate the immune response.
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Stress Management : Since stress is a major trigger, stress management techniques, such as meditation or behavioral therapy, may be beneficial.
What beauty routine for psoriasis?
A psoriasis-friendly beauty routine should be designed to soothe symptoms, hydrate the skin, and minimize irritation. Here is a recommended daily routine for people with psoriasis:
1. Gentle Cleansing
- Products to use : Opt for a gentle, soap-free cleanser that is specially formulated for sensitive skin. Look for hypoallergenic, fragrance-free, and alcohol-free products that won't disrupt the skin barrier.
- How to : Wash your face and body with lukewarm water, never hot, as hot water can dry out the skin and make psoriasis plaques worse.
2. Intense Hydration
- Products to use : Apply a thick moisturizing cream or balm that contains ingredients such as ceramides , hyaluronic acid, shea butter, or natural oils like argan oil or avocado oil.
- How to : Moisturize your skin immediately after showering, while skin is still slightly damp. This helps seal in moisture and protect the skin barrier.
3. Localized Treatments
- Products to use : If your dermatologist has prescribed topical creams (such as corticosteroids, retinoids, or vitamin D analogues), apply them to the psoriasis plaques after moisturizing. For over-the-counter treatments, products containing salicylic acid or coal tar may be effective in softening the plaques and reducing inflammation.
- How to : Apply treatment to affected areas, massaging gently until completely absorbed. Be sure to follow your dermatologist's instructions regarding frequency and amount to use.
4. Sun Protection
- Products to use : Use a broad-spectrum sunscreen SPF 30 or higher that is fragrance-free and non-comedogenic to protect your skin from UV rays, which can worsen psoriasis symptoms in some people.
- How to : Apply sunscreen generously to all exposed areas 15 minutes before going outside, and reapply every two hours if you are outdoors.
5. Exfoliation (Do with Caution)
- Products to use : Use a gentle scrub or chemical exfoliant with lactic acid or salicylic acid to gently remove dead skin cells, but avoid mechanical scrubs which can irritate the skin.
- How to : Limit exfoliation to once or twice a week, and be gentle. If your skin is very sensitive or is experiencing a flare-up, it's best to skip this step.
6. Soothing Bath or Shower
- Products to use : Add natural oils like colloidal oatmeal or Epsom salts to your bath to soothe the skin.
- How to : Do not stay in the water for too long (no more than 10-15 minutes) to avoid drying out your skin. After bathing, dry yourself by gently patting your skin with a towel rather than rubbing.
7. Avoid Irritants
- Avoid : Avoid products containing fragrances, dyes, parabens, or alcohol, as these can irritate the skin. Opt for soft cotton clothing and avoid rough or synthetic fabrics that can cause friction.
8. Scalp Care
- Products to use : Use a medicated shampoo containing salicylic acid, coal tar, or zinc sulfate to treat scalp psoriasis.
- How to : Gently massage the shampoo into your scalp and leave it on for a few minutes before rinsing. Avoid scratching the patches, even if they are irritating.
9. Stress Management
- Why : Stress is a major trigger for psoriasis. Incorporate stress management techniques into your daily routine, such as meditation, yoga, or deep breathing exercises.
10. Regular Consultation with a Dermatologist
- Why : A dermatologist can adjust your skincare routine based on how your psoriasis is progressing, prescribe specific treatments, and monitor for potential side effects.
Conclusion
Psoriasis is a complex disease that results from the interaction between genetic predisposition , the immune system, and various triggers . Although living with psoriasis can be challenging, proper management , including tailored psoriasis treatments and proactive symptom management, can significantly improve patients' quality of life . If you are experiencing symptoms of psoriasis, it is important to consult a healthcare professional for a diagnosis and personalized treatment plan.