Pathophysiology

Psoriasis involves the hyperactivation of the immune system, particularly T-helper (Th1 and Th17) cells, which release inflammatory cytokines like TNF-α, IL-17, and IL-23. This leads to:

• Accelerated keratinocyte proliferation
• Impaired skin barrier
• Chronic inflammation and angiogenesis
• Development of thick, scaly plaques

Symptoms

• Red, raised, inflamed patches of skin
• Silvery-white scales
• Dry, cracked skin that may bleed
• Itching, burning, or soreness
• Thickened or pitted nails
• Joint pain and stiffness in psoriatic arthritis

Diagnosis

Psoriasis is usually diagnosed clinically based on appearance and distribution of skin lesions. Diagnostic steps may include:

• Skin examination
• Medical and family history
• Skin biopsy: To rule out similar conditions like eczema or fungal infections
• Imaging (X-ray, MRI): For suspected psoriatic arthritis
• Psoriasis Area and Severity Index (PASI): Used to assess severity

Conventional Treatment

Treatment depends on the severity and extent of the disease:

Topical treatments (for mild to moderate psoriasis):

• Corticosteroids: Reduce inflammation and itching
• Vitamin D analogs (calcipotriol): Slow cell turnover
• Coal tar, salicylic acid: Help reduce scaling
• Calcineurin inhibitors (for sensitive areas)

Phototherapy:

• Narrowband UVB or PUVA therapy
• Effective for widespread or treatment-resistant psoriasis

Systemic medications (for moderate to severe psoriasis):

• Methotrexate
• Cyclosporine
• Acitretin (oral retinoid)

Biologic therapies:

• Target specific immune pathways (e.g., TNF-α, IL-17, IL-23)
• Examples: Adalimumab, Secukinumab, Ustekinumab
• Highly effective but require monitoring for side effects

Stem Cell Therapy in Psoriasis

Stem cell therapy offers a novel approach for managing psoriasis by modulating immune responses and promoting skin regeneration.
Types of stem cells:

• Mesenchymal stem cells (MSCs): Derived from bone marrow or adipose tissue

Mechanism of action:

• Suppress abnormal immune responses
• Reduce cytokine release (e.g., TNF-α, IL-17)
• Promote skin healing and barrier restoration

Clinical potential:

• Shown to improve skin lesions and immune markers

Hyperbaric Oxygen Therapy (HBOT) in Psoriasis

HBOT involves breathing pure oxygen in a pressurized chamber to enhance tissue oxygenation and healing.
Mechanism:

• Reduces hypoxia and inflammation in skin lesions
• Enhances wound healing and immune modulation

Applications:

• Adjunctive therapy for recalcitrant or severe psoriasis
• May improve skin appearance and reduce itching

Evidence:

• Limited but promising case reports and small studies
• Requires more randomized trials for validation

Lifestyle and Supportive Management

Moisturizers and emollients: Maintain skin hydration and reduce scaling

Diet:

• Anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids
• Avoid processed foods, sugar, and alcohol

Stress reduction:

• Stress management techniques like yoga, meditation, or therapy

Avoiding triggers:

• Infections, injuries, and harsh skincare products

Psychological Support

• Psoriasis can significantly affect mental health and social life
• High rates of anxiety, depression, and social withdrawal
• Support groups and counseling can help improve quality of lifeucts

Monitoring and Follow-Up

• Regular assessment using PASI or Dermatology Life Quality Index (DLQI)
• Monitoring for side effects of systemic or biologic therapy
• Screening for comorbidities like cardiovascular disease, diabetes, and obesity

Prognosis

Psoriasis is a chronic condition with a variable course. While it cannot be cured, many patients achieve long-term remission with appropriate treatment. Biologics and emerging therapies offer excellent disease control for moderate to severe cases.

Conclusion