Educational Image of Psoriasis by Nopsor

Psoriasis

What is Psoriasis?

Psoriasis is a condition where the immune system causes skin cells to grow too quickly. Normally, skin cells form and shed gradually, but with psoriasis, they build up rapidly, leading to scales and red, itchy patches on the skin. In some cases, painful pustules can form and dry out.

Psoriasis is a chronic (long-term) condition that can flare up and then calm down. Although there is no cure yet, its symptoms can be managed. At Nopsor, we’ve developed a formula that helps control these symptoms.

Who Gets Psoriasis?

Psoriasis affects around 2–3% of people worldwide, and it becomes more common as people age. Fortunately, life expectancy for people with psoriasis is similar to those without it.

How Do Psoriasis Lesions Appear?

Psoriasis lesions can look different from person to person, ranging from small spots to larger, thicker patches. Here’s a breakdown of some common types:

  1. Guttate Psoriasis: Small, red spots that may cover large areas of skin, often appearing suddenly after infections like strep throat.
  2. Plaque Psoriasis: The most common type, with lesions that range from coin-sized spots to larger patches, often on elbows, knees, and lower back. 
  3. Psoriasis Vulgaris (Common Psoriasis): Another term for plaque psoriasis, affecting about 90% of psoriasis patients.
  4. Pustular Psoriasis: Characterized by small, fluid-filled blisters (pustules) that can appear on inflamed areas of the skin.
  5. Palmoplantar Psoriasis: Affects the palms of the hands and soles of the feet, with thick, deep-rooted scales that may crack.
  6. Erythrodermic Psoriasis: An intense and widespread redness of the skin, which can be painful and require medical attention.

Where Does Psoriasis Appear?

  • Common Areas: Lower back, elbows, knees, scalp, and nails.
  • Less Common Areas: Mucous membranes (such as reproductive organs), flexible regions (armpits, groin), and sometimes the sacral area (lower spine).

    How Psoriasis Lesions Feel and Change

    • Texture: Lesions are often scaly, hardened, and red.
    • Feeling: They can be painful when dry or cracked and may cause some itching.
    • Life Cycle: Psoriasis lesions can grow and recede over time, with periods of calm and flare-ups. This cycle may last weeks, months, or even years.

      Triggers and Factors

      Some people carry the genetic predisposition for psoriasis but may never show symptoms unless triggered by factors like:

      • Infections: Viral infections, bronchitis, tonsillitis, or fevers.
      • Hormones: Changes during puberty, menopause, or other hormonal shifts.
      • Stress: Emotional stress can increase the frequency and severity of psoriasis symptoms.
      • Medications: Certain drugs, such as anti-malarial medications, lithium, and corticosteroids, may activate psoriasis symptoms in those with a genetic predisposition.

        By understanding these aspects of psoriasis, you can better recognize symptoms and identify possible triggers that may influence flare-ups.

        A Brief History of Psoriasis

        Psoriasis has been documented for thousands of years. Ancient Greek physician Hippocrates (460-377 BC) described scaly, dry skin conditions under the name “lopoi” (Greek for “scales”). For many years, psoriasis was even mistaken for leprosy.
        It wasn’t until 1809 that Dr. Robert Willan gave an accurate description of psoriasis, helping to finally distinguish it from other skin diseases.

        Dermatitis and Psoriasis

        Skin Cancer and Psoriasis

        Research suggests that psoriasis is rarely seen in people with sun-related skin cancers like melanoma or solar keratosis. However, certain psoriasis treatments, such as ultraviolet rays, methotrexate, X-rays, and corticosteroids, may increase the risk of skin cancer for some individuals.

        Types of Dermatitis and Their Connection to Psoriasis

        1. Seborrheic dermatitis can look similar to psoriasis, especially on the scalp and joints, but it usually has a yellowish, greasy texture and may cause some hair loss. Psoriasis lesions, by contrast, are more easily felt when touched.

        2. Atopic dermatitis (also known as eczema) rarely coexists with psoriasis. In a study, only 3 out of 1,170 patients with atopic dermatitis also had psoriasis. If there’s doubt, a dermatologist can perform a biopsy to distinguish between the two.
        3. Contact dermatitis occurs when the skin reacts to an allergen, leading to redness and itching. In some cases, psoriasis lesions may appear after exposure to an allergen, indicating a possible link between contact dermatitis and psoriasis.

          Plaque Psoriasis

          Plaque psoriasis is marked by raised, red, scaly patches called plaques. These plaques have well-defined edges, making them distinct from other types of skin inflammation. Typically, plaques are raised 2-3 millimeters, scaly, and vary in color based on skin type and location.

          The scales may flake off easily, and if scratched, the surface becomes dull and opaque. Removing scales often reveals a thin membrane beneath, representing the final skin layers. Due to frequent shedding, plaque psoriasis can affect self-esteem and daily life as flakes may be visible on clothing or in places the person visits.

          Where Plaque Psoriasis Commonly Appears

          • Scalp: The scalp is a common site for psoriasis, although hair often makes it harder to see the lesions. These patches can extend slightly beyond the hairline and may have a yellowish tint.
          • Intertriginous Areas: These are areas where skin rubs against skin, like armpits, groin, and between fingers. Plaques here appear shiny and reddish rather than dry.
          • Inverse Psoriasis: Found on the inner folds of joints, this type can resemble atopic dermatitis with its small to medium-sized scales.
          • Palmoplantar Psoriasis: Affecting the hands and feet, this form is challenging as the thickness of the skin in these areas makes it harder to treat.

            Koebner Phenomenon: New psoriasis lesions can develop in areas of prior skin trauma, often appearing 1-2 weeks after the injury.

            Guttate Psoriasis

            Guttate psoriasis often affects children and young adults and may be the first sign of psoriasis. It appears as small, drop-like red spots across the body and may follow infections like strep throat. Unlike plaque psoriasis, it doesn’t cause as much scaling and may cause mild fever or fatigue.

            Differentiation: Some skin conditions, like Psoriasis Rosea, are sometimes confused with guttate psoriasis, though their lesions tend to be larger and less common on the face.

            Pustular Psoriasis

            Pustular psoriasis is less common and typically appears after guttate or plaque psoriasis. It involves small, pus-filled blisters on red skin.

            Triggers for Pustular Psoriasis:

            • Pregnancy: Increased progesterone in late pregnancy may trigger pustules.
            • Corticosteroids and Other Treatments: Some medications, UV exposure, and skin irritants may bring on pustular symptoms.
            • Infections: Respiratory infections are a known trigger.

              Patterns of Pustular Psoriasis:

              • Zumbusch Pattern: A sudden outbreak of painful redness and pustules, often with fever.
              • Annular Pattern: Round, pustule-bordered patches that may persist or spread for extended periods.
              • Exanthematous Pattern: Sudden eruptions starting on hands and feet, spreading quickly.

                Subtypes of Pustular Psoriasis

                • Generalized Pustular Psoriasis (GPP): Also known as the Zumbusch pattern, GPP is a severe form with potentially serious effects and can be triggered by stress, hormonal changes, infections, or certain medications.
                • Pustular Psoriasis During Pregnancy (GPPP): Occurs due to hormonal shifts.
                • Annular Psoriasis (EACP): Characterized by ring-shaped red lesions with pustules, appearing suddenly and then receding.
                • Palmoplantar Pustular Psoriasis (PPP): Affecting hands and feet, PPP is more common in smokers.
                • Hallopeau Psoriasis: Triggered by trauma or infection, usually affects fingers or toes and involves pustules on a reddish base.

                  Common Psoriasis Treatments

                  In this section, we’ll cover the most common treatments for psoriasis, including Nopsor’s topical treatment. Nopsor combines essential ingredients with a unique herbal blend to control symptoms without causing rebound effects.

                  Topical Treatments for Psoriasis

                  Topical treatments can be used alone or in combination with other therapies and are often chosen based on:

                  • Location and Severity: Where and how severe the psoriasis is.
                  • Past Responses: Reactions to previous treatments.
                  • Risk vs. Benefit and Cost: Balancing effectiveness, safety, and cost.

                    When selecting a topical treatment, it’s crucial to consider how it works in the skin, the application method (creams, gels, lotions, shampoos), and the concentration and frequency of use.

                    Types of Topical Treatments

                    1. Corticosteroids - These synthetic drugs mimic cortisol, a hormone from the adrenal glands. They help reduce inflammation and slow down skin cell production but may have side effects with long-term use, such as skin thinning, stretch marks, and increased risk of infections.
                    2. Vitamin D Analogues - These compounds work by regulating skin cell production and inflammation. They include Calcitriol, Tacalcitol, and Calcipotriol. While they are effective for psoriasis, they are typically recommended for controlled use.
                    3. Retinoids (Tazarotene) - Tazarotene, a synthetic retinoid, helps reduce skin cell growth and inflammation. However, prolonged use may cause skin irritation and burning, so it’s used in controlled amounts.
                    4. Dithranol - Dithranol helps reduce skin cell production and inflammation but is less commonly used due to its unstable nature and lack of standardized formulations.
                    5. Tar - Derived from coal, tar has been used for over a century to treat psoriasis. It helps with inflammation and skin cell control and offers lasting effects. However, it may have drawbacks, including staining, odor, and potential skin irritation. Note: Nopsor incorporates coal tar in its formula for lasting results.
                    6. Calcineurin Inhibitors - These inhibit T-cell activation in the immune system, reducing inflammation.

                      Nopsor Treatment

                      Nopsor’s topical formula combines coal tar with a proprietary herbal blend designed to manage psoriasis symptoms effectively without rebound effects, making it suitable for long-term use.

                      Biological Treatments for Psoriasis

                      Biological treatments, or biologics, are derived from natural sources like human or animal cells and target specific parts of the immune system that contribute to psoriasis. These treatments are often used for moderate-to-severe psoriasis when other therapies are insufficient. Here’s a breakdown of some common types:

                      1. TNF-alpha Inhibitors
                        These drugs block the tumor necrosis factor-alpha (TNF-alpha) protein, which plays a key role in causing inflammation in psoriasis.

                        • Examples: Etanercept (Enbrel), Infliximab (Remicade), Adalimumab (Humira)

                      2. IL-17 Inhibitors
                        IL-17 inhibitors block the IL-17 protein, significantly reducing inflammation and overproduction of skin cells.

                        • Examples: Secukinumab (Cosentyx), Ixekizumab (Taltz), Brodalumab (Siliq)

                      3. IL-23 Inhibitors
                        By targeting IL-23, these treatments help decrease immune response and control inflammation.

                        • Examples: Guselkumab (Tremfya), Tildrakizumab (Ilumya), Risankizumab (Skyrizi)

                      4. IL-12/23 Inhibitors
                        These biologics target both IL-12 and IL-23 proteins, reducing inflammation and immune activity.

                        • Example: Ustekinumab (Stelara)

                      5. JAK Inhibitors
                        Although not a traditional biologic, JAK inhibitors are oral medications that interfere with Janus kinase pathways involved in immune response.

                        • Examples: Tofacitinib (Xeljanz), Baricitinib (Olumiant)

                      6. PDE4 Inhibitors (Apremilast)
                        Apremilast (Otezla) is an oral medication that inhibits phosphodiesterase 4 (PDE4), reducing inflammation. It’s commonly used for psoriatic arthritis and plaque psoriasis.

                      7. Traditional Immunosuppressants (Methotrexate and Cyclosporine)
                        These drugs suppress the immune system to control inflammation and are sometimes used when biologics aren’t suitable.

                      Risks of Biological Treatments

                      Biologics are powerful and effective, but they come with risks, including:

                      • Higher susceptibility to respiratory and skin infections
                      • Possible reactivation of latent infections, like tuberculosis

                      Biologics are tailored treatments, and the choice depends on individual factors such as health history, treatment goals, and the severity of psoriasis.