Plaque psoriasis is an immune system abnormality that results in a chronic inflammatory skin condition.  It is characterized by the development of thickened scaly red patches or plaques all over the body. A third of patients diagnosed with the disease acquire the symptoms before the age of 20, and it worsens with age.

Consulting the dermatologist would be the better option to understand the disease and to explore various treatment options. A rheumatologist is a medical practitioner qualified to treat patients when symptoms translate to inflammatory joint disease.

Around 10 percent of patients suffering from plaque psoriasis expose themselves to complications such as fatty liver disease, eye complications, Type 2 diabetes, inflammatory bowel disease, cardiac ailments, and depression. Once the condition is confirmed, plaque psoriasis treatment requires regular medical supervision and long-term care.

Chronic Plaque Psoriasis Is the Most Prevalent Form of Psoriasis

Roughly 90 percent of people suffering from psoriasis develop plaque psoriasis with patches distributed over the scalp, elbows and knees, the lower back, face, hands and feet, the edges of the nails, genital area, and within skin folds.

Plaque Psoriasis Scalp

The plaque psoriasis scalp is a common condition marked by the appearance of raised, reddish, scaly patches that stunt hair follicles. It may appear as one or more reddish patches, and go on to cover the entire scalp. It may also spread beyond the hairline onto the forehead, the slope of the neck, and cover the ears.

Psoriasis Area and Severity Index (PASI) Score

If plaque psoriasis spreads widely, its severity is determined using the Psoriasis Area and Severity Index (PASI) score. This is a clinical tool that assesses plaque formations and the area covered, and measures the severity on a scale from 0 to 72.  The score determines the type of treatment the patient undergoes.

Dermatology Life Quality Index (or DLQI)

Clinicians also use the Dermatology Life Quality Index (or DLQI) to assess how severely plaque psoriasis impacts the patient’s daily routine. DLQI is basically a questionnaire that rates patients on a score from 0 to 30. A score below 10 indicates mild impact; scores from 10–20 are assessed as moderate, and any score above 20 is considered severe requiring focused, long-term drug treatment, and therapy.

What Causes Plaque Psoriasis? Is It Genetic?

It is clear that plaque psoriasis is an autoimmune disease that makes white blood cells turn against healthy cells, and provoke skin cells to grow abnormally. Though what causes plaque psoriasis is largely unknown, researchers believe there are genetic triggers. This is evidenced by the fact that a third of the patients have a family member suffering from the disease. It is suspected that a chromosomal mutation in the PSORS1-PSORS9 location within the gene could mutate to trigger psoriasis. Major environmental triggers could be stress and infection.

Primary and Secondary Care for Patients With Plaque Psoriasis

In 80 percent of patients showing the progressive development of plaque psoriasis, primary care through topical corticosteroids is sufficient to bring symptoms (itching, inflammation, and pain) under control.

The condition becomes serious when plaques cover more than 10 percent of the body surface. Severe symptoms need secondary care that involves topical, oral, and injectable drugs acting in combination with other treatments such as biologics, disease-modifying drugs, and Photochemotherapy.

Stopping treatment is never an option because that may induce a more deadly form of psoriasis-like psoriasis mutilans where the bones of the fingers and feet disintegrate and deform the limbs permanently.

Lifestyle Changes Speed up Symptomatic Relief in Plaque Psoriasis

Major lifestyle changes like reducing obesity, curbing smoking, and avoiding alcohol can substantially reduce the adverse impact of plaque psoriasis. As the skin becomes tough and leathery, the dermatologist will prescribe emollients (including emollient soap substitutes) that can be applied regularly and liberally. This is an expedient way of improving the flexibility of the skin and reducing plaque formation and itching.

Around 15 to 47 percent of patients report substantial improvement and skin comfort following emollient use. Adopt a skincare routine that uses more of natural (safe herbal) products. Reducing stress, preventing anxiety attacks, and a heart-healthy diet will improve the body’s immune response.

Combination Treatments Involving Calcipotriol and Corticosteroids Are Effective

Following emollient treatment, corticosteroids working in combination with calcipotriol, a Vitamin D3 analog, represent the second line of defense against plaque psoriasis. The steroids reduce inflammation and pain, and calcipotriol keeps the skin soft and pliable. Mild to moderate plaque psoriasis can be controlled using coal tar and a keratolytic medium such as salicylic acid (concentration of 2 to 5 percent).

Patients of Plaque Psoriasis Need to Change Attitudes and Shore up Resolve

A medical review is important as it sensitizes the patient regarding the extent of the disease and the damage potential if it’s not controlled. Patients need to be realistic about their expectations from treatment. The focus of any treatment is the resolution of the discomfort that plaque psoriasis causes, even if the disease is incurable.

Patients can take comfort from the fact that their PASI scores will show an improvement between 40 to 70 percent after corticosteroid cum calcipotriol treatment. The most difficult forms of the disease are plaque psoriasis scalp and psoriasis affecting the face, genital areas, palms, and fingernails. Only the mildest steroid-potencies can be applied to these areas, and that implies extended treatment duration.

The most important thing for patients is not to tire of repeated sessions and to abandon treatment midway as that creates more complications.

Maintaining the Frequency of Follow-up Care in Plaque Psoriasis

After the initial treatment session, follow-up care is scheduled four weeks later for adults and two weeks for children. Once the initial session is completed, the body is rested for a minimum period of four weeks before reviewing the progress of the disease. During the rest period between two treatment sessions, topical steroid/calcipotriol treatment is discontinued, and emollient treatment is substituted.

Three Important Factors Medical Specialists Review in Plaque Psoriasis

  • The Extent of Joint Degeneration: This is an indicator of the progress of plaque psoriasis and whether the treatments availed have been effective or have failed.
  • The Improvement in the Quality of Life of the Patient: This is a very important parameter validating the success of treatments. If the physical symptoms have worsened and the patient appears depressive it may indicate one of two problems. The disease has struck a more virulent form, or the patient may not be successful in adopting lifestyle changes (reduction in smoking or alcohol consumption or weight loss). If the patient is depressive, professional counseling may be required.
  • The Risk of Acquiring Lifestyle Diseases, and Added Complications: If plaque psoriasis can’t be controlled by primary or secondary care, the patient may risk complications like cardiac ailments, visual problems, elevated blood sugar, bowel disease, and liver toxicity. Complications add a whole new dimension to the treatment of plaque psoriasis. As organs and systems start malfunctioning, the patient needs a panel of specialists coordinating treatment in an integrated manner.

It Is Normal for Plaque Psoriasis to Relapse After Initial Improvement

Patients may experience near-complete relief and then see the disease relapsing in three or four months. This should not be viewed as a failure of the treatment. Rather, it is the nature of the disease asserting itself. Remember that the disease has a strong genetic influence. Environmental triggers can be brought under control by modern science, not genetically imbibed traits.

The specialist studies the extent of the flare-up and decides whether to move to secondary treatments such as biologics or disease-modifying drugs or move on to more advanced therapies such as Photochemotherapy.    

When to Consult the Doctor in Plaque Psoriasis

These are the scenarios where it becomes important that you consult either the dermatologist or the rheumatologist without delay:

  • The mainly skin oriented inflammation, plaque formation, and pain translate into stiffness and pain in the joints, making movement difficult.
  • The plaques spread virulently, and the patient’s PASI score exceed 10 percent.
  • Pain and discomfort impact the quality of life of the patient. The DLQI score exceeds 10. The patient begins to experience redness in the eye, blurred vision, and eye pain.

Conclusion

According to the National Psoriasis Foundation, more than 7.5 million Americans suffer varying degrees of psoriasis, making it the most prevalent autoimmune disease in the US. It’s itchy, it’s painful, it’s embarrassing, and it can play havoc with the quality of life.

It is not curable but sufferers can take heart that there are proven methods of treating and bringing the symptoms under control. A tenfold improvement in symptoms is possible if patients can control smoking and alcohol, and bring their body mass index closer to the ideal weight.