Treatment and Preventive management of Psoriasis


The word psoriasis is derived from the Greek word "Psora" and "Iasis". Psora means Itch or scale and lasis means condition. Psoriasis is an inflammatory disorder that affects the skin and nails. It is marked by patches of thick, red skin covered with silvery scales that occur primarily on the elbows, knees, lower back and scalp. Although not life-threatening, it can be painful and cause psychological and emotional distress. According to modern point of view and symptomatology, Ekakustha can be correlated with Psoriasis. Psoriasis is universal in occurrence that affects about 125 million people worldwide. Approximately 1/3rd of patients with psoriasis have a relative similarity afflicted.

The most important finding in the pathogenesis of Psoriasis is greatly accentuated epidermal cell turnover. In psoriatic skin the epidermal cell matures in 2 to 5 days in constant to normal skin where the turnover time is around 21 days. The factors initiating this process are not known. Trauma, infection, emotional stress and climate are some of the precipitating factors in the pathogenesis of Psoriasis. The onset of Psoriasis can occur at any age with equal frequency in males and females. The disease has been considered to be of a multi factorial origin. A genetic influence in the causation of Psoriasis is now fairly well established. A sharp definable border, a bright red color & silvery white scale demarcate the lesions of Psoriasis. The sharp border, which is seen abruptly, demarcates the epidermal & dermal changes in Psoriasis. These occur an accelerated proliferation of keratinocytes as well as distributed cell maturation. The epithelial cell proliferation increases resulting in a 12 fold shortening of the cell cycle. Turnover rate of normal epidermis is 457 hours, which is shortened to 37.5 hours in Psoriatic.

Psoriasis according to Ayurveda

Acharya Charak has described the involvement of Vata and Kapha in Ekkushtha.
Accumulation of Toxins or Ama (toxins), could also Lead to this Disease Condition.
Psoriasis occurs when the immune system mistakes the skin cells as a pathogen, and sends out faulty signals that speed up the growth cycle of skin cells.

The most common form, Plaque Psoriasis, and is commonly seen as red and white hues of scaly patches appearing on top first layer of the epidermis.

Types of Psoriasis

Plaque Psoriasis: The most common form, plaque psoriasis causes dry, raised, red skin lesions (plaques) covered with silvery scales. The plaques itch or may be painful and can occur anywhere on your body, including your genitals and the soft tissue inside your mouth. You may have just a few plaques or many, and in severe cases, the skin around your joints may crack and bleed.

Nail Psoriasis: Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails may become loose and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.

Scalp Psoriasis
Guttate Psoriasis
Inverse Psoriasis
Pustular Psoriasis
Erythrodermic Psoriasis

Psoriatic Arthritis: In addition to inflamed, scaly skin, psoriatic arthritis causes pitted, discolored nails and the swollen; one faces painful joints that are typical as seen in arthritis. It can also lead to inflammatory eye conditions, such as conjunctivitis. Symptoms range from mild to severe, and psoriatic arthritis can affect any joint. Although the disease usually is not as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity.

Etiological Factors: Psoriasis was previously thought to be a disorder of primarily of skin cells (Keratinocytes) but is now recognized to be mediated by Immune System. Changes in skin cell differentiation and proliferation are probably initiated and perpetuated by T-Lymphocyte cells and their signals to many other components of immune system. Genetic factors play some role, but environmental factors also contribute to disease susceptibility. Psoriasis is not contagious.

What does Heredity have to do with it?

Scientists now believe that at least 10 percent of the general population inherits one or more of the genes that create a predisposition to psoriasis. However only 2-3 percent of the population suffers from this disease.

This is perceived because only 2-3 percent of people encounter the "right" mix of genetics and triggers, which leads to the development of psoriasis. Those who have a genetic disease but don't have a family history of it, for example, may have "inherited" two genes from their father and two from their mother—neither of whom had all four and therefore never developed the disease.

Risk Factors

Anyone can develop psoriasis, but these factors can increase the risk of developing the disease to anybody:

  • Family history. Perhaps the most significant risk factor for psoriasis is having a family history of the disease. About 40 percent of people with psoriasis have a family member with the disease, although this may be an underestimate.
  • Viral and bacterial infections. People with HIV are more likely to develop psoriasis than people with healthy immune systems. Children and young adults with recurring infections, particularly strep throat, are at high risk.
  • Stress. Because stress can impact your immune system, high stress levels may increase the risk of psoriasis.
  • Obesity. Excess weight increases the risk of inverse psoriasis. In addition, plaques associated with all types of psoriasis often developed in skin creases and folds.
  • Smoking. Smoking tobacco not only increases the risk of psoriasis but also increases the severity of the disease. Smoking may also play a role in the initial development of the disease.

Complications

Depending on the type and location of the psoriasis and how widespread the disease is, psoriasis can cause complications. Complications like; thickened skin and bacterial skin infections caused by scratching in an attempt to relieve severe itching. Fluid and electrolyte imbalance in the case of severe pustular psoriasis. Low self-esteem, Depression, Stress, Anxiety, Social isolation.

If one has psoriasis, there is greater risk of developing certain diseases, such as metabolic syndrome, a cluster of conditions that include high blood pressure and elevated insulin levels; inflammatory bowel disease; cardiovascular disease; and possibly cancer.

In addition, psoriatic arthritis can be debilitating and painful, making it difficult to go about your daily routine. Despite medications, psoriatic arthritis can cause joint damage.

Provocation Factors

Local factors: Local injury to skin produces psoriatic lesions, the well-known Koebner Phenomenon which usually occurs within 7-14 days.

Emotional stress: The disease itself could produce a reactive depression, which could further exacerbate the disease.

Infections: Streptococcal UTI has been shown to exacerbate Psoriasis. Other infective foci from sinus, tonsil, gall bladder and oral cavity may be the cause for exacerbation.

Drugs: Beta-blockers, NSAIDS, Anti depressant, Corticosteroid therapy withdrawal, Alcoholic beverages etc.

Lifestyle and Home Remedies

Although self-help measures won't cure psoriasis, they may help improve the appearance and feel of damaged skin. Following measures may benefit patient:

Take daily baths. Bathing daily helps remove scales and calm inflamed skin. Add bath oil, colloidal oatmeal, Epsom salts or Dead Sea salts to the water and soak for at least 15 minutes. Avoid hot water and harsh soaps, which can worsen symptoms; use lukewarm water and mild soaps that have added oils and fats. Nimb leaf bath is the best natural way of bath.

Use moisturizer. Blot the skin after bathing, then immediately apply a Coconut oil, which is useful as a topical ointment and is a safe and effective treatment for Psoriasis. It has been used to moisturize skin for centuries. However, the true benefits of coconut oil are its anti-septic and anti-inflammatory properties.

Cover the affected areas overnight. To help improve redness and scaling, apply an ointment-based moisturizer to the skin and wrap with plastic wrap overnight. In the morning, remove the covering and wash away the scales with a bath or a shower.

Expose skin to small amounts of sunlight. A controlled amount of sunlight can significantly improve lesions, but too much sunlight can trigger or worsen outbreaks and increase the risk of skin cancer. If patient wants sunbathe, it is suggested to try short sessions three or more times a week. Keep a record of when and how long one was in the sun to help avoid overexposure. And be sure to protect healthy skin with a broad-spectrum sunscreen with an SPF of at least 15. Apply sunscreen generously, and reapply every two hours — or more often while swimming or perspiring. Before beginning any sunbathing program, ask doctor about the best way to use natural sunlight to treat the skin.

Avoid psoriasis triggers, if possible. Find out what triggers, if any. Triggers worsen psoriasis and take steps to prevent or avoid them. Infections, injuries to the skin, stress, smoking and intense sunlight exposure can worsen psoriasis.

Avoid drinking alcohol. Alcohol consumption may decrease the effectiveness of some psoriasis treatments.

Eat a healthy diet. Although there is no evidence that certain foods will either improve or aggravate psoriasis, it is important to eat a healthy diet, particularly when one has a chronic disease. A healthy diet includes eating a variety of fruits, vegetables of all colors and whole grains. While eating meat, focus on lean cuts and fish. If patient think certain foods make his/her symptoms better or worsen, keep a food diary to see what effect different foods have on own body.

Treatment Psoriasis according to Ayurveda

Ayurveda believes that impurities in the blood associated with emotional factors are the causes of the disease. Psoriasis is believed to occur due to vitiation of all the three doshas (Vata, Pitta, Kapha) in varying degrees, but predominantly Vata and Kapha according to the Ayurvedic concept.

The predominance of vatta causes pain, dryness and scaling of skin. Pitta vitiation leads to burning sensation, redness, inflammation etc. Kapha causes rashes, itching, discharge, thickening of skin etc. From these signs and symptoms, the doshic involvement is analyzed carefully in each patient, which is of utmost importance in the treatment of this disease. Irregular food habits, consumption of foodstuffs that are advised not to be eaten together (incompatible foods like dairy products with fish), excessive intake of yogurt, paneer, black gram, seafood, sour and salted items etc. which activates the pathogenesis. The produced toxins accumulate in deep tissues like rasa (nutrient plasma), rakta (blood), mamsa (muscles), and laseeka (lymphatic). These toxins cause contamination of deeper tissues, leading to Psoriasis. Alcohol and tobacco consumption will act as a catalyst here. Ayurveda also emphasizes on the effect of stress in the pathogenesis of Psoriasis. The vitiated doshas affect the skin and blood tissues. They also influence water element of the affected region on skin. Thus the skin, which is influenced by affected doshas, becomes discolored (white or copper colored), scaly and thin.

Treatment primarily focuses on blood purification and balancing the vitiated Doshas. Treatment of Psoriasis comprises of:

  • Shodhana chikitsa (Detoxification) through Panchakarma therapies
  • Shamana chikitsa through administration of internal medication and external applications
  • Rasayana chikitsa (immunomodulation) through kayakalpa
  • Very strict Diet regime
  • Lifestyle changes
  • Stress management

Ayurveda experts have experienced the best treatment success rate in treating Psoriasis. If the patient can implement all the instructions as advised and completely follows the diet regime & healthy lifestyle, Psoriasis is completely curable without any recurrence.

The Treatment of Psoriasis based on counseling to the patient’s life style management, diet management, Ayurveda Panchakarma especially Vamana and Virechana, are very effective in case of Scalp Psoriasis while, Shirodhara with proper oils Is also very effective treatment.

Stress Management

It is important to maintain a healthy lifestyle in order to adapt to this condition. Regular exercise and stress management are also very important. Yogic Asanas and Pranayama can help to keep the mind and body fit and healthy.

Ayurveda Psoriasis treatment includes:

  • Oral Ayurveda Medicines
  • Immunomodulators For Immunity
  • External applications
  • Yoga And Meditation to Relieve Mental Stress
  • Regular Follow Up

Some effective natural Psoriasis treatment, precautionary tips and natural cure for Psoriasis

  • The use of curd in the form of buttermilk has proved useful in psoriasis and the patient should drink it in liberal quantities.
  • Do not control natural urges like vomiting, urination, bowel emptying etc.
  • Avoid taking spicy food and consume only easily digestible food.
  • Do not eat too much of salty, sour or acidic foods.
  • Avoid consuming opposite foods.
  • Include more fruits, vegetables and fruit juices in diet. Bitter gourd, curd, boiled vegetables, pumpkin etc. are good psoriasis diets.
  • Avoid animal fats, eggs, and processed canned foods from your diet.
  • Application of avocado oil gently on the affected part is found to be an effective treatment.
  • Cod liver oil, lecithin, linseed oil, vitamin E, and zinc fasten the healing process.
  • Apply moisturizing cream or gel at regular intervals to maintain the moisture level of the skin.
  • Avoid using soap while taking bath instead use gram flour and use herbal scrubber.
  • Avoid pricking, peeling and scratching skin.
  • Use separate, clean clothes and towel.
  • Taking bath in seawater is found to be very effective in psoriasis treatment.
  • Drinking fresh bitter gourd juice mixed with one teaspoon of lime juice empty stomach is an effective psoriasis treatment.
  • Applying aloe vera cream thinly to irritated skin and rubbing lightly is effective.
  • Mental health is absolutely necessary for an effective treatment of psoriasis. Try deep breathing and relaxation exercises to reduce stress.
  • Exposing to mild sunlight daily for 30 minutes will improve the texture of the affected area of the skin.

Article by Dr. Gaurang Joshi

Dr. Gaurang Joshi, (B.A.M.S., Gujarat Ayurved University), International Ayurveda Physician, Expert Ayurveda Skin Specialist, Expert in Ayurveda Oncology, Director- Atharva Multispecialty Ayurveda Hospital, Cancer Research Center, Panchakarma And Skin Care Hospital, Rajkot, President-International Psoriasis Foundation, Practicing since last 22 years. Chairman- At... Read More →

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