Psoriasis is an endogenous immune mediate condition(believed to be autoimmune) where there is increased epidermal cell proliferation which is result of excessive cell division in basal layers and transit time of keratinocytes through epidermis is reduced and reduced epidermal turnover from 28days to 5-6 days; its clinically characterized by well-defined erythematous plaques with silvery scales and flakes
A strong association has been noticed between certain loci on genome , many genes have been identified but still it remains unclearance how they all might be interelated
Most of the gene identified are related to MHC (Major Histocompatibility Complex) and T cells.
- 9 Loci on different Chromosomes are identified by Genome-wide linkage Analysis which are supposed to be linked with Psoriasis and named Psoriasis Susceptibility 1 to 9 (PSORS1 till PSORS9) within this locus are also found genes contributing in pathways of inflamation and certain mutations in this region have been found in psoriasis. Genome Wide Association Scan identified many other non-specific genes which are responsible in expressing inflamatory protiens which affects the cells of immune system which are also involved in psoriasis.
- PSORS1 is located on chromosome 6 in Major Histocompatibility Complex ; 3 Genes in this Locus are associated with Psoriasis vulgaris viz:- 1)HLA-C variant HLAC-w6 it encodes a MHC Class 1 Protien 2)CCHCR1 variant WWC it encodes coiled protein which if found to be overexpressed in epidermis of Psoriatic patch on skin.
- CDSN Variant allele5 which encodes Corneodesmosin it is expressed in Granular and Cornified layers of Epidermis and upregulated in Psoriasis.
- IL12β gene on chromosome 5q which expresses Interlukin12B(IL12B)
- IL23R gene on Chromosome 1p which expresses interlukin23 receptor and is inlolved in T cell differentiation;psoriasis is belived to be T cell medaited inflamatory condition.
- Both this above mentioned genes are also involved in upregulating Tumour Necrosis Factor α (TNFα) and Nuclear Factor κB.
- Gene encoding CARD14 is found directly linked to Plaque type Psoriasis; any mutation in this gene and environmental trigger causes plaque type psoriasis.
ii)Envirinmental and lifestyle
Harsh environment like excess of heat and cold, extreme dry wether, irregular diet and sleep pattern, excess of mental and physical stress, substance abuse, regular exposure to excess of chemicals and other pollutants etc have been associated with aggravations in those with prexisting psoriasis and precipitates in those genetic predesposition to develop psoriasis.
After infection with certain bacteria and virus its been observed that body develops an autoimmune state resulting into psoriasis.
Certain medicines induce it, like beta blockers calcium channel blockers , antihyperlipidaemic medications , captopril , anti malarials, lithium, NSAIDS, terbinafin, glyburide, interleukins, interferons , TNF inhibitors like infliximab and adalibumab, terbinafin , Granulocyte colony stimulating factor, glyburide, withdrawal of cortocosteroidal topical applications shows severe rebound aggravations.
TYPES OF PSORIASIS
OTHER MAJOR SUBTYPES :-
Generalised pustular psoriasis/pustular psoriasis of Von Zumbusch; during pregnancy its termed as impetigo herpetiformis
Any of above type may present with involvement of nail and joints and it will be termed as nail psoriasis and Psoriatic Arthritis respectively.
SIGNS & SYMPTOMS FOR DIAGNOSIS
Though all signs may not be present or common in every case and also many different type of psoriasis present in different manner but still there are few signs and symptoms ; the presence of which may help us in diagnosis.
Silvery adherent scales and flakes
Well defined margins
Itching irritation and pain restricted only on papuler/pustules /plaque
Red erythematous base with plaque above
Frequently observed cyclic pattern of eruptions
Extensor surface involvement
Auspitz’s sign ; there is pin point bleeding when the scale is removed
Koebner Phenomenon; in this we observe psoriatic lesions are induced at the site of trauma to the skin.
Common Homoeopathic medicines for Psoriasis
A constitutional approach is required in its treatment
Remedies are selected after proper case taking and repertorisation ; Few of the remedies frequently prescribed are:
- Natrum Muriaticum
- Calcarea Carb
Few solved Psoriasis cases at Dr. SHAH’s Homoeopathy with before and after pics in links below