The name of the disease is derived from the Greek word ‘psora’ which means ‘itch’. In ancient Hahnemanian days, diseases were categorised into three miasms - psora, syphilis and sycosis. They called itch and functional diseases as psora; complicated, destructive and veneral diseases as syphilis; and fig wart and tumourous diseases as sycosis. Syphilis and sycosis usually arise complicating the initial psora. Psoriasis is one of the most maltreated diseases from olden days, which continues now with the search of a good remedy.

Psoriasis is a non-contagious, dry, inflammatory, ugly skin disorder, which can involve the entire system of a person. This disease is chronic in nature with a tendency to relapse. It is mostly inherited. In this disease, the skin keeps scaling as flakes, due to rapid, excessive multiplication of the epidermis cells which look like fishy skin (plaques - thick accumulation of silvery, scaly skins) and finally peels off as exfoliation. The silvery plaques are caused by accelerated regeneration of skin due to a rapid destructive process. It will not spread from one person to another by contact, but can be transmitted genetically (25 per cent).

Incidence - Psoriasis occurs most commonly in the third decade of life. It has higher incidence in females than males. Children are rarely affected. Whites suffer more than blacks. It can occur in single or multiple spots. It is often found to be persistent without any spread in case of single area involvement (tip of fingers, elbows, etc), whereas it spreads rapidly in case of multiple spots occurrences. It usually has a familial trait. Psoriasis most commonly occurs on the extensor aspect, i.e. elbows, knees & lower back. The other common places are scalp, tips of fingers or toes, palms, soles, umbilicus, gluteus, under the breasts aand genitals. Nearly 30 per cent of psoriasis patients have arthritis problems.

Causes - The causes remain unknown. It is supposed to be an auto immune disorder which is inherited. The occurrences are more common in winter and better in the warm climates. The complaint is also seen to be aggravated after depression, worries, excessive sweating, hot sun, periods, full moon or new moon phases, drugs, fever, etc. Sometimes food can also trigger the disease process. For example - citrus fruits, sour foods, sauces, coffee, tea, alcohol and soft drinks.

Symptoms - may vary, depending upon the type and intensity of the psoriasis. The main symptoms are skin symptoms, but other symptoms like joint pains, problem involving the heart can also occur. Symptoms of psoriasis can shine and wane any time and rebound any time with variation in intensity and remission periods. However, in most cases, psoriasis is persistent and occurs symmetrically denoting its systemic origin. The common symptoms are

• Dryness of skin
• Intense itching which leads to scratching
• Cracks in skin
• Burning of skin
• Macules, papules and pustules in the skin
• Adherent silvery scales - when peeled off shows red skin
• Yellow or discoloured pitted nails
• Pustular blisters
• Joint pains with inflammation and swelling
• Sometimes spondylosis, gout, renal stones, abdominal disorders

Types - Depending upon the place of involvement and type of symptoms, psoriasis has been classified as following types. Plaque psoriasis – is the commonest psoriasis named after the characteristic occurrence of plaque as crusts. The removal of plaque will expose raw inflamed skin.

• Psoriatic arthritis – psoriasis accompanied by joint pain
• Pustular psoriasis – psoriasis with pustular blisters
• Guttate psoriasis – multiple dotted occurrence of psoriasis
• Flexural psoriasis – smooth inflamed psoriasis in folds of skin without scaling
• Erythrodermic psoriasis – severe form of psoriasis with terrible itching and redness

Diagnosis – is made easily by clinical examination. Usually no tests are required to diagnose psoriasis, but to rule out other complications, blood tests, urine test and imaging studies are often performed. Sometimes biopsy may be necessary to differentiate it from fungal infections. Blood tests are done for total count, differential count, ESR, RA factor, ASO titre, Serum uric acid level, T-cells, etc. Leucocytosis and increased T-cell lymphocytes are often noted. The microscopic examination of the discharges or blister fluid shows only lymphocytes infiltration. Imaging studies like X-ray or bone scan can help in diagnosing the case with joint pain. Psoriasis is often confused with diaper dermatitis, seborrhoeic dermatitis and fungal infection of skin and nails.

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