Psoriasis and Psoriatic Arthritis

Psoriasis is a common and chronic skin disorder that affects over 80 million people worldwide. It is prevalence in men and women and across all socio-economic groups. Psoriasis can develop at any age, although it commonly appears between the ages of 15 and 22. Females tend to develop psoriasis slightly earlier than males, and those with a family history also have an earlier age of onset. The disease can last for a short period of time or for a lifetime, with periods of relapses and remissions therefore difficult to predict the course of the disease.

Psoriasis is an inflammatory and proliferative disease of the skin that results in a rapid replication or turnover of the skin cells. The rapid replication of skin cells is more than 5 times of the normal rate, leading to thickening of the outer layers of the skins. Simple put, the skin cells replenishes itself faster than the shedding of the outer skins. This results patches of dull-red or pinkies thickened patches with silvery scales which are sometime known as lesions or plaques.

Psoriasis Plaque

Psoriasis on Scalp

Psoriasis on Knees

The common area where the disease presents itself are; elbows, knees, shins, scalp, fingernails, toenails, lower back and buttocks. Psoriasis also involves the groins, armpits, prineum and the area under the breasts, the lesions tend to be less scaly and rather shiny. Up to 50% of affected patients experience significant itch, especially on the scalp and lower legs.

In some cases, psoriasis is associated with psoriatic arthritis, a conditon similar to rheumatoid arthritis, that causes inflammation and stiffness in and around joints. About 15% of people with psoriasis will develop psoriatic arthiritis, and psoriatic arthritis can also be present without psoriasis.

Psoriasis causes is unknown, believed to have a genetic component and some link it to over active immune system. Several but common triggers include trauma, infection, and certain drugs. Diagnosis of psoriasis is based on appearance and distribution of the plaques.

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Western Medicine View

There are various theories on the causes of psoriasis from the western medicine point. One theory with some evidence is that psoriasis can be inherited but there is much controversy over the mode of  inheritance. The history of psoriasis in some families seem to suggest a simple autosomal inheritance with reduced penetrance, although evidence has been presented for multifactorial genetic components.

Note: Penetration is the frequency  with which a mutant gene produces its characteristic effect in those invididual prossessing it.

Genetics Double Helix

There are also suggestion of link with human leucocyte antigen (HLA) phenotypes. The precise cause of psoriasis is not clear but the enhanced keratinocyte proliferation results in thickening of the epidermis. The augmented growth rate of the epidermis (or outer skin) is a result of an increased proportion of cycling cells recurited from the base epidermis rather than a chnge in the cell cycle time.

According to the autoimmune theory, psoriasis is a skin disorder driven by the immune system, especially involving a type of white blood cellcalled a T cell. Normally, T cells help protect the body against infection and disease. In the case of psoriasis, T cells are put into action by mistake and become so active that they trigger other immune responses, which lead to inflammation and to rapid turnover of skin cells.

Auto Immune Response

Chinese Medicine View

Chinese medicine blame the disease to deficiency of the blood, blockages of the flow of Qi, the food one consume and the emotional well being of a person. Combination of different type of causes will manifest itself in the pattern or appearance of psoriasis on the skin. For example, if the skin is itchy and red the cause is usually Wind and Heat; thick and purplish patches are likely to be due to Blood Stasis; Heat and Damp are indicated by red, weeping patches and if the patient feels tired easily and the patches are thick, pale and dry this is often due to a deficiency of blood and Qi.

Qi Meridians

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• Oriental Medicine Classification of Psoriasis

Psoriasis is called “SONG PI XIAN” in chinese. When it appears in dotted form it is called “BAI BI” literary means white skin. It is said to be caused by malnourishment of the skin due to Blood Dryness. Such dryness can be caused by Invasion of Pathogenic Wind or by Heat.  The defination of “Heat”, in Traditional Chinese Medicine (TCM), refers to both heat which you can measure, like a fever, or heat which you can’t measure – like hot flashes. Heat is also inflamation, hyperactivity, or over stimulation.

Yin and Yang

From the point of Oriental Medicine, psoriasis can be classified based on the patterns of symptoms. For example, if the skin is itchy and red the cause is usually wind and heat; thick and purplish patches are likely to be due to blood stasis; heat and damp are indicated by red, weeping patches and if the patient feels tired easily and patches are thick, pale and dry, this is often due to deficiency of blood and Chi.

Study of Body Chi

In the Oriental view, psoriasis is divided into three basic categories based on the share “PATTERNS” of symptoms according to traditional theory. Individuals may show symptoms from more than one category and rarely does an individual demonstrate all symptoms within a single category.

Type one is typically seen in weak or elderly patients who may be thin, undernourished, of frail constitution, or who tire easily. In this type of patient the digestive system or lungs may be weak or compromised in some fashion. Consequently there may be patterns of asthma, respiratory allergies, sinus problems, digestive discomforts, or more severe disorders such as IBS, crohnes, and chronic fatigue syndrome.

Oriental Medication

The second type of psoriasis is usually seen in individuals with high stress levels, and those dealing with anger, type A personalities. These presentations have more to do with the liver organ system and therefore often present together with those who consume large amounts of alcohol, tobacco, sugar, coffee, and other medications and drugs. Other accompanying symptoms could be: Heat, migraines, high blood pressure, shoulder and neck tension, red itchy eyes, allergies, history of stroke, cramps, spasms, ticks, and PMS.

Stress Out

The third type of psoriasis manifests in those who consume large amounts of fried foods, gooey, heavy, creamy foods, sugar, and those who live in damp, tropical environments. These individuals may or may not be overweight, but usually have sluggish metabolism and sluggish energy levels. Sometimes these patients will test positive for harmful bacterias, yeasts, and will often feel lethargic, heavy, have frontal headaches, difficulty concentrating, poor memory, foggy thinking, and strong body odors.

Sweet Foods

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