Psoriasis and Psoriatic Arthritis

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.

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.

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.

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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.

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.

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.

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.

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.

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• Causes of Psoriasis

Psoriasis have many clinical variants. These differ in severity, location, longevity, shape and pattern of scaling. The most comment variants are:

Plaque psoriasis

Nail psoriasis

Pustular psoriasis

Flexural psoriasis

Erythrodermic psoriasis

Guttate psoriasis

Psoriatic arthritis

These variants present differing symptoms and signs which are briefly described below.

(a) Plaque Psoriasis

It is also known as chronic stable plaque psoriasis or psoriasis vulgaris. This is the most common form of psoriasis. The lesions are of deeper pink color than those seen in eczema or seborrhoeic dermatitis. The distinctive nature of this hue of pink is lost in dark-skinned individual. The most area of manifestation are the knees, elbows, buttocks, scalp and the anterior shins and forearms.

(b) Nail Psoriasis

This form of psoriasis causes discoloring under the nail plate, pitting of the nails, lines across the nais, thickening of the skin under the nails, loosening and crumbling of the nails.

(c) Pustular Psoriasis

Pustular psoriasis appear in two forms; palmar-plantar and generalised. Palmar-plantar psoriasis are localised form in the area of palms and soles. This form is extremely rare before adulthood.

The Generalised Pustular psoriasis is a dermatological emergency. Pustules appear as red patches widespread randomly on any part of the body. It was known that oral steriods can trigger this condition and should never be used routinely for the treatmetn of psoriasis. The patients with such conditons will have to be admitted to a hospital as a matter of urgency.

(d) Flexural Psoriasis

Flexural lesions of psoriasis occur under the breast and armpits. This is more common in older patients, as well as in those who are overweight.

(e) Erythrodermic Psoriasis

Erythrodermic psoriasis term is used when more than 95% of the skin is involved in a rash of any kind.

(f) Guttate Psoriasis

This form of psoriasis are more commonly affects children and young adults. It often follows a streptococcal sore throat. It appears as many small, red, drop-like, scaly spots. Guttate psoriasis may develop into the more common chronic plaque form of psoriasis.

(g) Psoriatic Arthritis

As the name implies, it involves the joint and connective tissue by causing inflamation. It is most common at the joints of the fingers and toes. About 15% of those who have psoriasis will develop psoriatic arthritis.

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