Plaque psoriasis is an autoimmune condition in which symptoms are easy to identify and hard to ignore as they can cause intense irritation. They usually appear around joints like the elbows and knees, the scalp, and the trunk. This condition is most commonly diagnosed among men and women between the ages of 18 and 25. Although it can’t be cured, plaque psoriasis, once diagnosed, can be treated and managed to reduce the frequency and severity of flare-ups.

Types
The condition can be categorized as “small” and “large” plaque psoriasis, depending on the extent to which it affects the skin.

• In the case of the former, the plaques are no bigger than a few centimeters in diameter and appear pinkish in color with a finer scale.
• Large plaque psoriasis can be described as large, well-defined plaques that are reddish in color with silvery scales.

The disease may also be categorized as localized and general.

• Localized psoriasis has plaques limited to a particular part of the body, such as the elbows or knees.
• Generalized psoriasis is characterized by plaques on the joints as well as the scalp and trunk.

Symptoms
The symptoms of plaque psoriasis may vary from person to person. They do not appear with the same frequency or intensity and usually last for a few weeks to a few months before improving. However, with time, the symptoms will come back and the cycle will repeat itself.

The common signs of this disease include

• Red, raised patches on the skin
• Patches with silvery scales and well-defined edges
• Cracked skin that may bleed
• Itchiness
• Burning sensation around the skin
• Soreness of joints
• Nails that appear thicker or ridged
• Swelling of the joints

The size of these patches ranges from the size of a coin to the size of your palm. These patches typically appear on the

• elbows,
• knees,
• scalp,
• lower back,
• palms,
• soles, and
• face.

Causes
Plaque psoriasis is an autoimmune disease that affects skin cells. Autoimmune diseases are conditions wherein the immune system cannot differentiate between healthy cells and foreign bodies, such as bacteria and viruses. Instead of attaching harmful germs, it releases antibodies that attack healthy cells in the body.

• In case of plaque psoriasis, the immune system produces an excessive amount of several types of proteins, including one known as tumor necrosis factor. This makes the skin cells grow faster than normal, which, in turn, leads to buildup on the surface of the skin.
• The exact trigger for this condition is unknown. The combination of environmental factors and genetic predisposition are believed to have an effect.
• In terms of genetics, this type of psoriasis tends to run in families. But it’s important to note that not everyone with the genes linked to psoriasis develops this disease. Studies show that only around 3% of the people born with the gene linked to psoriasis ultimately get the disease.

Plaque psoriasis can develop in a person due to factors like

• Smoking
• Stress
• Previous injuries to the skin
• Bad sunburn
• Underlying infections like strep throat
• Certain medications like beta-blockers
• Allergies

Environmental factors such as a change in the weather or diet can cause flare-ups or aggravate an existing episode. It is important to note that plaque psoriasis cannot be transferred from person to person.

Diagnosis
If you notice any of the above symptoms, do not try to self-medicate. You may be able to suppress the symptoms, but this can set the stage for further complications. Instead, consult a skin specialist at the earliest.

The doctor should be able to confirm a diagnosis by examining the patient’s medical history and visible symptoms. He/she may also want to know about the age at which the symptoms first emerged, the extent of the plaque patches, any medication you may be currently taking, previous treatments, and any other health issues you may be suffering from.

It may be categorized as mild, moderate or severe on the basis of the percentage of skin affected and the severity of the rash. The condition may be categorized as mild if it is present as only 1-2 patches. In some cases, a biopsy may be needed. This involves taking a small sample of skin cells and examining it under a microscope. Also, in the case of plaque psoriasis, the skin appears thicker and more inflamed than if it were merely a case of eczema.

Treatment options
Plaque psoriasis treatment is aimed at relieving symptoms. There are many types of treatment options available, and the best form depends on the severity of the disease and personal choices. Since the disease cannot be cured, treatment usually starts with the mildest form and progresses to stronger forms only as and when needed. Slowing down the turnover of skin cells with the least side effects is the priority.

The most common forms of treatment include

• Topical ointments

They can help reduce inflammation and slow down the growth of skin cells. These ointments may or may not include steroids. Topical ointments are usually prescribed in cases where the patient has a few plaque sections on the skin. If the plaque affects the scalp, medicated shampoos may be used instead.

• Phototherapy

This is advised in cases where the rash and plaque are more widespread. Phototherapy involves exposing the skin to ultraviolet light for a specific duration of time under medical supervision. This must be repeated on a regular basis. UV light penetrates the skin and slows down the growth of infected skin cells. Treatment may be administered at the doctor’s office or in the patient’s home.

• Systemic medications

In cases of severe inflammation, the doctor may prescribe systemic medications that calm the immune system and reduce the speed at which skin cells grow. Systemic medications should always be taken under medical supervision, be it intravenous or oral. This is because these medicines can have a number of serious side effects such as liver issues, depression, and an increased risk of skin cancer. If this type of medication is prescribed, the dosage should not be changed or stopped without the doctor’s advice.

• Biological medications

Like systemic medications, biological ones also target the immune system. But these medications only target specific types of cells. They may also keep the proteins responsible for inflammation from being generated. However, biological medications can make it harder to fight infections.

Natural remedies
While natural remedies and alternate medication should not be used as the sole form of treatment against plaque psoriasis, these can be beneficial when administered along with conventional medication. These remedies include

• Aloe vera
  The gel from aloe vera is cooling and known to reduce inflammation. This gel can be bought in a store or extracted from the plant. It can be applied topically over the affected parts. To extract aloe vera gel, cut off a leaf from the plant from near the stem. Trim the edges of an aloe leaf and remove the hard outer skin. The gel can then be scooped up. Do not use any of the yellow sap. Fresh aloe gel should ideally be used right away.
• Coal tar

When choosing a soap or shampoo, choose one that contains coal tar. Coal tar is beneficial since it helps relieve itchiness and reduces scales. Coal tar has no long term side effects, and hence, can be used for extended periods of time. However, pregnant and breastfeeding women should avoid using products with coal tar.

• Fish oil
  Fish oil is often used in combination with light therapy. The oil may be applied topically on the affected areas. It should then be covered with a dressing for 5-6 hours. Fish oil reduces inflammation and can improve scaling. This type of treatment may be continued for up to 4 weeks.
• Essential oils

Stress is one of the major contributors to this condition. One of the ways to fight stress is by using essential oils that calm the mind. Lavender oil is the most common type of essential oil used to reduce stress. Alternatively, you could use Ylang Ylang oil, chamomile oil, jasmine oil, or clary sage oil. Keep a scent diffuser with a few drops of any one of these oils and water near your bed or your table.

• Warm-water bath

When you bathe, do so with warm, and not hot, water as this could further aggravate the condition. Also, avoid using a sponge or loofah. Instead, use the palms of your hands to cleanse the skin. Use a gentle, unscented soap. After your bath, pat the skin dry with a soft towel and moisturize your skin with a hypoallergenic moisturizing cream.

• Lifestyle changes

To fight the infection of plaque psoriasis, you must quit smoking and reduce your consumption of alcohol. Set a schedule for your day so that you go to bed and wake up at the same time every day, to improve the quality of your sleep. You should also avoid consuming caffeinated drinks in the evening.

• Get some sun
  Many people diagnosed with a form of psoriasis have a vitamin D deficiency. This is one vitamin that is not found in many food items. The richest form of vitamin D is sunlight. To increase your vitamin D levels, expose yourself to sunlight in the early mornings for a few minutes. Always use sunscreen before stepping out, to protect yourself against the risk of skin cancer.

Foods to have and avoid
The food you eat can influence the speed at which a plaque psoriasis flare-up spreads or subsides. Some types of food should be avoided as they can contribute to underlying conditions that increase the risk of psoriasis, while others that curb inflammation should be added to your diet.

These foods give you a better chance of preventing plaque psoriasis:

• Omega-3-rich foods

These foods can help fight inflammation and reduce the severity of symptoms. This nutrient is found in oily fishes, beans, nuts, and seeds.

• Antioxidants

They can reduce stress in the body and fight inflammation. Vitamins A, C, and E and minerals like copper, iron, selenium, zinc, and manganese are the best examples of antioxidants. There are vitamins and minerals present in vegetables, fruits, spices like peppermint and cloves, nuts, and herbs like oregano and sage.

• Good fats

Not all fats are bad for the body. Nuts and avocados contain good fats that are needed to energize the body. That being said, these foods should be eaten in limited quantities.

You must avoid these foods to prevent plaque psoriasis:

• Fatty foods

Avoid foods with high amounts of fat content to ensure weight management. This can reduce the severity of plaque psoriasis symptoms too.

• Gluten

Many people who suffer from this psoriasis also have celiac disease. Thus, you should ideally avoid foods that contain gluten, such as wheat and wheat products, bread, beer, cornflakes, and processed foods.

• Sugar

Sugar is high in calories and contains no nutritional value. It also contributes to weight gain and increases inflammation. Hence, it should be avoided as much as possible. Instead, you could use honey or jaggery to sweeten foods.

Long-term outlook
Plaque psoriasis is a common skin condition, and though it cannot be cured, the long term outlook is not one to cause too much worry. With medication and a few changes in your lifestyle and diet, it can be easily managed, so that the symptoms do not disrupt your life.