Author Archives: Dr. Vaidya Karanvir Singh

In guttate psoriasis, small, droplet or round spots called papules that are raised and sometimes scaly.

Who gets guttate psoriasis?

Guttate psoriasis can affect people of any age. But it is a young person’s condition. It is seen commonly seen in   children, adolescents, and adults less than 30 years of age. Respiratory illnesses or viral infections are common triggers.

Clinical presentation of guttate psoriasis

In Guttate psoriasis spots aren’t very thick as compared to plaque psoriasis, which causes raised lesions. Guttate spots are also small that have thin covering of flaky skin called scales.

Appearance of Guttate psoriasis lesions

• Small in size
• Red or dark pink in color
• Different from each other
• On the torso or limbs
• Lesions are thinner than plaque psoriasis lesions

Like psoriasis, guttate psoriasis is also not contagious. It can’t spread to others through skin-to-skin contact.

Guttate psoriasis may persist for whole life if not treated, or it may convert into plaque psoriasis.

Cause of guttate psoriasis

The exact cause of psoriasis is not known yet. However combination of genetic, environmental, and immune system factors may play a role in triggering this condition.

Other factors that may trigger this skin condition may include 

• Any kind of  skin injury, like a cut, an insect bite, or a burn
• Sunburn
• Stress factor
• Some medications, like antimalarial drugs and beta-blockers (drugs used to treat heart disorders)
• Cigarette smoking

What are the stages of guttate psoriasis?

 There are mainly three stages of psoriasis, including guttate psoriasis. These stages are :

• Mild. In this condition, there are only lesions, which appear on your skin.
• Moderate. Lesions cover more area as compared to mild stage. 
• Severe. In this, lesions cover 10 percent or more of your body, sometimes the entire body.

Diagnosis of guttate psoriasis

• Diagnosis of guttate psoriasis can be made by taking physical history and by doing a physical examination. 
• Complete medical history is helpful to rule out other skin conditions. 
• PASI score is helpful to diagnose the condition and severity of condition.
•  Skin biopsy is helpful to confirm the diagnose and eliminate other possible conditions of skin and to help determine the type of psoriasis.

Following skin conditions may be mistaken with guttate psoriasis:

• Tinea corporis (ringworm of the body)
• Secondary syphilis
• Nummular eczema
• Pityriasis rosea (Christmas tree rash)
• Scarlet fever ras

Treatment options for guttate psoriasis

Treatments for guttate psoriasis depend upon to the severity of the condition. As in some mild cases, no treatment is needed. And in some cases it is seen that guttate psoriasis will clear up on its own within several weeks or months.

For treatment of psoriasis following options may be used.

Topical steroid treatments

• This is the most common treatment that is used for psoriasis. Use of topical corticosteroids can help by reducing redness, itching, and inflammation.
• Mild topical corticosteroids are helpful to treat the mild cases.
• However, topical corticosteroids can be used on their own, but often they are used in combination with other treatments for moderate to severe cases. They can be applied once or twice per day. 

Topical nonsteroidal treatments

These are usually prescribed when topical steroids are not working for you. Topical non-steroidal contains- 

• Synthetic vitamin D3. 

This is helpful for slow skin cell growth.

• Vitamin A. 

 Retinoids are a type of compound that contain vitamin A.         These help psoriasis by limiting the production of new skin cells and also help to reduce inflammation. 

OTC topical treatments

• They are used to reduce symptoms. They’re often used to reduce redness, soften lesions, or relieve itching
• Main active ingredients in OTC products are salicylic acid and coal tar. Other products may contain ingredients like:

• aloe vera
• jojoba
• zinc pyrithione
• capsaicin

Other topical products like soaps, shampoos, and gels are also available to treat psoriasis.

Phototherapy

• Phototherapy is used to treat moderate to severe cases, either alone or in combination with topical medications. 
• In Phototherapy, there is regular exposure of the skin to ultraviolet (UV) light is done. 

Other medications

• Other medications are helpful to treat severe or recurrent cases of guttate psoriasis or for cases that convert into plaque psoriasis. These medications require a doctor’s prescription and include:

Cyclosporine and methotrexate 

• These acts as an immunosuppressant. These drugs work by suppressing your immune system and it is   used to treat severe psoriasis. 

Natural treatments or home remedies for guttate psoriasis

• Sunlight.  Regular exposure to sunlight for short periods of time, may help reduce your symptoms.
• Bath salts. Soaking in a bath with Dead Sea salts will help to reduce inflammation and wash away dead skin cells.
• Coconut oil. Coconut oil will help to soften the scales on your lesions and make it easier for topical medications to get to the skin below.
• Vitamin D. Vitamin D may help reduce inflammation and improve the health of your skin. It’s usually applied topically.
• Avoid using soaps and other cosmetics that may cause itching or can irritate the skin. 

Many lifestyle changes can help you to manage your guttate psoriasis. These include:

• A nutritious diet. Having nutritious food will help to reduce guttate psoriasis symptoms. 
• Daily exercise. It’s important tofollow a proper regimen for exercise when you have psoriasis, especially for your cardiovascular health. 
• Meditation or yoga. Meditation or yoga are helpful to relax  your mind by reducing stress and overall good functioning of your body, that will help to reduce the symptoms, particularly itching.  These are helpful as stress is one of your psoriasis triggers.

What is flexural psoriasis?

• Psoriasis is a skin condition which is common nowadays. In this condition skin becomes scaly and red – thickened patches of skin are visible.  Inverse psoriasis is another name used for flexural psoriasis. In this, psoriasis is mainly localized to the skin folds and genitals. 
• Common sites of flexural psoriasis are:

1. Armpits
2. Groin
3. Under the breasts
4. Umbilicus (navel)
5. Penis
6. Vulva
7. Between the buttocks 
8. Around the anus

This condition is sometimes seen inside the ear canal, behind the ears, through the scalp, and on elbows and knees.

Clinical features of flexural psoriasis

• Appearance of the psoriasis flexural is slightly different due to moist nature of skin folds.  It’s not look like silvery scale, but is shiny and smooth. 
• Sometimes a crack (fissure) in the depth of the skin crease. The deep red colour and well-defined borders characteristic of psoriasis may still be obvious.
• It is difficult to differentiate flexural psoriasis seborrhoeic dermatitis, or sometime both conditions can co-exist. 

Complications of flexural psoriasis include:

• Irritation on skin  from heat and sweat
• Secondary fungal infections are commonly noticed particularly Candida albicans (thrush)

Common Triggers factors

In General psoriasis is an autoimmune disorder.  Combination of genetic factors and environmental factors can play a role in causing psoriasis.

More common factors that can trigger the condition of psoriasis are

• Stress
• Smoking
• Alcohol
• Certain medications, such as beta-blockers and lithium
• Infections, especially strep and upper respiratory tract infections
• Skin trauma, including sunburns, cuts, and abrasion
• Obesity

Diagnosis of Flexural psoriasis

• Diagnosis of psoriasis is done by taking proper medical history of patient and by doing visual examination of the skin. Any kind of lab investigations or other test is not helpful in confirming the diagnosis.
• A dermatologist will help to diagnose the type of lesions or damage of any other part and evidence of plaque psoriasis on the scalp or other parts of the body. Medical history may hold clues to support the diagnosis, including a family history of psoriasis or risk factors associated with the disease.
• Skin biopsy may be helpful to confirm the diagnose.

Differential diagnose of flexural psoriasis

Differential diagnose of flexural psoriasis is done with  other skin conditions which include 

• Cutaneous candidiasis (a type skin fungus)
• Erythrasma (a bacterial skin infection)
• Darier’s disease (also known as keratosis follicularis)
• Lichen sclerosus (a condition mostly affecting the genitals)
• Tinea corporis (ringworm)

What is the treatment for flexural psoriasis?

Treatment of Flexural psoriasis is done by using topical ointments. But this condition usually reoccur. Medicines that are useful to 

• Topical steroids

Sometime weak topical steroids are used mainly in combination with an antifungal agent to treat flexural psoriasis but it this condition usually recurs after discontinuing treatment. However use of  stronger topical steroids need to be used with care and only for a few days, thinly and very accurately applied to the psoriasis. You can stop the steroid cream after complete clearance of lesions.

• Vitamin D-like compounds

Calcipotriol cream is effectively used for treating psoriasis and it is safe to use and can be applied twice daily. But sometimes it can cause irritation so  If it irritates, it can be applied once daily and hydrocortisone cream 12 hours later.

• Topical calcineurin inhibitors

Topical calcineurin inhibitors and pimecrolimus cream may be effective and do not cause skin thinning.

These ointments can be used alone or in combination. When flexural psoriasis triggered by bacterial and yeast infection then  Antiseptics and topical antifungal agents are oftenly used .

• Systemic agents are helpful to treat for  flexural psoriasis.
• Use of Phototherapy is ineffective because the folds are hidden from light exposure.

AYURVEDIC TREATMENT OF FLEXIURAL PSORIASIS

Chandigarh Ayurved centre provides effective Ayurvedic  treatment for flexiural psoriasis . CAC provides a kit named ‘Psoriasis care kit’. This kit contains medications that are very effective to treat this kind of skin condition.

Psoriasis care kit

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Description of medications

1.Detox Premium Powder

The powder is very beneficial to cure any kind of body pain as it removes excess toxins from the body and balances the aggravated pitta and vata dosha. The ingredients help in reducing swelling, redness, shrinkage of tear lining in the anus, burning sensation, etc.

2.Blood Purifier Syrup 

It is ayurvedic syrup that consists of various natural ingredients such as Khadir Chall (Acacia catechu), Manjistha (Rubia cordifolia), etc. As the syrup purifies the blood by removing excess toxins it is very beneficial in maintaining proper circulation and improves the skin naturally.

 3.Twak Tailam 

Twak tailam is very effective for the skin as it deeply nourishes the tissues and improves the skin luster. The tailam is composed of yashtimadhu (Glycyrrhiza glabra), manjistha (Rubia cordifolia), etc. The tailam supports skin health, helps in reducing uneven pigments, improves complexion, and helps in deep detoxification and blood purification without any side effects.

4. Skin care tablet

Skin care tablet is a pure ayurvedic formulation. It help to maintain the texture of your skin depending on the type of skin you have. Skin care is a blood purifying tablet. It cools and detoxifies the blood, increase blood circulation of the skin. It minimizes the blemishes, lighten sun tan, delay ageing of skin and heal skin problems.

5. Panchatikta Ghrita Guggulu

Panchatikta Ghrita Guggulu is an ayurvedic preparation mainly used for skin diseases. This tablet promotes detoxification and rejuvenation. Panchatikta Ghrita Guggulu tablet is a natural source of anti – oxidant. It promotes engender vibrant and healthy skin.

6. Panchsakar Churna

Panchsakar Churna is an ayurvedic formulation that consists of five ingredients named as – Saindhav Lavana (Rock Salt), Swarnapatri (Cassia angustifolia), Shatapushpa (Anethum sowa), Shunti – (Zingiber officinale), Balaharitaki  (Unripe fruits of Terminalia chebula). Panchsakar Churna is naturally detoxifying, thus it removes the toxins from the body. It relieves inflammation and useful in all types of skin problems. 

7. Neem soap

Neem soap is natural and herbal handmade soap prepared from the standard extract of herb Neem (Azadirachta indica). It is such a wonderful herb that is easily available and shows Anti-bacterial, Anti-inflammatory, Antioxidant, Anti-microbial, Antifungal, Antiseptic properties. Neem cleanses the pores and protects the skin from various infections, Psoriasis, Eczema, Leprosy, Skin ulcers. 

8. Trikatu Tablet

Trikatu Tablet helps to eliminate excess Kapha or mucous from the body, supports respiratory system, manages weight, helps to take out impurities or ama from the body, supports healthy detoxification, reduces swelling. It shows anti-inflammatory, analgesic, expectorant, antioxidant properties.