Description

Psoriasis is a chronic, immune-mediated inflammatory skin disease characterised by well-demarcated erythematous plaques with silvery-white scales. It affects approximately 2–3% of the global population and is associated with systemic comorbidities including psoriatic arthritis, cardiovascular disease, and metabolic syndrome.

Symptoms

Well-demarcated erythematous plaques with silvery scales
Commonly on elbows, knees, scalp, and lower back
Nail changes (pitting, onycholysis, oil-drop sign)
Koebner phenomenon (lesions at sites of trauma)
Pruritus (variable)
Joint pain if psoriatic arthritis develops

Causes & Triggers

Genetic susceptibility (HLA-Cw6 and others)
T-cell mediated autoimmune response (Th17/IL-23 axis)
Triggers: infections (streptococcal), stress, medications (lithium, beta-blockers)
Epidermal hyperproliferation (shortened cell cycle)
Inflammatory cytokine cascade (TNF-α, IL-17, IL-23)

Severity Classification

Mild Less than 3% BSA, limited plaques, responsive to topical therapy

Moderate 3–10% BSA, multiple plaques, affecting quality of life

Severe Greater than 10% BSA, widespread plaques, or any involvement causing significant disability

Treatment Ladder

1 Mild: Topical corticosteroids + vitamin D analogues (calcipotriol)
2 Scalp/limited: Topical steroids + salicylic acid (descaling)
3 Moderate: Phototherapy (NB-UVB) or topical combination therapy
4 Moderate–Severe: Systemic agents (methotrexate, cyclosporine, apremilast)
5 Severe / Refractory: Biologic agents (anti-TNF, anti-IL-17, anti-IL-23)

Relevant Compounds

Aloe Vera

Soothing moisturiser — adjunct to topical therapy

Aloe vera is derived from the inner gel of Aloe barbadensis miller leaves. It contains over 75 activ…

Ceramides

Barrier repair — addresses impaired lipid barrier

Ceramides are a family of waxy lipid molecules that make up approximately 50% of the lipids in the s…

Hydrocortisone

Mild corticosteroid for facial/flexural psoriasis

Hydrocortisone is a low-potency topical corticosteroid identical to endogenous cortisol. It is the m…

Niacinamide

Anti-inflammatory and barrier-repair adjunct

Niacinamide is the physiologically active amide form of vitamin B3. It is a versatile, well-tolerate…

Panthenol

Soothing and promotes skin repair

Panthenol (D-panthenol or dexpanthenol) is the alcohol analogue of pantothenic acid (vitamin B5). Up…

Salicylic Acid

Keratolytic — removes scales to improve drug penetration

Salicylic acid is a lipophilic beta hydroxy acid with keratolytic, comedolytic, and mild anti-inflam…

Recommended Drugs

Cortaid OTC hydrocortisone for mild facial/flexural plaques

Suggested Cosmetics

Cetaphil Gentle Skin Cleanser Non-irritating cleanser for psoriatic skin Re'equil Ceramide & Hyaluronic Acid Moisturiser Barrier-repairing emollient for dry psoriatic skin Venusia Max Intensive Moisturising Cream Emollient for dry psoriatic plaques

Lifestyle Tips

Use thick emollients regularly to reduce scaling and itching
Avoid skin trauma — cuts, scrapes can trigger Koebner response
Moderate alcohol intake and avoid smoking
Manage stress — psychological stress is a common trigger
Screen for metabolic syndrome and cardiovascular risk factors
Regular joint assessment for early psoriatic arthritis detection

When to Refer

Moderate-to-severe disease requiring systemic or biologic therapy
Joint symptoms suggestive of psoriatic arthritis
Erythrodermic or pustular psoriasis (urgent)
Failure of topical therapy after 8–12 weeks
Significant psychological impact