Plaque psoriasis is the most common form of psoriasis, an auto-immune skin disease. It produces scales of red patches called plaques which are covered with white or silvery scales. Such lesions may develop at elbows, knees, scalp, the lower back and at any other area of skin. 

Psoriasis is common in all parts of the world, though the global incidence has been estimated to be from 1% to 8%. Recent year data showed that there is an upward trend in the incidence rate of childhood psoriasis. 

Psoriasis is known to affect the male and female population in equal proportion. The disorder manifests in people for the first time between ages 15 to 22 years and secondly between the ages of 55 to 70 years. 

• Immune System Activation: There are specific white blood cells called T cells more specifically Helper T cells which are activated and begin to attack the skin cells. These lead to a response through inflammation by the body. 
• Cytokine Release: Thus, activated T cells through cytokines TNF-alpha, IL-17, and IL-23 cause inflammation and boost the immune cell activity. 
• Keratinocyte Proliferation: These inflammatory cytokines are responsible for provoking mitosis of keratinocytes, the cells inherent in the skin epidermis. 
• Abnormal Skin Cell: Practically, every skin cell makes a cycle of one month of maturation and shedding, in normal conditions this takes several weeks, whereas in psoriasis it only takes three days, hence these are left with immature skin cells. 
• Plaque Formation: These cells reproduce at a faster rate, accumulate one on top of the other, forming thick layers or plaques that is rough and may have scales on the skin. 
• Chronic Inflammation: The ongoing immune response and constant skin cell turnover lead to persistent inflammation and the typical appearance of plaques. 

Plaque Psoriasis is a chronic form of autoimmune skin diseases characterized by the immune system erroneously perceiving healthy skin cells or pathogens’ invasion and attacking them. This results in faster division of skin cells and thick build-up of layers of skin on the skin surface that form scales. This disease arises due to genetic susceptibility, infections, stressful conditions, or physical injury and has components of immune dysfunction. 

Age Group: 

Above 40 years is a common age group for developing plaque psoriasis. 

• Plaques 
• Thickness and Texture 
• Location 
• Nail Changes 
• Joint Involvement 
• Scalp Examination 

Psoriatic Arthritis 

Metabolic Syndrome 

• Mild: It is typically, usually less than 5 centimetres in diameter and may be in limited sites as the elbow, knee, and scalp. 
• Moderate: These are broader plaques which can spread their effect to wide areas possibly in different parts of the body. 
• Severe: They are large and numerous, occupy large areas of the skin, and cause common signs/symptoms such as itch and discomfort. 

• Topical Treatments: The treatment for first line treatment are topical corticosteroids, vitamin D derivatives, calcipotriene, tar products and topical calcineurin inhibitors such as tacrolimus. 
• Phototherapy: Narrow-band UVB photochemotherapy is used for moderately severe and severe manifestations. 
• Systemic Treatments: Where the symptoms are worse, the patient can be prescribed oral medicines which include methotrexate, cyclosporine and acitretin.  
• Biologic agents: Biologic agents which directly act on the immune system are given to patients who fail to respond to the conventional treatments or in severe cases. 
• Lifestyle and Supportive Measures: Use of certain products and practices such as smoking and stress, and a healthy living would also be useful in the overall handling of the situation. 

Dermatology, General

• Moisturize Regularly: To prevent skin scaling it is recommended that you frequently apply thick creams or ointments on the skin.
• Healthy Diet: Anti-inflammatory foods are supposed to be included and these are mainly fruits and vegetables among others; foods rich in omega 3.
• Avoid Triggers: It should be instructed not to go near an area where smoking takes place or consumption of alcohol or specific medicines that are not suitable for the patient. 
• Regular Exercise: Sustainable weight management and improvement of a general state of health is through physical fitness. 

Dermatology, General

• Triamcinolone: This is mainly used in preparations of relatively lower concentration. Its use may result in reducing the inflammation and the itching of the skin. It is usually given to those individuals who have Psoriasis of mild to moderate nature. 
• Betamethasone: It comes in many potencies. High-potency formulations are available too. Since its anti-inflammatory action is intense, it’s most preferably used to treat moderate to severe Psoriasis. 

Dermatology, General

Tapinarof topical 

Tapinarof is used topically to treat plaque psoriasis. This medication is among the new modalities of treatment that act as non-steroidal, anti-inflammatory drugs. Tapinarof decreases inflammation and reduces rapid growth of skin cells, which happens in the case of Psoriasis.  

Dermatology, General

Coal Tar 

Since it has an anti-inflammatory effect, it treats the condition that causes the excessive skin cell production, and fights itchiness. Coal-tar preparations exist in different presentation forms including shampoos, ointments, creams, etc. 

Anthralin 

Anthralin reduces the level of cell proliferation. Its chemically reducing properties may also act to upset the oxidative metabolic processes, further reducing epidermal mitosis. 

Dermatology, General

Apremilast 

Apremilast is used in the treatment of moderate to severe plaque psoriasis. It is an orally administered selective phosphodiesterase type 4 inhibitor and a compound involved in the modulation of inflammatory and immune responses. Because of that, apremilast may reduce symptoms and signs of the psoriatic plaques because of action on the processes associated with inflammation. 

Dermatology, General

Calcitriol: This is the form of vitamin D3, it regulates the growth and differentiation of skin cells. It re-establishes the normal growth cycle of skin cells and decreases inflammation. 

Calcipotriene: Calcipotriene helps in reducing the rate of skin cells division and inflammation. 

• Assessment and Diagnosis: This involves the determination of Psoriasis sensitivity and the degree of the condition through physical checking. The diagnosis can be supported, if needed, by skin biopsy. 
• Initiation of Treatment: Topical corticosteroids or vitamin D analogs are initiated. If it involves a case of moderate to severe Psoriasis, then systemic medication or biologics can be given. 
• Monitoring and Adjustment: Regular follow up to assess the response to treatment, adjustment of drugs and dealing with the side effects. 
• Maintenance: Long-term management with ongoing treatments to maintain remission and prevent flare-ups. 
• Patient education: Patient education on self-care, lifestyle adjustment, and how to manage triggers to improve quality of life.