Psoriasis is a chronic inflammatory skin condition characterised by red and scaly plaque rash. It is thought to be immune-mediated inflammatory (autoimmune) disease. It is not contagious. Psoriasis also can affect nails and joints (causing psoriatic arthritis). Psoriasis affects 2-4% of males and females. It affects at any age from childhood to adult. It has peaks onset of 30-39 years and 50-69 years.

Risk factor for triggering or worsening psoriasis:

  • Family history especially in those with first degree relatives. Genetics suspectibility with major histocompatibility complex on chromosome 6p21, IL-12 and IL-23 genes had been implicated in psoriasis
  • Smoking
  • Obesity
  • Drugs such as Lithium, Beta- blockers, antimalarials, nonsteroidal anti-inflammatory drugs
  • Infections due to viral or bacterial infections. Poststreptococcal infection causes flare of guttate psoriasis. HIV is known to worsen the condition of psoriasis.
  • Excess alcohol consumption

Clinical features:

Psoriasis usually presents with symmetrically distributed, red, scaly plaques with well defined borders. The scale can be silvery white and may have peeling surface. Scaling and redness of skin occurs due to increased growth than normal and cells turnover in psoriasis with inflammation. In normal skin, the skin cells turnover is 27 days but in psoriasis, the skin cells turnover become shortened to 4 days. The most common sites affected are scalp, elbows and knees. In severe form of psoriasis, it can affect the whole body. Some patient can complain itchy of the skin leading to scratching and lichenification (thickened leathery skin).

Tinnitus is the perception of sound experienced by a person as noise in the absence of external noise. Tinnitus is not a disease itself. The sound can be buzzing, hissing, whistling, roaring, ringing, humming or hissing. It can be continuous or occur intermittently. It may be pulsatile or non-pulsatile. Tinnitus does not have to dramatically affect your quality of life. You should avoid focussing too much attention on your tinnitus. Avoid excessive noise, find relaxation and stress management techniques that work for you.

Approximately, 17 to 20% of Australians suffer from some degree of tinnitus, varying from mild to severe. It is common for a person's to be affected by stress or tiredness.

Tinnitus can be triggerred along the auditory pathway. The majority of patients have tinnitus due to hearing loss at the cochlea or cochlear nerve level. PET scanning and functional MRI studies indicate that the loss of cochlear input to neurons in the central auditory pathways (such as occurs with cochlear hair cell damage due to ototoxicity, noise trauma or a lesion of the cochlear nerve) can result in abnormal neural activity in the auditory cortex causing tinnitus.

Meniere disease is thought to arise from abnormal fluid balance in the inner ear, which is the centre of hearing and balance. During an attack, the person experiences vertigo- a sensation that they or the world around them is moving. They feel dizzy and sick, their hearing is dominated by a hissing or roaring sound (tinnitus) and one or both ears feel full.

The inner ear contains a series of canals filled with fluid. These canals are at different angles. When your head is moved, the rolling of the fluid inside these canals tells your brain exactly how far, how fast and in what direction your head is moving. Information from these canals is passed along to the brain via the vestibular (balance) nerve. If your brain knows the position of the head, it can work out the position of the rest of your body. 

The cochlea is the snail-shaped hearing organ in your inner ear, which is also filled with fluid. This fluid moves in response to sounds. Messages are passed along the hearing nerve to the brain to tell you what you are hearing.

Meniere disease is diagnosed only if the patient complain of both episodic vertigo and sensorineural hearing loss. Vertigo may be associated with nausea and vomiting, and persists from 20 minutes to 24 hour duration. Sensorineural hearing loss is usually fluctuating and often initially affects lower frequencies. Hearing loss progresses over time and often results in permanent hearing loss at all frequencies in the affected ear over an 8 to 10 year period.