Psoriasis is a common, genetically determined chronic, relapsing, inflammatory disorder of the skin characterized by red, scaly, sharply demarcated plaques that typically exhibit silvery-white scales. Psoriasis is one of the significant common chronic inflammatory diseases of the skin, affecting 2–3% of the population [1]. Up to now, there's no cure known for this disease, which is related to the extensive psychological and physical burden. This disease evolves overtime in an exceedingly complex interplay of heterogeneous genetic and environmental factors [2]. Psoriasis isn't only a skin problem but may additionally include inflammation of the joints in psoriasis arthritis [3] and comorbidities like metabolic syndrome with increased insulin resistance, increased cardiovascular risk [4,5]. Several risk factors and pathways are known to enable the event of psoriasis. Genetic factors seem to possess a task when interacting with environmental factors like drugs, stress, or streptococcal infection [6]. Almost all styles of trauma are known to be related to plaque psoriasis.

additionally, excessive scratching can trigger or aggravate localized psoriasis. The event of psoriatic plaques at any site of trauma is thought of because of the koebner reaction. The emergence of the latest psoriatic lesions within the non-involved (healthy) skin region following an injury/trauma to the healthy skin areas of psoriatic patients [7]. Sunlight is understood to be beneficial for patients with plaque psoriasis; however, during a small number of patients, the disorder could also be aggravated by light. Clinical improvement of psoriasis following sun exposure is preceded by a rapid reduction in local and systemic inflammatory markers, strongly suggesting that immune modulation mediated the observed clinical effect [8]. It was recently reported that tonsils from patients with psoriasis are more frequently infected with β-haemolytic streptococci, especially group C streptococci, than recurrently infected tonsils from patients without psoriasis [9]. Nevertheless, the immunological basis for the association of psoriasis and streptococcal throat infections continues to be under investigation.

This study was conducted at the O.P.D. of the Department of the skin and V. D. B.R.D. Medical

dactylitis, distal inter phalange (D.I.P.), and proximal inter phalange (P.I.P.) involvement and spinal inflammation.

The detailed clinical history and examination were recorded. Each patient was categorized into mild to severe psoriasis.

Each patient has undergone the following investigation.

1. Routine blood tests
2. Liver function test, kidney function test (if required)
3. Skin biopsy
4. Tests for Rheumatoid factor and serum uric acid.
5. Radiographs of both hands and feet.
6. Radiographs of the lumbosacral spine and both sacroiliac joints.
7. Radiographs of affected joints (if any).

This study was conducted on 228 patients with psoriasis attending the Dermatology outpatient department of Nehru Hospital, B.R.D. Medical College, Gorakhpur, from July 2005 to October 2006.

Table 1: Age and Sex Distribution of the subjects

The very best interest appeared in late winter and early spring [12]. The trend of online researches also implied the association between the psoriasis flare and, therefore, the weather. Our study shows that in summer, psoriasis condition improves in 43.8 6% where is aggravated in 19.2 9% and remain affected in 32.45%. Psoriasis in winter aggravated in 55.2 6%, improved in 15.7 8% and had no effect in 28.94 %. In spring, it gets aggravated in 21.9 to twenty-eight improve in 42.9 8% and no effect in 35%. In presence of sunlight improved in 21.5 0% aggravated in 14.0 3% and remain unaffected in 64.9 0%. Heinrich Koebner (1838–1904) reported the emergence of the latest psoriatic lesions within the non-involved (healthy) skin region following an injury/trauma to the healthy skin areas of psoriatic patients [7].

Still, within the present study, most of the patients were household workers and farmers. Thanks to the character of their profession, minor trauma might well be ignored, which could are related to the disease. Patients with psoriasis were 4-5 times more likely to be colonized by Staphylococcus aureus (S. aureus) on the skin and 60% more likely to be colonized within the cavity compared with healthy controls [relative risk and 95% confidence interval (CI), skin: 5.54 (3.21-9.57); nares: 1.60 (1.11-2.32)] [13]. In our study, 4.35 percent of patients with psoriasis reported pharyngitis, and during this, children and young adults below 20 years were more affected. Smoking [14-18]. And metabolic syndrome [18,19] are recognized as risk factors for severe psoriasis, but our study shows alcohol smoking, and mental stress found no relation with psoriasis.

Pregnancy in women with psoriasis represents a high-risk situation thanks to the limited therapeutic options and multiple comorbidities [20,21]. Moderate-to-severe psoriasis is associated during pregnancy with pregnancy-induced hypertensive disorders, low birth weight (L.B.W.) for age, preterm birth (PTB), depressive disorders, and gestational diabetes [21]. Even abortion [22-24] during this study, we found that 4.35 percent of pregnant women with psoriatic cases found it aggravated; in 3.5% cases, the condition improved, whereas 25.4 3% cases remain unaffected with pregnancy.

Psoriasis is aggravated during winter, but in summer and spring condition improves. At the same time, alcohol and smoking found no effect on psoriasis.