Psoriasis

Definition

Psoriasis is a common skin disease, characterized by thickened patches of inflamed, red skin. Elbows, knees, the groin area, genitalia, arms, legs, scalp and nails are the most common areas affected by psoriasis. It will often appear in the same place on both sides of the body. The patches can range from .04" to 2.5" in size.

Description

Normally, skin cells mature and shed after about a month. In psoriasis, the cell maturation speeds up, taking only three to four days. Because the lower layer of skin cells divides more rapidly than normal, dead cells accumulate in thicker patches on the skin's outermost layer (called the epidermis).

Forms and Classifications

Psoriasis occurs in a variety of forms that differ in their intensity, duration, location, shape and pattern of scales. The most common forms are:

Discoid or "plaque" psoriasis the most common form of psoriasis, characterized by raised, inflamed, red lesions covered with a silvery-white buildup of dead skin cells (scales). This is found primarily on the trunk, elbows, knees, scalp and finger or toe nails.

Pustular psoriasis is characterized by small pustules (blister-like lesions) found all over the body or confined to the palms, soles and other isolated areas of the body.

Guttate psoriasis occurs most frequently in children and is characterized by numerous small, red, drop-like scaly patches that develop rapidly over a wide area of skin (often after a sore throat).

Inverse psoriasis occurs in the armpit, under the breast, in skin folds, around the groin, in the cleft between the buttocks and around the genitals.

Psoriasis is classified as mild to moderate or severe. Mild psoriasis is considered to be scaling over less than 10 percent of the body, moderate psoriasis is considered to be scaling over 10 to 20 percent of the body and severe psoriasis is considered to be scaling over 20 percent of the body.

In 5 percent of all psoriasis sufferers, arthritis will develop. This condition is called psoriatic arthritis. Arthritis is inflammation of a joint, usually accompanied by pain, swelling and changes in joint structure.

Causes and Risk Factors

Psoriasis is a chronic skin disorder of unknown origin, however, heredity seems to play a role in susceptibility (1 in 3 people with psoriasis have an immediate relative with the disease).

Psoriasis can be triggered by a number of factors, such as stress, climate changes, streptococcal or HIV infection, superficial wounds, physical illness, or taking certain drugs such as lithium, beta-blockers such as propranolol or Inderal, quinidine (a heart medication) or antimalarial medications.

Diagnosis

Dermatologists diagnose psoriasis by examining the skin and noting specific characteristics of the lesions. Occasionally they may need to biopsy the lesion and examine the skin under a microscope to confirm diagnosis. There are no blood tests or other laboratory tests available for establishing diagnosis.

Treatment

There is no cure for psoriasis at this time, but there are various treatments that can, in most cases, temporarily clear the skin of psoriasis. Occasionally, psoriasis will go into spontaneous remission without treatment. If the psoriasis does not clear up, the following is a list of available treatment methods:

Topical Therapy (used to treat mild to moderate psoriasis):

• emollients (moisturizers) help soften scales and reduce discomfort

• steroid creams help reduce inflammation

• Anthralin helps slow skin cell reproduction

• coal tar preparations

• vitamin D3 or calcipotriene (brand name Dovonex)

• bath solutions, such as mineral salts or oatmeal additives, assist in soothing skin and encouraging healing

• sunbathing. Exposure helps about 95 percent of all people who tan easily. This must be practiced cautiously by those who sunburn easily.

Phototherapy(used alone or in combination with topical therapy to treat moderate to severe psoriasis):

• Ultraviolet Light B (UVB), either outdoors or from a light box in a physician's office, helps to heal lesions.

• Day Treatment Program helps heal lesions.

• Psoralen and Ultraviolet Light A (PUVA) - PUVA involves the combined use of a photosensitizing medication, called psoralen and a long-wave ultraviolet light (UVA).

• Combination therapies can also help.

Internal Medications (used for severe psoriasis):

• Methotrexate (MTX) helps to slow down cell reproduction.

• Retinoid Therapy (Etretinate (Tegison) and Accutane) helps to reduce inflammation

• Hydroxyurea (Hydrea)

• Sulfasalazine helps reduce inflammation.

• Cyclosporin A

Trial and error will tell which treatments are effective for each individual. Healing can take as little as a few weeks or as long as several months. Dermatologists may rotate patients through many different therapies to avoid long-term side effects and to determine which ones work best for that individual.

Self Care

• Keep skin lubricated. Oils, creams and petroleum jelly preparations are suggested.

• Use a humidifier in the home.

• Get out in the sun.

• Bathing in hot water may help reduce scaling.

• Use mild soaps or soap-free cleaners. Mild soaps such as Nivea Cream, Neutrogena Dry Skin, Phisoderm, Gentle Cleansing Bar, Dove, Dial or Lever 2000 are recommended.

• Minimize stress.

• Protect against skin injuries and skin infections.

Questions to Ask Your Doctor

What form of psoriasis is this?

How severe is the psoriasis? Can it increase in severity or spread?

What are the chances that another rheumatic disease may develop?

What type of treatment will you be recommending?

What measures can be taken to help prevent reoccurrence?

If over-the-counter lotions are recommended, which ones seem to be most effective?

If a biopsy is recommended, what will the result tell you?