Psoriasis is a chronic skin disorder that affects over 5 million people in the United States. The cause of psoriasis is unknown. We do know, however, that you cannot catch psoriasis; it is not contagious. There are many treatments for psoriasis but, to date, there is no cure.
SYMPTOMS:
The most common form of psoriasis is called plaque psoriasis. It is characterized by raised, inflamed (red) lesions covered with a silvery white buildup of dead skin cells, called scales. The technical name for plaque psoriasis is psoriasis vulgaris (vulgaris means common). There are other forms of psoriasis. They are pustular, guttate, inverse, and erythrodermic psoriasis.
The initial lesions of plaque psoriasis might appear as red, dot-like spots and may be very small. These initial eruptions gradually enlarge and produce a silvery white surface scale. Surface scales come off easily and are shed constantly, but those below the surface of the skin are quite adherent. When forcibly removed, they may leave tiny bleeding points known as the Auspitzs sign.
The plaques may cover large areas of skin and merge into each other. Often, the lesions appear in the same place on the right and left sides of the body. Any body surface can be affected, but the lesions appear most often on the scalp, knees, and elbows. Lesions vary in size and in shape from individual to individual. Sometimes the nails are affected, causing pitting and scaling of the base, or ridging and furrowing with an alteration in the transparency of the nail. Emotional response to the persistence and cosmetically disfiguring effects of psoriasis can be severe.
ASSOCIATED DISEASES:
To date, no other disease, with the exception of psoriatic arthritis, has been associated with psoriasis. Psoriasis, however, can appear simultaneously with any other disease. Statistically, about 10 percent of people with psoriasis develop a kind of arthritis known as psoriatic arthritis. Some physicians feel that psoriatic arthritis is even more common. Psoriatic arthritis causes pain, swelling and tenderness of the joints and the tissue around the joints. The joint may not move easily. Prompt treatment can relieve pain and inflammation and possibly help prevent joint destruction if severe arthritis is present. Psoriatic arthritis is classified as different from other arthritic diseases.
AFFECTED POPULATION:
Anyone can develop psoriasis, though heredity seems to play a role. There is a family association in one out of three cases. Psoriasis affects about 2 percent of the U.S. population and is less common in African-Americans and Asians. About 10 percent of patients have arthritis associated with their psoriasis (psoriatic arthritis).
Psoriasis appears in men and women in equal number. There are no personality types that have been identified as being more likely to develop psoriasis. It can appear at any age, but appears most often between the ages of 15 and 35. In approximately 10-15 percent of individuals with psoriasis, the disease first appears before the age of ten. The disease is also reported in infants.
CAUSES:
The cause of psoriasis is unknown. It is thought that some type of biochemical stimulus triggers the abnormal cell growth that characterizes psoriasis.
A normal skin cell matures in 28-30 days. In psoriasis, cells move to the top of the skin in three or four days. The excessive skin cells that are produced heap up and form the elevated, red, scaly lesions that characterize psoriasis. The white scale that covers the red lesion is composed of dead cells that are continually being cast off. The redness of the plaques is caused by the increased blood supply necessary to feed this area of dividing skin cells.
Skin injury, emotional stress and some forms of infection are thought to help trigger the development of psoriasis. For example, psoriasis will sometimes appear at the site of a surgical incision or after a streptococcal throat infection. When injury to the skin leads to the appearance of psoriasis, it is known as the Koebner phenomenon.
DIAGNOSING THE DISEASE:
Typically, psoriasis is diagnosed simply through observation -- the inflamed lesion topped with silvery white scales. There are no blood tests for psoriasis; the diagnosis is made by a physicians examination of the skin lesions and occasionally by looking at a skin biopsy under a microscope. Sometimes, small pits in the fingernails can aid in diagnosing psoriasis.
African-Americans may not have the typical red, scaly patches. Their psoriasis may be the same color as the rest of their skin. The treatment is the same, however, for all races.
STANDARD TREATMENT:
There is not a cure for psoriasis at this time, but there are treatments that can, in most cases, temporarily clear the plaques or significantly improve the skins appearance. The goal of psoriasis treatment is to clear psoriasis lesions from the skin. Once the treatment works, it is generally discontinued and resumed if the psoriasis returns.
The treatment used will depend upon several things: the type of psoriasis, location on the body, severity, the patients age, and medical history. Topical medications are used for mild to moderate psoriasis. These include emollients (moisturizers), steroids (cortisone-type medications), anthralin, various coal tar preparations, and vitamin D3. These may be used alone, in combination, or with ultraviolet light (UVB). Regular sunbathing can clear psoriasis for some people because of the exposure to natural ultraviolet light.
Treatments for moderate to severe psoriasis include the topical medications already mentioned for mild to moderate psoriasis, ultraviolet light type B (UVB); PUVA (an oral or topical medication [psoralen] plus ultraviolet light type A); an oral or injected medication called methotrexate (MTX); and oral retinoid medications (Tegison and Accutane). These treatments may be used alone or in combination with each other.
Systemic treatments for severe psoriasis are more toxic than topical treatments and their benefits must be weighed against their risks. A rule of thumb in psoriasis therapy is to use the most effective therapy for an individual that poses the least amount of side effects. Generally, physicians will start with the least potent therapy and work towards the most potent and effective treatment along the way.
There is no single treatment that works for everyone who has psoriasis. Reactions to psoriasis treatments will vary from individual to individual. Often experimentation is required before an effective approach is discovered for the patient. A treatment regimen may need periodic adjustment. A once-effective treatment can cease working which will necessitate switching to another therapy.
It is important to remember not to give up on treatment because of slow results. A commitment to lengthy treatment may be necessary to achieve clearance.
INVESTIGATIONAL TREATMENT:
There are a variety of new medications under investigation for psoriasis. The National Psoriasis Foundation (NPF) regularly reports on this progress in its national newsletters, the Bulletin and Pharmacy News.
ADJUVANT THERAPY:
Treatment developments are always featured in the National Psoriasis Foundations (NPF) national newsletter, the Bulletin and Pharmacy News. You may always contact the NPF about specific treatments. The NPF has information on other less commonly used therapies, nontraditional treatments, and experimental medications as well.
PREVENTION:
It is not possible to predict or prevent psoriasis. Heredity plays a role but the mode of inheritance is not clear. Environmental factors may trigger the onset of psoriasis, even in people without an apparent family history of psoriasis. These factors may include physical trauma to the skin, reactions to some medications, and infections. Psoriasis can be treated to clear the skin of the lesions for periods of time. This is called a clearance or remission. Occasionally, psoriasis will go into a spontaneous remission on its own without treatment. Sometimes a treatment that has kept psoriasis in check will stop working. Psoriasis simply becomes resistant and a new type of treatment will have to be tried. You can follow a regimen of keeping your skin moisturized, taking advantage of sunshine, and protecting your skin against injuries that may help keep psoriasis in check.
CONCLUSION/SUMMATION:
The emotional impact of psoriasis is as important to understand as the physical impact. Psoriasis can be unsightly and cause, or contribute to, low self-confidence and self-esteem. It may induce feelings of embarrassment, anger, depression, and guilt. Learning about psoriasis is the first step in coping effectively with this skin disorder.
PATIENT SUPPORT GROUPS:
The National Psoriasis Foundation (NPF) is a lay nonprofit organization dedicated to educating people throughout the world about psoriasis, while stimulating research to find a cure. This primary mission of the NPF is accomplished by publishing the most current information on psoriasis; providing a forum for those who have psoriasis to speak out; funding thousands of dollars for psoriasis research; and establishing an alliance between people who have psoriasis, the scientific community, the medical community, and the pharmaceutical industry. The NPF is governed by a national lay Board of Trustees, counseled by a prestigious Medical Advisory Board of leading dermatologists, and is run by a nonmedical staff.
The NPF supports the formation of local support groups, or Psoriasis Communication Networks. The NPF assists members with the development of local networks so people can support one another in living with psoriasis and attend educational meetings. The NPF sponsors pen pal clubs, or Correspondence Networks, for members to write to others about living with psoriasis.
Until the cause of psoriasis is known and a cure is available, the NPF will continue to work towards easing the burden of psoriasis for the 5 million Americans who live with it every day. Continuing education is a vital part of living with a chronic skin disease. The NPF keeps members informed about treatment choices and psoriasis research through two national newsletters, the Bulletin and Pharmacy News. Members benefit from others experiences, make fact-based decisions, and have a genuine understanding of their skin disorder. Join the NPF today to support psoriasis education and research by making a yearly donation of any amount. For a free information packet about psoriasis and the benefits of NPF membership, contact the NPF.
NATIONAL PSORIASIS FOUNDATION
6600 SW 92nd Avenue
Suite 300
Portland, OR 97223-7195
503.244.7404
800.723.9166
fax: 503.245.0626
This information is published as an educational service and is not intended to replace the counsel of a physician. The National Psoriasis Foundation (NPF) advises that you consult a physician before initiating any treatment. The NPF does not endorse any medications, products, or treatments for psoriasis.
This article is printed with permission from the National Psoriasis Foundation/USA, 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223. All printed information by the NPF is copyrighted.
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