Psoriasis

1.    What is Psoriasis?

Psoriasis [pronounced sore-EYE-ah-sis] is a non-contagious, inherited skin disease caused by an overactive immune system that stimulates a higher-than-normal turnover of skin cells.  This results in recurring red plaques with silvery scales, on either localized or generally dispersed regions of the skin.  A very difficult disease to treat, psoriasis often causes shame, embarrassment, and humiliation to individuals, and sometimes lasts throughout their entire lifetime. Approximately 7.5 million Americans have psoriasis.

2.    What Does Psoriasis Look Like?

Psoriasis is characterized by salmon-pink, round, well-bordered bumps and plaques with silvery scales on their outer layer.  Psoriasis plaques can either itch or feel sore.  The scales are loose and easily removed by scratching, which often results in minimal bleeding.   Psoriasis may be localized to one area such as the nails or genitals, dispersed to an entire region such as the scalp, or universally distributed to the skin throughout the entire body.  Common areas include the elbows, knees, palms, shins, nails, arches of feet, lower back, genitals, and anal folds.  Psoriasis may also cause a type of arthritis called “Psoriatic Arthritis” with joint pain, weakness, chills, and fever. Without early recognition and treatment, psoriatic arthritis can potentially be disabling and crippling.

3.    Who Does Psoriasis Affect?

Psoriasis can begin at all ages, but most commonly begins near or around two age peaks of 23 years and 55 years, and occurs equally among males and females.  A significantly lower incidence occurs in people of Japanese, Inuit, West African, North American Indian, or South American Indian descent.  Psoriasis is inherited through multiple genes, and having a parent with psoriasis gives an individual an approximate eight percent chance of inheriting the disease.  Smoking and obesity also appear to be associated with psoriasis, though the cause and effect relationship is not clear.

4.    What Causes Psoriasis?

Psoriasis begins in the immune system.  For reasons yet unknown, T cells are mistakenly activated and begin signaling skin cells to shorten their normal cell cycle duration.  This causes a much faster turnover of skin cells, and an increase of up to 30 times the normal production. Swelling and inflammation ensue.  The long-term result is a significant reddening, thickening and scaling of the affected region.

5.    What Triggers Psoriasis?

Certain triggers may exacerbate pre-existing psoriasis plaques, or cause a sudden onset of plaques, especially in areas that have been affected once before.  These factors include physical trauma such as rubbing and scratching, bacterial infections, alcohol consumption, smoking, stress, weather changes, dry climates, or certain medicines. 

6.    How Can My Psoriasis Be Treated?

Although management and control of psoriasis is very difficult, it is certainly possible and can be attained with a well-planned treatment regimen.  Phototherapy for psoriasis in the form of narrow band UVB  phototherapy helps treat large areas of the skin without the side effects of oral or topical medications.  During narrow band UVB treatment, patients stand in a unit containing 48 fluorescent bulbs that emit UVB light at 311 nm.  For localized areas, patients place their hands or feet in a small light chamber, or use a light-emitting comb to treat the scalp.  This treatment is given two to three times per week until the psoriasis plaques subside.  In addition, the Excimer laser has been extremely successful in treating psoriasis.  This laser uses a carefully focused beam of narrow-band UVB light delivered through a sophisticated fiber optic device, and allows higher doses of narrow-band UVB light with minimal exposure of nearby, healthy skin.  Other therapies may include topical steroids, emollients, and tar formulations.  Additionally, more systemic therapies include oral or intravenous drugs such as cyclosporine, retinoid drugs, methotrexate, and the most recent addition to the armamentarium, the “biologic” agents that directly target a portion of the immune system that triggers psoriasis.  For more information on these treatments for psoriasis, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute. In addition, the National Psoriasis Foundation has a very helpful website for gathering more information about psoriasis at http://www.psoriasis.org/about/psoriasis/.

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