Psoriasis: What Is It and How Is It Treated?
One of the oldest diseases known to man, psoriasis affects millions of people worldwide. Psoriasis is persistent and continues to baffle dermatologists and suffers alike.
What Is Psoriasis?
Psoriasis, in its many forms, is typically genetic and produces a lifelong battle for those who suffer with it. It is characterized by raised red patches covered with white scales. These patches are caused by skin cells that multiply as much as 10 times faster than normal skin cells. Healthy skin cells mature and are shed within about 28 days. In cases of people with psoriasis, this process occurs within 3 to 4 days. As these cells reach the outer layers of skin and die, the over abundance of cells cause bumpy red patches. Psoriasis generally appears on the knees, elbows, and scalp first, then spread to other areas if not properly managed. Although psoriasis is not contagious, it does tend to run in families. Psoriasis outbreaks are linked to the weakening of the immune system, whether through immuno-suppression medications or common illnesses.
Types of Psoriasis
Plaque psoriasis is the most common form of the disease and often the starting point for other forms. Sufferers of plaque psoriasis experience raised, red patches of thickened skin, covered by silvery white scales.
Guttate psoriasis produces small splattered looking lesions along the limbs and trunk. This form often follows some sort of upper respiratory infection (i.e. streptococcus, sinusitis, ear infection, etc).
Erythrodermic or exfoliative psoriasis covers almost the entire skin surface with intense redness and swelling. Patients might also experience chills and sensitivity to sunlight. Typically, erythrodermic psoriasis sufferers have had psoriasis for many years and can no longer control or manage their outbreaks. Onset may accompany another underlying illness, alcoholism or drug abuse. Changes in medications for high blood pressure or diabetes or the use of corticosteroids may induce erythrodermic psoriasis. Other symptoms include fever, decreased blood pressure, severe itching, anemia, and shortness of breath.
Pustular psoriasis is similar to erythrodermic psoriasis in many of its symptoms with the addition of numerous pustules on a red background. There are various sub-types of pustular psoriasis, including Palmar and Planter psoriasis, which affects only the hands and feet and tend to be much more painful. Pustular psoriasis generally accompanies other illnesses.
Who Is Susceptible?
Psoriasis is not contagious. Although anyone can be at risk for developing the disease, it tends to produce itself more in fair skinned people. It is very rare among people with darker complexions. Since psoriasis is hereditary, anyone with one or more blood relatives with the disease is at a greater risk for developing the disease themselves.
Causes of Psoriasis
While the exact cause of psoriasis is unknown, researchers do know that it is linked to a weakening of the immune system, whether through systemic infection, emotional stress, skin injury, or certain medications. Drugs such as lithium, high blood pressure medications and corticosteroids may provoke or induce the disease. Psoriasis may also develop in areas of the skin subjected to trauma such as burns or sunburns. This phenomenon is called the "Koebner reaction." Some dermatologists believe psoriasis can result from infection by bacteria, fungus, and/or viruses. Studies have also shown that psoriasis sufferers are born predisposed to the illness. However, this does not exclude those without a family history of psoriasis. Psoriasis flare-ups come and go, generally worsening in the winter. Studies suggest that the amount of sunlight a patient is exposed to may be a factor in controlling the severity of the outbreaks.
Fortunately, the number of treatments for psoriasis is great and continues to grow steadily. Patients must remember that not every treatment is right for every case. It may take time to find a medication or procedure that most benefits them. In all cases, it is best to first consult with your physician.
Proper self-care is one of the most beneficial things an individual can do. Proper nutrition, exercise, and healthy lifestyles will aid in managing outbreaks. Most importantly is the application of moisturizing creams, ointments, or lotions to the skin. There are a wide variety of products sold over the counter that have proven to be quite effective when dealing with mild cases of psoriasis. Of course, more serious degrees of the disease require more aggressive therapy. Bathing treatments, such as salts, may relieve some of the itching and help to ease the scaling. Moderate exposure to sunlight (15 to 20 minutes a day) has been found to aid in lessening the severity of mild cases of psoriasis. However, prolonged exposure to UV rays, whether from sunlight or tanning beds, can be very harmful.
Topical medications, such as lotions, ointments, and creams, are generally the first step in treating mild to moderate cases. Over the counter topical corticosteroid creams have their pros and cons. On the positive side, they are readily available, relatively inexpensive, easily applied, and safe if used properly. On the negative side, they do have limited potency, are ineffective in stubborn or more severe cases, and can be dangerous if too much is absorbed into the skin. In cases where the psoriasis is mild and the affected areas are small, topical creams are generally very effective and cost is minimal. The same applies to prescription creams that contain corticosteroids. Excess use of topical steroids over a prolonged periods of time can result in a thinning of the skin, acne, stretch marks, and the psoriasis itself becoming immune to the treatments. Over the years, the use of oral steroids has proven to be an ill-fated treatment for psoriasis sufferers. Although they seemed helpful at first, the disease always came back at a much more intense level. Sometimes even developing into pustular or erythrodermic psoriasis
A preparation of tar made from coal has been a popular treatment for many skin diseases for decades. Studies show that coal tars slow the growth of skin cells and help ease the inflammation. Tars are safe, effective, quite affordable, and do well in long term continued use. The tar is usually applied in the evening before going to bed and then washed off in the morning.
Anthralin is similar to coal tar in that it probably slows the rate of cell growth, thereby helping to reduce inflammation. It too is messy and unappealing, causing it to be an unpopular, although effective treatment in some cases.
Topical vitamin D is a relatively new treatment but is believed to be effective and safe on a long-term basis. Use of the therapy is best suited for those with smaller, more mild psoriasis as application over large areas can be time consuming and expensive.
Zinc Pyrithione is also a relatively new and popular treatment for psoriasis. It comes in pump sprays, bar soaps, and scalp treatments. So far, no adverse side effects have been noted. Unfortunately, it is still quite expensive.
One tried and true psoriasis therapy is the administration of ultra-violet light. Treatment starts with two to three sessions per week, gradually increasing the exposure time. Most dermatologists have access to light therapy machines whether in office or at a local hospital. Light therapy is generally reserved for moderate to severe cases with the intent to reduce the intensity of the disease and to then use less invasive means of controlling the outbreaks. Long-term effects are similar to those associated with excessive sun exposure. Wrinkling and toughening of the skin, pre-cancerous spots, and skin cancer are possible side effects of long term use of light therapy. Dermatologists are very careful in monitoring the amount of light given to avoid such serious side effects.
PUVA therapy (psoralens plus UVA light) has been in use for approximately 20 years and is very effective in patients with widespread areas of psoriasis. Ingestion of a topical application of the drug psoralens is used in conjunction with UVA light therapy. The process is essentially the same as with light therapy with additional side effects, such as cataracts and an increase risk of skin cancer. This treatment weakens the immune system, thus making it inappropriate for those with impaired immune systems (AIDS, cancer, etc.).
The oral medication acitretin is a derivative of Vitamin A and generally given only to patients with severe psoriasis, usually those with erythrodermic or pustular psoriasis. Men and women of childbearing age are typically not given this drug, as it is very harmful to an unborn child. Side effects include dry skin, nosebleeds, chapped lips, and some thinning of the hair. This drug is expensive but designed mainly to reduce the intensity of the disease so that more mild methods of treatment may be used.
Methotrexate is a drug used in chemotherapy for cancer patients. As of late, it has become a popular and very effective treatment of psoriasis. Careful and precise records must be taken to ensure proper dosage of the drug. Over dosage can cause liver damage and even death. Even though the procedure is expensive, it has proven very cost effective in the long run.
The immuno-suppression drug cyclosporine is relatively new and very effective in treating severe or life threatening cases of psoriasis. Due to severe side effects and expense, this therapy is commonly seen as a last resort.
In conclusion, psoriasis patients need not suffer in silence. With so many treatment options available, dermatologists are extremely successful in finding a therapy that is beneficial for each individual case. Not only is this disease physically taxing it is emotionally draining as well. Support groups are available and please remember to consult your physician before beginning and treatment program.