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Psoriasis is a skin condition within which skin cells grow too quickly. This accelerated growth results in thick, white, or red patches of skin. Normal skin cell growth occurs over about a twenty-eight day period. Mature skin cells are dispelled gradually during this four week period as new cells replace these older cells. With Psoriasis, however, this cycle is completely changed. Skin cells do not mature but instead move rapidly up to the surface of the skin in a three to five day period, forming patches that are either red or white in color. The size of the patches can vary. They are typically located on the knees, elbows, scalp, hands, feet, genitals, or lower back. Though Psoriasis is more prevalent in adults, children and teenagers may be affected by this condition. This disease affects males and females, equally. Psoriasis is chronic, genetic, non-contagious, but not life threatening.
Psoriasis occurs in various forms. The most common of which is Plaque Psoriasis. A condition that is distinguished by raised, thickened patches of red skin covered with silvery-white scales. Other types of Psoriasis include Pustular Psoriasis, Erythrodermic Psoriasis, Guttate Psoriasis or Inverse Psoriasis. Each Psoriasis is characterized by different symptoms and unique appearances.
Pustular Psoriasis is distinguishable due to the pus-like blisters that are created from this condition.
Erythrodermic Psoriasis features extreme redness and swelling of certain areas on the skin surface.
Guttate Psoriasis is most easily recognized by small, drop-like lesions on the skin.
Inverse Psoriasis is characterized by smooth lesions, red in color, located in the folds of the skin.
According to the National Psoriasis Foundation, it is estimated that worldwide Psoriasis affects up to 3% of the population. In the United States approximately 2.5% of Americans suffer with Psoriasis. For some reason, certain cultures and nationalities are more prone to Psoriasis than others.
The Cause of Psoriasis:
The specific cause or causes of Psoriasis is not fully understood, but there are some facts that are known, however. It is not totally clear as to whether genetics alone determine this disease, but it does appear to be, in many cases, a heredity issue. There are other factors though, that appear to contribute to the development of Psoriasis, including but not limited to, the following: an immune system dysfunction; existence in a cold, dry climate; certain skin injuries; reactions to some medications; various infections; and high stress and anxiety.
The Symptoms of Psoriasis:
Psoriasis can be practically unnoticeable in the early stages of development. As the condition progresses, people often encounter itching and/or burning sensations. Symptoms can also vary in appearance and severity. It can be mild, with small areas of rash, while for others the skin can be inflamed with raised red patches topped with loose, shiny, scaling skin. When severe in nature, Psoriasis can become itchy, uncomfortable, and tender, covering large areas of the human anatomy. Some additional symptoms of Psoriasis may include joint swelling, tenderness, and pain. This is commonly referred to as Psoriatic Arthritis. For almost fifty percent of people who have active psoriasis, a condition called Psoriatic Nail is a glaring symptom. With this particular affliction of the fingernails or toenails, pitting, discoloration, separation of the nail from the nail bed, and skin buildup under the nails most often occurs. Sometimes the complete loss of the nail is the eventual result.
A doctor can usually, with minimal effort, diagnose Psoriasis by the appearance and location of the patches on your skin, scalp, or nails. At times a skin KOH test is given to rule out the possibility of a fungal infection.
The Treatment of Psoriasis:
The first step, prior to any treatment, requires an accurate diagnosis from a licensed physician. Please note, that although treatment can help control the symptoms of Psoriasis, there is currently no known cure. The actual types of treatment for Psoriasis fall into three main categories: Topical, Phototherapy, and Biologic/Systemic treatments.
Topical Treatments
Topical products are substances that are applied directly onto the skin. They are most effective when treating mild to moderate cases of Psoriasis. Topical preparations should be considered first when treating the symptoms of Psoriasis since they involve fewer side effects and are normally much less expensive. These kinds of products may include medications as well as moisturizers and scale removers. These preparations may be in the form of over-the-counter products or medications that require prescriptions. It has been discovered that topical products when combined with phototherapy tend to increase their effectiveness. The topical medications that have been approved by the U.S. Food and Drug Administration (FDA) for treatment of Psoriasis are:
Anthralin - Anthralin, is also known as Dithranol or Cignolin, has been available for over one hundred years. It is believed that the product acts on psoriatic lesions by normalizing the growth rate of skin cells (keratinocytes). This activity limits the size and thickness of the skin condition while reducing the inflamation. Though somewhat effective, side effects include skin and apparel staining and skin irritations.
Coal Tar - Quite similar to Anthralin, Coal tar has been used to treat a number of skin conditions for over one hundred and fifty years. Other than the unpleasant odor and extreme messiness, the side effects have been minimal. Coal tar seems to work by decreasing the rapid growth of the skin cells that cause plaques. The most popular and effective usage of coal tar is as the main ingredient in shampoos that are formulated specifically to combat scalp Psoriasis.
Corticosteriods - Corticosteroids are effective at reducing rapid skin cell growth and diminishing inflammation and the itching associated with this accelerated growth. Corticosteroids are most ofter prescribed for a limited period of time since the adverse, side effects may offer potential danger for the user.
Retinoid - Tazarotene - Retinoid medication like Tazarotene normalize DNA activity in skin cells. This retards rapid cell growth allowing for limited inflammation and skin plaques. Tazarotene has also been reported to effectively treat Psoriatic Nails. The most common side effect is skin irritation. This is mainly due to an allergic reaction to Vitamin A. When used in combination with topical Corticosteroids, the effectiveness of Tazarotene becomes enhanced. The chance for skin irritation is decreased and some of the side effects that are associated with Corticosteroids are slightly reduced.
Vitamin D3 - Calcipotriene - Is thought to slow down the rate of skin cell growth and, thus, reduce skin inflammation. Calcipotriene is a man-made form of vitamin D that has been approved for the treatment of mild to moderate plaque Psoriasis. Side effects include, allergic reactions to the medication that may include burning, itching, hives, rashes, redness, and shortness of breath.
Pimecrolimus and Tacrolimus - These are relatively new medications used to treat Atopic Eczema and some forms of Psoriasis. These medicines are classified as TIMs (topical immunomodulator medications). Their basis for usage is to interfere with the activation of T cells, a type of white blood cell responsible for triggering immune responses that contribute to the development of Psoriasis. Though these new medications demonstrate much promise in treating skin conditions, they are quite new and will require additional studies in order to understand long-range side effects and treatment effectiveness.
Moisturizers and Scale Removers - These products are available in several forms, including creams, gels, lotions and shampoos. They effectively treat certain types of Psoriasis by helping to lock in water to soften or remove scales. This action can allow other topical medications to penetrate the skin more deeply. Topical products may also reduce the redness and itching by keeping the skin lubricated. Salicylic acid is often used for this purpose since it can effectively remove scales, reducing redness and irritation.
Phototherapy
Psoriasis treatment, especially for moderate to severe conditions, may require the usage of light, usually ultraviolet light, to improve the symptoms. The light rays applied directly to the skin. Two types of ultraviolet light treatments may be used. Ultraviolet B (UVB) a common, safe and very effective treatment, that is generally employed when Psoriasis plaques are thin. The other is Psoralen plus Ultraviolet light A (PUVA). This treatment combines the use of light-sensitive medication Psoralen with UVA. It is also commonly referred to as Photochemotherapy. PUVA is most frequently tried when UVB has not worked effectively or if the Psoriasis plaques are thick. Lasers are also used to derive similar results with certain Psoriasis conditions. Lasers emit short bursts of light to target blood vessels under the skin to reduce Psoriasis symptoms. The major side effects may include burning, redness, possible scarring, and pain.
Biologic/Systemic
This type of Psoriasis treatment involves the usage of oral, injected, or infused medications. Treatment of this nature is most often recommended with cases that involve very severe or disabling Psoriasis. While somewhat effective, many of these medications can only be used for limited periods of time to minimize the side effects and toxicity that can result from constant usage. The systemic medications approved by the U.S. Food and Drug (FDA) Administration for the treatment of psoriasis are:
Acitretin - Acitretin, like many other medications, normalizes the growth of skin cells, thus preventing the rapid growth of skin plaques.
6-Thioguanine - Though approved for treatment of Leukemia, Thioguanine has demonstrated an ability to treat Psoriasis, especially pustular Psoriasis. There are possible side effects associated with this medicine that may include anemia, decrease in white blood cells, platelets, and bone marrow toxicity.
Alefacept - The medication, Alefacept, inhibits the activities of T cells, a type of white blood cell, that offers relief from the symptoms of psoriasis. The most serious side effects are a reduction in the number of immune cells, possible infections, may increase malignancies, and allergic reactions.
Efalizumab - This biologic medicine, much like Alefacept, limits the activation of the T cells. Preventing this T cell activity decreases inflammation and itchiness. Studies shows that stopping the usage Efalizumab, results in the return of the symptoms of Psoriasis. Since Efalizumab is an immunosuppressive agent, it has the potential to increase the risk of infection and the risk of a malignancy.
Cyclosporine - Another Biologic/Systemic medication is Cyclosporine. Much like other medicines in this classification, it too inhibits T cell activity that decreases the rapid growth of skin cells, thus limiting the adverse effects of Psoriasis. Side effects associated with usage of this medication include; bleeding, tender, or enlarged gums, high blood pressure, kidney problems, increased hair growth, trembling and shaking of hands, and the worsening of cancerous malignancies.
Methotrexate - By blocking certain parts of the immune system, Methotrexate decreases rapid skin cell growth which suppresses inflammation. The most frequent adverse reactions include mouth sores, an upset stomach, and low white blood counts. Methotrexate can additionally cause severe toxicity of the liver and bone marrow. Methotrexate, though well tolerated, can cause severe toxicity.
Etanercept - Infliximab - Adalimumab - These latest medications are being studied in clinical trials to determine their effectiveness in the treatment of Psoriasis. All three medicines have received FDA approval for treating rheumatoid arthritis. Only Etanercept is presently FDA approved for the treatment of Psoriatic Arthritis. Infliximab has received FDA approval for the treatment of Crohn's disease. Adalimumab is still being tested for usage with certain forms of Psoriasis.
Hydroxyurea - Used orally, Hydroxyurea is a medication used to treat a form of leukemia. It has demonstrated remarkable effectiveness when used to treat plaque Psoriasis. Possible side effects include anemia, a decrease in white blood cells and platelets, and possible bone marrow toxicity.
Isotretinoin - This medication, taken in an oral form, has been FDA approved for the treatment pustular Psoriasis. It must be noted that Isotretinoin is a very potent drug that can cause severe birth defects. For this reason, it should not be used by a woman who is pregnant or nursing an infant.
Mycophenolate Mofetil - This FDA approved medicine is used to prevent the rejection of a transplanted kidney, liver or heart. Like many other systemic medications, this drug is a potent immunosuppressant. This type of activity causes the slowing of rapid cell growth that inhibits some kinds of Psoriasis. Dangerous side effects can include the risk of cancer of the immune system.
Sulfasalazine - Taken in tablet form, Sulfasalazine is used to treat Psoriatic Arthritis and Rheumatoid Arthritis. Studies have shown that people who respond well to this medication, tend to respond quite rapidly. Caution should be taken prior to using this medicine. Gastrointestinal disturbances frequently occur with patients taking sulfasalazine. This would include Nausea, vomiting, gastric distress, and anorexia. Unfortunately, this occurs to about one of every three patients receiving this drug.
The Prevention of Psoriasis:
There is no known cure for Psoriasis. For this reason, prevention is almost impossible. There are ways, however, to lessen and relieve the symptoms when a flare-up occurs. Here are some meaningful tips to alleviate the afflictions associated with this disease:
- Keep your skin moisturized with a light emollient or lotion. Consult with your pharmacist or dermatologist for the product with that will render the best results. This is essential to avoid irritation due to dry skin.
- Try to keep your skin as cool as possible by avoiding exposure to the sun or to heat.
- Wear light-weight clothing for coolness.
- Always try to avoid scratchy, irritating fabrics that are worn against your skin.
- Environmental conditions like climate and temperature can adversely affect the symptoms associated with Psoriasis, it is highly recommended that prolonged exposure to cold temperatures may actually worsen the condition. A moderate sunny climate has been determined to be the most beneficial.
- Stressful situations, physical trauma, and infections, can increase the occurrences of break outs of Psoriasis.
Once the initial appearance of Psoriasis has been detected, it is extremely important to react quickly to reduce and limit the symptoms. Since pruritus (itchiness) is a serious concern, topical preparations should be applied to the affected areas of the skin. This may lessen the duration and intensity of the flare-up. Products containing Zinc can be of great value in reducing pruritus. Keeping skin cool, avoiding certain spicy, hot foods, refraining from excessive alcohol intake, and wearing correct apparel can also keep adverse symptoms at a minimum.
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