Psoriasis is a common skin disease triggered by a faulty immune response. This causes the skin to grow too quickly resulting in localized or generalized areas of skin redness and thickening. The most commonly affected areas are the scalp, elbows, and knees although the lesions can occur anywhere. It can occur at any age but occurs more commonly in adults than children. It is not contagious. The exact cause of psoriasis is unknown, but you are more likely to have psoriasis if it has affected other family members.
What are the symptoms?
The symptoms are rough, dry scaly areas of skin. Often the skin is red. Itching is usually absent but can be mild-moderate or severe. Most psoriasis occurs in patches or plaques. Sometimes acute guttate psoriasis, small drop-like lesions, can develop rapidly. It can also affect the fingernails or toenails causing them to have small pits and dents or get thick and misshapen. Some patients develop joint pains and arthritis. Generally, psoriasis improves in the summer with sun exposure and worsens in the winter when it is dry and cold.
What triggers psoriasis?
Many people say their psoriasis began after a stressful event, a sore throat, or some medications like lithium or antimalarials. Psoriasis can worsen when you injure the skin such as a cut, burn or bite or if your skin is exposed to constant friction from work or clothing. Moderate alcohol consumption can also worsen psoriasis.
How do we diagnose it?
In general, the skin findings are typical enough for a dermatologist to be able to make the diagnosis after an examination of your skin and nails. Occasionally a small sample of skin, called a biopsy, can be taken to confirm the diagnosis
Tips for Management
Education is power. Learning about the disease will help you make informed decisions about treatment and lifestyle changes necessary to control the disease. Some good resources are the American Academy of Dermatology, AAD.ORG, Psoriasis.net, and the National Psoriasis Foundation.
Take Good Care of Yourself. Smoking, drinking, and overeating not only worsen psoriasis but also make treatment less effective. Psoriatics are also more prone to Metabolic Syndrome, which is hypertension, heart disease, and diabetes. It is very important that your primary physician is aware of this association.
Be aware of your joints
Between 10%and 30% of psoriatics have arthritis. This can be mild to severe and there are excellent treatments available.
Many psioratics experience depression
Joining a support group or seeing a mental health professional can improve your outlook which will also improve your psoriasis.
Learn the treatments that are available for psoriasis
In recent years, doctors have developed new treatments which can clear psoriasis in a high percentage of cases. If you can not afford the treatment, many pharmaceutical companies offer patient assistant programs. Do not stop treatment without supervision from your dermatologist. This can lead to severe worsening.
It is very important that you enter into an intelligent dialogue with your dermatologist. All psoriasis treatments can cause side effects. The degree to which psoriasis affects your quality of life will affect which treatment you choose. Some people choose a therapeutic regimen with few if any side effects as the rash do not bother them much. Others experience severe anxiety and depression and are willing to be exposed to a higher risk. Weighing the risk-benefit ratio of any treatment is of utmost importance when trying to decide which treatment is best for you.
Today, all patients with psoriasis can experience results, and most will see clearance up to 75-100%. Don’t give up if you don’t see the improvement you are expecting with the first treatment you try. Steroid ointments and creams are the most commonly prescribe treatments. Use this first if your rash is on a small area.
Tar preparations such as bath oils, creams, or shampoos can complement topical steroids. Vitamin-D like creams (calcipotriene) can be alternated with steroids to lessen steroid side effects such as thinning skin and stretch marks.
Because the body absorbs steroid creams in significant amounts, you should not use them on large areas of your body. If used for extended periods of time this can cause systemic side effects such as diabetes and immune suppression. For this reason, you should use the medications exactly as prescribed and be monitored on a regular basis.
Get some sunshine
The oldest and least expensive treatment for psoriasis is natural or artificial sunlight. When combined with tar preparations, the Goekerman regimen can lead to dramatic improvement. UV exposure can increase your risk of skin cancer and you should discuss this with your dermatologist. PUVA combines an oral medication called psoralen with long-wave UV light, UVA. Only a doctor can give this treatment as it carries the same risks of long-term exposure. Newer forms of UV light called narrow-band UV are more effective and have less risk of skin cancer development.
How long will it last/is it curable?
Psoriasis is a chronic disease. This means you will likely have to deal with it for the rest of your life. However, this does not mean you will always have to suffer. Early and aggressive treatment will often stop the problem from progressing and often put the disease in remission. I encourage you to learn as much as you can from proper websites. Not everything you read on the internet is factual and many have conflicts of interest, meaning they have financial gains if you follow their advice. The best websites are the American Academy of Dermatology and National Psoriasis Foundation. In conclusion, the more you learn about psoriasis the better chance you have of safely controlling it.