Psoriasis is a chronic skin disease whose physical symptoms directly affect the emotional well being of sufferers. The physical symptoms — red, patchy skin topped by white or silvery scales — result from skin growth that is seven times faster than normal. Psoriatic skin grows faster than the body can shed it, causing the build-up commonly associated with the disease. The cause of psoriasis is unknown, but immune system and genetic factors are believed to play a role.
Psoriasis affects more than 7.5 million people in the U.S., including some 2.6 million children. The emotional effects of psoriasis are many, including loss of self-esteem and depression, and often directly impact the quality of life of sufferers. According to a May 2002 study by the National Psoriasis Foundation, one third of people with moderate to severe cases of the disease say it is a very large problem in their lives. Among those with moderate to severe cases, 75 percent said it had a moderate to large impact on their everyday lives. More than a quarter of respondents said the disease altered their daily activity and 21 percent said they stopped normal daily activities because of their psoriasis; 36 percent said it affected their sleep and the same percentage said they bath more than normal, the study reports. Psoriasis generally manifests itself on the elbows and knees. It does not cause scarring or hair loss, and rarely affects the face. Psoriasis is not contagious.
There are several different types of psoriasis: plaque, guttate, inverse, erythrodermic, generalized pustular and localized pustular. Plaque psoriasis is the most common form of the disease. Severity of the disease – from mild to moderate to severe – is measured by how much of the body psoriasis affects and how it affects an individual’s quality of life. It is estimated that 75 to 80 percent of cases are mild and that 20 to 25 percent are moderate to severe. Psoriasis can disappear, but a predisposition for its return remains and the condition can reappear even after years of absence. It is thought that stress can trigger the appearance of psoriasis. Some people with psoriasis – perhaps 10 to 30 percent — also develop a related form of arthritis, known as psoriatic arthritis.
While there is no cure for psoriasis, there are many forms of treatment for its symptoms, including:
• Coal tar has been used for many years. It major drawback is its strong odor and the stains it produces.
• Dithranol, also known as anthralin, is a topical treatment no longer prescribed often. It produces brown stains, can irritate the skin and is not tolerated well by fair-skinned individuals.
• Topical steroids, which are clean and soothing. On the weaker end of the scale of topical steroids is hydrocortisone, sometimes used on delicate areas; at the stronger end is Micronized Betamethasone Dipropionate (see DermaZinc™ Spray/Drops compounded with Micronized Betamethasone Dipropionate). Stronger steroids must be used with care and for limited periods, as long term use can result in thinning skin and could – when used incorrectly – aggravate psoriasis.
• Vitamin D-like compounds, such as calcipotriol, are safe and reduce itching and scaling. These work well for approximately one in three people; one in five experience skin irritation.
• Baths, including bath oil in warm water and use of a non-detergent soap (such as DermaZinc™ Soap) can soften psoriatic skin and lift scales. Detergent soaps and antiseptics are not necessary and might even irritate skin.
• Emollients, or moisturizing agents, help keep psoriasis plaques and scales soft, an important element in treatment. (see DermaZinc™ Cream).
• Occlusive dressings, or waterproof dressings adhered to the skin, can help reduce psoriatic patches.
• Scalp care includes specially medicated shampoos or liquid lotions. Coal tar shampoo may be purchased over the counter, along with DermaZinc™ Shampoo. For more severe scalp conditions, DermaZinc™ Spray/Drops (which comes with a special scalp applicator) or DermaZinc™ Shampoo can be compounded with Micronized Betamethasone Dipropionate.
• Sunshine can help clear psoriasis in some cases. The symptoms of psoriasis tend to improve dramatically in summer months. Caution is advised, however, as psoriasis can develop in sunburned areas of the skin and premature aging that could lead to skin cancer can result from exposure to ultraviolet radiation, in either natural or synthetic forms.
Biologic drugs, or “biologics,” are given by injection or intravenous (IV) infusion. Biologics are different from traditional systemic drugs that impact the entire immune system. Biologics, instead, target specific parts of the immune system.
Anyone considering taking a biologic drug should talk with his or her doctor about the short- and long-term side effects and risks. It is important to weigh the risks against the benefits of using the drugs. Biologics can increase the risk of infection. Individuals who develop any sign of an infection such as a fever, cough or flu-like symptoms or have any cuts or open sores should contact their doctor right away.
Common side effects for biologics include:
- Respiratory infections
- Flu-like symptoms
- Injection site reactions
These side effects are generally mild and in most cases do not cause individuals to stop taking the medication.
Rare side effects for biologics include:
- Serious nervous system disorders, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes;
- Blood disorders;
- Certain types of cancer.
All the current biologics can be used with other treatments such as phototherapy or topicals.
These generally are reserved for cases where more than 40 percent of the skin is affected or when the condition interferes greatly with function. Acetretin is an oral medication that produces slow improvement in most cases, but has numerous side effects that can include peeling of the skin on the palms and soles of the feet, dry lips, muscle pain, fatigue and liver damage.
Ultraviolet Radiation (UV):
This typically is used in winter months. A six-week course of treatment generally is prescribed and can lead to substantial clearance. However, ultraviolet radiation can produce premature aging of the skin that has been linked to skin cancer and, therefore, should not be used indefinitely. PUVA, or psoralens with long wave ultraviolet radiation, is known as photochemotherapy and is more effective than ultraviolet radiation. It is popular for its ease of use and efficacy, but can cause burning and skin cancer.
Dermalogix Partners, Inc. furnishes this information for educational purposes only. It is not intended as medical advice and Dermalogix Partners, Inc. claims no liability for any information that might be inaccurate. Please consult your physician for further information.