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Psoriasis

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What is Psoriasis?

Psoriasis is a chronic (long-lasting) autoimmune disease of the skin that causes scaling and inflammation. It occurs when skin cells quickly rise from their origin below the surface of the skin and pile up on the surface before they have a chance to mature. Usually this movement (also called turnover) takes about a month, but in psoriasis it may occur in only a few days. In its typical form, psoriasis results in patches of thick, red (inflamed) skin covered with silvery scales. One of the most prominent symptoms of psoriasis is itching, and the condition's name derives from psora, the Greek word for itch.

What are the symptoms of Psoriasis?

The symptoms of psoriasis vary and depend on the type. Plaque psoriasis, one of the most common forms, is characterized by skin that is red and covered in silver scales. These may crack and bleed when the skin is scratched. The patches can grow in size and merge together, covering large areas. When the fingernails and toenails are involved, there can be discoloration, crumbling, and even detachment of the nail.

These patches or plaques usually itch or feel sore. They most often occur on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet, but they can occur on skin anywhere on the body.

Many people with psoriasis experience joint inflammation that produces symptoms of arthritis. This condition is called psoriatic arthritis. Psoriatic arthritis is characterized by pain and swelling in the joints. The National Psoriasis Foundation estimates that between 10% to 30% of people with psoriasis also have psoriatic arthritis.

Mild psoriasis affects less than 3% of the body surface. Most cases are limited to less than 2% of the skin. Moderate psoriasis covers 3%-10% of the skin. If more than 10% of the body is affected, the disease is considered severe.

The disease may also affect the fingernails, the toenails, and the soft tissues of the genitals and inside the mouth.

What are the causes of Psoriasis?

Psoriasis is a skin disorder driven by the immune system, especially involving a type of white blood cell called a T cell. Normally, T cells help protect the body against infection and disease. In the case of psoriasis, T cells are put into action by mistake and become so active that they trigger other immune responses, which lead to inflammation and to rapid turnover of skin cells.

In about one-third of the cases, there is a family history of the disease. Researchers have studied a large number of families affected by psoriasis and identified genes linked to the disease.

People with psoriasis may notice that there are times when their skin worsens, then improves. Worsening of symptoms is called a flare-up. Conditions that may cause flare-ups include infections, stress, and changes in climate that dry the skin. Also, certain medicines, including lithium (a mood stabilizer) and beta-blockers (used to treat high blood pressure), may trigger an outbreak or worsen the disease.

How is Psoriasis diagnosed?

Psoriasis is frequently difficult to diagnose by simply examining the skin because it often looks like other skin diseases. Diagnoses are usually confirmed by examining a small skin sample under a microscope.

How is Psoriasis treated?

Psoriasis is usually treated in steps based on the severity of the disease, size of the areas involved, type of the disease, and the patient's response to initial treatments. This is sometimes called the 1-2-3 approach. In step 1, medicines are applied to the skin (topical treatment). Step 2 uses light treatments (phototherapy). Step 3 involves taking medicines by mouth or injection that treat the whole immune system (called systemic therapy).

Over time, affected skin can become resistant to treatment, especially when topical corticosteroids are used. Also, a treatment that works very well in one person may have little effect in another. Thus, doctors often use a trial-and-error approach to find a treatment that works, and they may switch treatments periodically (for example, every 12 to 24 months) if a treatment does not work or if adverse reactions occur.

What is it like to have Psoriasis?

People with psoriasis may experience significant physical discomfort and some disability. Itching and pain can interfere with basic functions, such as self-care, walking, and sleep. Plaques on hands and feet can prevent individuals from working at certain occupations, playing some sports, and caring for family members or a home. The frequency of medical care is costly and can interfere with an employment or school schedule. People with moderate to severe psoriasis may feel self-conscious about their appearance and have a poor self-image that stems from fear of public rejection and psychosexual concerns. Psychological distress can lead to significant depression and social isolation.

What Psoriasis research has been done?

Significant progress has been made in understanding the inheritance of this disease. A number of genes involved in psoriasis are already known or suspected. In a multifactor disease (involving genes, environment, and other factors), variations in one or more genes may produce a greater likelihood of getting the disease. Researchers are continuing to study the genetic aspects of the disease. Since discovering that inflammation in psoriasis is triggered by T cells, researchers have been studying new treatments that quiet immune system reactions in the skin. Among these are treatments that block the activity of T cells or block cytokines (proteins that promote inflammation). Several of these drugs are awaiting approval by the U.S. Food and Drug Administration (FDA).

Advances in laser technology are making it possible for doctors to experiment with laser light treatment of localized plaques. A UVB laser was recently tested in a study that was conducted at several medical centers. Although improvements in the skin were noted, this treatment is not without possible side effects. In some patients, the skin became inflamed, blistered, or discolored following treatment.

How common is Psoriasis?

In the United States, psoriasis affects 2% to 2.6 percent of the population, or between 5.8 and 7.5 million people. Although the disease occurs in all age groups, it primarily affects adults. It appears about equally in males and females.

*The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient.