What is Psoriasis?
Psoriasis is not infectious and is not an allergic reaction. A common skin condition that affects more than 3% of Americans and more than 5 million adults, psoriasis is when white/silver scaly patches called scales appear on the skin. Psoriasis causes skin redness and irritation upon which the scales are located. These patches are itchy and can feel sore.
Where is Psoriasis most commonly found and who does it affect?
Psoriasis can be found on any part of the body, but the most common areas affected by psoriasis are the elbows, knees, lower back, face, palms, soles of feet and scalp. Skin around affected joints commonly cracks. Some people experience joint inflammation with the same symptoms as arthritis, also known as psoriatic arthritis. People of all ages are affected by this disease, however it primarily affects adults. Males and females are found to be equally affected by psoriasis. Researchers have found a familial genetic link to psoriasis, so there is usually a family history with this disease.
What causes Psoriasis?
Psoriasis occurs when skin cells, which originate below the surface of the skin, pile up on the surface before they have fully matured. This process can take as short as a few days up to a month. Psoriasis is an auto-immune disease involving T cells, a type of white blood cell. T cells’ job is to protect the body from diseases and infections. When psoriasis occurs, T cells are mistakenly active and trigger other immune responses, causing inflammation and rapid turnover of skin cells.
People with psoriasis may experience skin flares, when the condition worsens and then improves. Some triggers for flares include stress, infections, too much alcohol, and climate changes which cause skin dryness. Certain medicines, like lithium, may cause an outbreak or exacerbate the condition.
What are the symptoms of Psoriasis?
Psoriasis can appear suddenly or take time to appear. It goes away and flares up repeatedly. Patches of skin which are itchy and irritated appear, as well as redness, on different parts of the body. The skin patches can be covered with silvery, flaky skin and may be raised and thick. Joint pain may be symptomatic of psoriasis as well as nail thickening, yellow/brown spots on nails or separation of the nail from its foundation.
How is Psoriasis diagnosed?
It can be hard to diagnose psoriasis because it is similar to other skin conditions. A detailed examination, sometimes with a microscope, may be necessary by a dermatologist. There are different types of psoriasis including:
1- Plaque Psoriasis. The skin cells accumulate, forming silvery-white scales.
2- Pustular Psoriasis. In Pustular Psoriasis, blisters of pus which are not infectious appear on the skin. This type of psoriasis can be triggered by stress, exposure to specific chemicals, infections or medications.
3- Guttate Psoriasis. In Guttate Psoriasis, little teardrop shaped lacerations appear on the skin. This type of psoriasis is commonly triggered by upper respiratory infections such as streptococcus.
4- Inverse Psoriasis. Red, smooth patches appear in the folds of skin in the genital area, under breasts or in the armpits. Friction and sweat may exacerbate this condition.
5- Erythrodermic Psoriasis. This condition involves reddening and scaling of the skin throughout the body. It can be a reaction to extreme sunburn, specific medications, or an extended case of psoriasis which was inadequately cared for.
How is Psoriasis treated?
Depending on the psoriasis type, severity, size in the affected areas, and the patient’s response to initial treatment, doctors choose the appropriate treatment. There is a process also known as the “1-2-3” approach, which helps treat psoriasis. In step 1 doctors apply a topical medication on the area. Step 2 involves light treatment, also called phototherapy. Medicines can also be taken orally or via injection which treats the entire immune system, also known as systemic therapy.
Recently, combination therapy, using lower doses of various topical lights and systemic treatments has an increase in its effectiveness Additionally, laser therapy, using an advanced pulse dye laser has successfully treated various kinds of skin lesions in both adults and children. This has proven to be a highly effective form of treatment for psoriasis. Five to six monthly treatments would be necessary for its effectiveness.
All forms of treatment have different success rates on each patient. What works for one does not necessarily work for the other. Therefore, doctors will use a trial-and-error approach and may need to switch forms of treatment in order to find the most effective kind of treatment for the patient.
How does pulse dye laser (PDL) therapy work?
Pulse dye laser therapy is specifically effective for psoriasis because it removes the specific small blood vessels which are responsible for the psoriatic plaque growth. Once these blood vessels are gone, the growth of psoriasis should be minimal to none. This laser helps stable cases of localized psoriatic plaque in mild to moderate psoriasis. Results are seen within three to four weeks after about five to six treatments monthly.
Advanced Dermatology’s Medical Director, Joshua Fox, M.D., Speaks with NASRF’s fellow on Psoriasis
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