A B C D E F G H I J K L M N O P R S T U V W

PSORIASIS

What is Psoriasis ?

Psoriasis is a common chronic condition which varies in appearance from one person to another. It can come on at any age, and particularly affects the skin of the elbows, knees and scalp. Dull red, scaly raised areas or plaques develop. The scales have a characteristic silvery sheen. Psoriasis is usually not itchy, but in some people this can become a problem. The fingernails and toenails are frequently affected. Small pits on the surface of the nail may occur. Sometimes the nail thickens or comes off altogether. In the scalp, the skin becomes red. Scales accumulate and make lumps in the scalp.

How does Psoriasis occur ?

Psoriasis is an inherited condition so is present from birth. Psoriasis, however, needs a trigger to bring it out in the skin and the trigger can occur at any age. Psoriasis is now regarded as an autoimmune disease which means that for some reason the immune system of the body is reacting in a way that leads to the changes seen in psoriasis. In the skin, the cells appear to be growing more quickly. This leads to the thickening of the skin and the silvery scaling which is so typical of the disorder.

Why does Psoriasis occur ?

Although a tendency to psoriasis is inherited, it may remain dormant for many years before showing itself. A large number of factors have been suggested as triggers for the condition. These include injury, infection, the hormone changes of puberty and menopause, and some drugs, such as lithium. The way in which these factors provoke an attack of psoriasis is not known.

Treatment Involved for Psoriasis

Management of the condition depends on the severity of the disease, and on your ability to carry out the treatment. In most cases, creams are used, with or without the use of sunlight therapy. In more severe cases, drugs and occasionally a special form of sunlight treatment (called PUVA) are used. Anti-psoriatic creams generally contain tar, dithranol, cortisone-like drugs (steroids) or vitamin A-like or vitamin D-like preparations. Tar in white soft paraffin is an effective treatment, especially when used with sunlight therapy. It tends to be messy, though. Dithranol can be used as a cream base or in a paste. Treatment is started with a weak concentration, which is gradually built up. The cream is left on for 12-24 hours at a time. Some doctors recommend high concentrations right from the start. In this case, short application times of 15-60 minutes are essential. It must always be carefully washed off. Steroids are effective in milder cases. Steroids can be combined with tar or salicylic acid. It is important not to use steroid creams for too long as they can damage the skin and the skin often becomes resistant to them after a period of treatment. If using a strong steroid cream, treatment periods of not more than two to three weeks should be employed. Only one vitamin A-like preparation is effective in psoriasis, a gel containing Tazarotene. This is effective in psoriasis used once daily but its usefulness is limited because it causes irritation. Skin inflammation and itching due to the use of this gel can be limited by the use of lots of moisturisers. Synthetic vitamin D-like drugs, calcipotriol and tacalcitol are available for the treatment of psoriasis. These creams and ointments attack the cause of the psoriasis and are very effective in 40 to 50% of patients, giving partial responses in a further 40 to 50%.

In patients who do not respond fully to the vitamin D-like preparation alone, it can be combined with a steroid cream to enhance its effect. In hospital, ultraviolet light treatment can be given, usually in the physiotherapy department. This will enhance the benefit of creams in the treatment of psoriasis. Severe psoriasis may justify specialized treatment with a number of drugs. Methotrexate is used to treat not only the skin but also the arthritis which occurs in some cases. It is usually given as tablets once weekly. The main drawback is that it may cause liver damage. Special tests must be performed before and after treatment is given. Another drug called cyclosporin may be used in your case if you have severe psoriasis. It is given as tablets which must be taken daily in a dose which depends on your body weight. It is only used in severe cases because the drug can occasionally damage the kidneys and raise your blood pressure. Acetretin is a form of synthetic vitamin A which is taken as a tablet. It can be used by itself or in a combination with some of the creams. In PUVA , a plant extract psoralen, which magnifies the effect of ultraviolet light on the skin, is taken as a tablet. Two hours later, ultraviolet A light is given to the entire body. This is a popular method of treatment because it requires no creams! Scalp psoriasis is difficult to treat. The first choice is usually a tar shampoo. If this fails, then steroid lotions and scalp applications are added. In difficult cases, special creams such as coconut compound ointment can be applied at night and washed out the next morning. There is no effective treatment for nail involvement, but nail disease can sometimes be hidden by nail varnish.

During Treatment for Psoriasis

Both tar and dithranol are messy and stain clothing. Tar can irritate the skin and dithranol may burn the skin if it is too highly concentrated. Dithranol always stains the skin, and this is evidence that it is working. Calcipotriol may cause irritation of the skin, particularly if used on your face. Take care to wash your hands after using the cream, to reduce the risk of transferring it to your face. Acetretin and PUVA may dry the skin. Chapping of the lips is often seen with acetretin. Since this drug can cause changes in the blood, regular blood tests will need to be performed. Acetretin may affect an unborn baby and it is important not to become pregnant while on the drug or for 2 years after stopping it. A long-term problem with PUVA is the production of skin cancers. PUVA is therefore usually used only for those patients who fail to respond to one or other form of cream application.

After Treatment for Psoriasis

Psoriasis is a chronic condition. It invariably recurs days or months later, even after successful treatment. Psoriasis may be associated with a form of arthritis which can occur in up to 25% of patients with psoriasis. The development of the arthritis does not depend on the severity of the psoriasis or its duration.

If Psoriasis is Left Untreated

Psoriasis runs a chronic course, but even without treatment individual lesions may clear, particularly with sunlight exposure. In those who are more severely affected, the psoriasis tends to increase in its extent. In rare cases, the psoriasis may affect the whole body which can be very dangerous, as the body loses heat through the red skin, and the skin may become infected. This requires urgent hospital treatment.

Effects on Family of Psoriasis

Psoriasis is a disfiguring disease and tends to cause enormous psychological problems for those affected. Support of family and friends is always necessary. This is an inherited disease and brother, sister, parents and children are more likely to develop psoriasis at some stage in their lives.