Psoriasis affects the skins protective functions, causing loss of fluids, nutrients and control of the body temperatures. Very often the patient will feel cold and at times hot due to the imbalance of the body’s thermostatic control. The psoriatic eruptions can be induced by trauma. The site of the trauma will exhibit the psoriatic plaques. Sunburn can be such a traumatic agent and this type of trauma is known as the “Koebner phenonomen”. Other causes can be any sort of irritation to the skin, such as tight clothing, topical medications, such as in anti-malarial treatment, beta-blockers, lithium and indomethicin. Withdrawal of corticosteroids given in other conditions can precipitate the psoriatic flare-up. Stress and anger suppression can be a causative factor.
Alcohol could be a trigger, as could high blood sugar levels and high cholesterol levels. Smoking could also be a trigger, as well as being exposed to second hand smoke for extended periods of time. Diet, although not well defined may be a trigger that triggers or possibly worsens the lesions of psoriasis when they are already present. Eruption of the psoriatic lesions is probably due to the proliferation of the epidermal cells. Normally these epidermal cells will turnover in 14 days. In psoriasis, activated T-cells will cause these to turnover in 2 days as opposed to the normal 14. It is this rapid turnover that is the classic result of scaling in psoriasis. Characteristically, psoriasis will involve the extensor surfaces of the extremities, particularly the elbows, knees and soles of the feet.
Other sites are the scalp, eyebrows, back, buttocks, navel area, genitals and the anal region. It can also be generalized and effect the entire body. The lesions of psoriasis generally are sharply defined and are usually non-pruritic (itchy), reddened, raised or flattened plaques that are covered with silvery or opalescent, shiny scales. If the scales are forcibly removed, there can be bleeding at the site. During some stages of the disorder, there can be itching of a severe nature, due to extreme dryness of the skin. The lesions heal without scarring, and will usually not affect the re-growth of hair. When psoriasis affects the nails of the hand and/or feet, they will appear as if they have a fungus infection. They become thickened, pitted and stippled. They can become discolored, and separate from the nail bed. Psoriasis affects approximately 9 million people in the United States and one million in Canada, and many millions throughout the world. It affects women slightly more than men. Blacks are less affected than whites. Average age of onset is 28, but can affect the newborn, and as late as age 90. Of the 9 million affected, 10 to 15 % will have onsets under age 10. The degrees or seriousness of psoriasis can be rated as mild, moderate, or severe. A side effect of psoriasis can be joint arthritis and is called “Psoriatic Arthritis”, and can affect 10% of psoriatic sufferers.
This form of arthritis closely resembles rheumatoid arthritis and can be equally as crippling. The blood serum does not show the rheumatoid factor that is found in rheumatoid arthritis. There are other forms of psoriasis. These are: exfoliative psoriatic dermatitis (common or plaque type), guttate, pustular, and erythrodermic flexural psoriasis. Each form can exhibit mild, moderate or severe symptoms. Treatment is usually geared to the severity of the condition. Topical steroids are generally used to treat mild psoriasis. It is the prolonged use of these steroids that causes thinning of the skin, making the individual prone to purpura, which is bleeding and bruising under the skin caused by the slightest trauma to the skin. Systemic steroids are at times taken orally, or injected intramuscularly. At times the steroids are injected into the psoriatic site itself. Coal tar has been an age-old remedy and is used in soaps, shampoos and in combination with other medications. Coal tar is also used in a bath as a soak for the entire body. During the past several years, other medications have been introduced, such as Anthralin, Vitamin D3, Pycnogenol, Salicylic Acid and Topical Retinoid Therapy.
Sunbathing and baths with Epsom salts, Dead Sea Salts and ollated oatmeal are in wide use. There are also dozens of creams and ointments on the market that claim to be remedies for psoriasis. What one individual finds of benefit may not help the majority. Very often treatments are hit and miss, and if a treatment is found to be beneficial, that may not be of lasting effect as they become accustomed to the treatment. They then need to find another treatment, before returning to the treatment that was beneficial. With moderate psoriasis, the use of phototherapy (UVB) has been a staple, and is used in widespread or localized unmanageable psoriasis. The side affects after long-term usage can be the risk of skin aging, cancer and also thinning of the skin. The patient can use phototherapy at home when they purchase a home therapy unit, usually under the prescription and supervision of a Dermatologist.
Photochemotherapy (PUVA) is used in combination with the drug Psoralen, which is taken orally. Psoralen has the effect of enhancing the affect of the phototherapy. Psoralen can also be used as body paint or placed in a bath just before the phototherapy treatment. Here again, there can be long term side affects, such as aging of the skin, non-aggressive forms of skin cancer, pigmented areas, freckles, redness, itching, cataracts, osteoporosis, high blood pressure, hair loss, liver and kidney abnormalities. It can cause severe gingivitis that can result in tooth extractions, and at times can result in nausea. Fetal malformation can be another result. For severe psoriasis, the more potent types of drugs are used. Methotrexate, Retinoids, Cyclosporin, IL-2 Fusion Protein and Hydroxyurea are some of these drugs. These drugs can have very severe side effects and can have devastating effects on the liver and other body organs. Many of these drugs are used in a program of using one of the drugs for several months, then switching to another. This is known as Rotational Therapy.
The prognosis of psoriasis usually depends on the severity of the condition and at the age of onset. Although acute attacks may clear up faster with the simplest forms of treatment, the long-term prognosis is not usually permanent. People with psoriasis generally will be on one form of treatment or another since the onset of the disorder. Finding a treatment that works can be a lifelong chore for the psoriatic patient. Finding effective treatments has been my goal for over 39 years. What I have learned is that not all treatments will be effective in all cases. The important thing is that the treatment should do no harm. Side effects can be more devastating than the condition itself and must be avoided if at all possible.