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Ask Your Doctor: Psoriasis
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Psoriasis is a common skin disorder and it is more than a cosmetic condition. Psoriasis may be one of the oldest recorded skin conditions. It was probably first described around 35 AD. Some evidence indicates an even earlier date. Yet, until recently, little was known about psoriasis. Although the disorder is generally manageable, it can cause significant distress, and patients may be severely affected psychologically.
What is Psoriasis?
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Dr. Brett Hodge
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Psoriasis is an inflammatory skin condition. It is not contagious. You cannot get it by coming in contact with a person who has the disorder.
There are five types, each with unique signs and symptoms. Between 10% and 30% of people who develop psoriasis get a related form of arthritis called “psoriatic arthritis,” which causes inflammation of the joints.
Plaque psoriasis (psoriasis vulgaris) is the most common type of psoriasis. About 80% of people who develop psoriasis have plaque psoriasis which appears as patches of raised, reddish skin covered by silvery-white scale. These patches, or plaques, frequently form on the elbows, knees, lower back, and scalp. However, the plaques can occur anywhere on the body.
The other types are guttate psoriasis (small, red spots on the skin),
pustular psoriasis (white pustules surrounded by red skin), inverse psoriasis (smooth, red lesions form in skin folds), and erythrodermic psoriasis (widespread redness, severe itching, and pain).
Regardless of type, psoriasis usually causes discomfort. The skin often itches and it may crack and bleed. In severe cases, the itching and discomfort may keep a person awake at night and the pain can make everyday tasks difficult.
Psoriasis is a chronic, meaning lifelong, condition because there is currently no cure. People often experience flares and remissions throughout their life. Controlling the signs and symptoms typically requires lifelong therapy.
Who Gets Psoriasis
Psoriasis occurs about equally in males and females. Recent studies show that there may be an ethnic link. Worldwide, psoriasis is most common in Scandinavia and other parts of northern Europe. It appears to be far less common among Asians and is rare in Native Americans.
There also is a genetic component associated with psoriasis. Approximately one-third of people who develop psoriasis have at least one family member with the condition.
Research shows that the signs and symptoms of psoriasis usually appear between 15 and 35 years of age. About 75% develop psoriasis before age 40. However, it is possible to develop psoriasis at any age. After age 40, a peak onset period occurs between 50 and 60 years of age.
About 1 in 10 people develop psoriasis during childhood, and psoriasis can begin in infancy. The earlier the psoriasis appears, the more likely it is to be widespread and recurrent.
Causes
While scientists still do not fully know what causes psoriasis, research has significantly advanced our understanding.
Immune Mediated
Researchers now believe that psoriasis is an immune-mediated condition. This means the condition is caused by faulty signals in the body’s immune system. It is believed that psoriasis develops when the immune system tells the body to over-react and accelerate the growth of skin cells. Normally, skin cells mature and are shed from the skin’s surface every 28 to 30 days. When psoriasis develops, the skin cells mature in 3 to 6 days and move to the skin surface. Instead of being shed, the skin cells pile up, causing the visible lesions.
Genes
Researchers have identified genes that cause psoriasis. These genes determine how a person’s immune system reacts. These genes can cause psoriasis or another immune-mediated condition, such as rheumatoid arthritis or type 1 diabetes. The risk of developing psoriasis or another immune-mediated condition, especially diabetes or Crohn’s disease, increases when a close blood relative has psoriasis.
Family History
Some people who have a family history of psoriasis never develop this condition. Research indicates that a “trigger” is needed. Stress, skin injuries, a strep infection, certain medications, and sunburn are some of the known potential triggers. Medications that can trigger psoriasis are anti-malarial drugs, beta-blockers (medication used to treat high blood pressure and heart conditions), and lithium.
Quality of Life
All types of psoriasis, ranging from mild to severe, can affect a person’s quality of life. Living with this lifelong condition can be physically and emotionally challenging.
Itching, soreness, and cracked and bleeding skin are common. Nail psoriasis can be painful. Even the simple act of squeezing a tube of toothpaste can hurt.
Several studies have shown that people often feel frustrated. In some cases, psoriasis limits activities and makes it difficult to perform job responsibilities. Studies also have shown that stress, anxiety, loneliness, and low self-esteem are part of daily life for people living with psoriasis. One study found that thoughts of suicide are three times higher for psoriatics than the general population.
Embarrassment is another common feeling. Imagine getting your haircut and noticing that the stylist or barber is visibly uncomfortable. What if you extended your hand to someone and the person recoiled? How would you feel if you spent most of your life trying to hide your skin?
Treatment
Treatment depends on the severity and type of psoriasis. Some psoriasis is so mild that the person is unaware of the condition. A few develop such severe psoriasis that lesions cover most of the body and hospitalisation is required. These represent the extremes. Most cases of psoriasis fall somewhere in between.
Initial management for any patient with psoriasis includes a good skin care regime and intensive lubrication. Patients should take short, warm shower or baths and use a moisturizing soap. After firefly towel drying, a thick moisturizer should be applied. Ointments are better than creams. Lotions should be avoided. Currently topical corticosteriods are the most commonly prescribed treatment for psoriasis.
With the emergence of several new therapies, including the biologic agents, more people are experiencing substantial improvements and reporting a greatly improved quality of life.
Conclusion
Psoriasis is a common skin disorder that causes severe distress the patient. Involvement of visible areas, such as the hands and scalp may even lead to self-inflicted ostracism. Although there is cure for psoriasis, new therapies are now available to manage this skin disorder.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.