Psoriasis
 

1. What causes psoriasis?
The cause is unknown. The skin sheds itself too rapidly, every three to four days. People often notice new spots 10 to 14 days after the skin is cut, scratched, rubbed, or severely sunburned. Psoriasis can also be activated by infections, such as strep throat, and by certain medicines. Psoriasis cannot be passed from one person to another, though it is more likely to occur in people whose family members have it. In the United States two out of every one hundred people have psoriasis (four to five million people). Approximately 150,000 new cases occur each year.

2. What types of psoriasis are there?
Psoriasis comes in many forms. Each differs in degree of severity, how long it lasts, where it is, and in the shape and pattern of the scales. The most common form begins with little red bumps. These gradually grow larger and scales form on top of the bumps. These small red areas then grow, sometimes becoming quite large.

Elbows, knees, groin and genitals, arms, legs, scalp, and nails are the areas most commonly affected. Psoriasis will often appear in the same place on both sides of the body.

Psoriatic nails may have tiny pits on them. Nails may loosen, thicken or crumble.

Inverse (reverse pattern) psoriasis occurs in the armpit, under the breast and in skin folds around the groin, buttocks, and genitals.

Guttate psoriasis usually affects children and young adults. It often shows up after a sore throat, with many small, red, teardrop-like, scaly spots appearing on the skin.

About seven percent of psoriasis patients have arthritis, which fortunately is not too severe in most people. The arthritis may be worst when the skin is very involved and may improve when the condition of the patient's skin improves.

3. How is Psoriasis Diagnosed?
Dermatologists diagnose psoriasis by examining the skin, nails, and scalp. A skin biopsy may be needed to confirm the diagnosis.

4. How Is Psoriasis Treated?
The goal of therapy is to reduce inflammation and to slow down rapid skin cell division. Sunlight exposure helps the majority of people with psoriasis.

There are several effective treatments for psoriasis. Topical steroids (Cortisone) may clear the skin temporarily and control the condition in many patients. These must be used cautiously since side effects of the stronger cortisone preparations include thinning of the skin, dilated blood vessels, bruising, and skin color changes. After many months of treatment, the psoriasis may become resistant to the steroid preparations. Anthralin is a tar based medication that works well as a long term treatment on tough-to-treat thick patches of psoriasis. It can cause irritation and temporary staining of the skin and clothes. For more than 100 years, coal tar has been used to treat psoriasis. Today's products are greatly improved and less messy. Stronger prescriptions can be made to treat difficult areas. A synthetic Vitamin D, calcipotriene, is now available in prescription form. It is useful for individuals with localized psoriasis and can be used with other treatments. When psoriasis has not responded to other treatments or is widespread, PUVA is effective in 85 to 90 percent of cases. Patients are given a drug called psoralen, then are exposed to a carefully measured amount of a special form of ultraviolet (UVA) light. Because psoralen remains in the lens of the eye for 24 hours, patients must wear UVA blocking eyeglasses. Methotrexate is an oral anti-cancer drug that can produce dramatic clearing of psoriasis when other treatments have failed. Because it can produce liver disease, regular blood tests are performed and liver biopsies may be required. Prescription Vitamin A drugs known as retinoids may be used alone or in combination with ultraviolet light for severe cases of psoriasis. Side effects include dryness of the skin, lips and eyes, elevation of fat levels in the blood, and formation of tiny bone spurs. Retinoids should not be used by women of child-bearing age, as birth defects may result. Special diets have not been successful in treating psoriasis.

 

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