Psoriasis
Psoriasis is an inflammatory condition of the skin that gives rise to reddened skin covered with dry, silvery scales. These scales, known collectively as plaques, consist of several layers of dead skin cells.
Our skin is constantly in the process of renewing itself. After cells are created in the under-layer, or dermis, they move outwards towards the skin's surface. On their journey to the outermost layer, the epidermis, they die and become keratinized (hard). The cells then separate from each other and slough off. This process normally takes a month from start to finish.
When a person has psoriasis, the skin cell production goes into overdrive, causing the outer layers of skin to build up; instead of taking a month, the entire renewal process now takes a mere few days.
Psoriasis characteristically involves the scalp, the extremities (particularly elbows and knees), the sacral (lower back) area, buttocks and - in males - the penis. The nails, eyebrows, armpits, navel or groin region may also be affected. In some cases, psoriasis is so mild that people don't know they have it. However, severe psoriasis may involve large areas of the body. Psoriasis is characterized by frequent recurrences and remissions and is not contagious.
HOW COMMON IS PSORIASIS?
Psoriasis affects approximately one percent of the population. Although the condition can strike at any age, from infancy to old age, it most commonly affects people between the ages of 15 and 50. Caucasians are affected by psoriasis more than other ethnic groups.
WHAT CAUSES PSORIASIS?
Why the skin cells begin to multiply in an abnormal manner is not well understood. Heredity is a factor on approximately one-third of psoriasis cases. Psoriasis appears to be related to the immune response and is inflammatory in nature. Irritations or injuries such as cuts, burns, insect bites or rashes seem to aggravate psoriasis as do infections such as strep throat. Psoriasis scaling may be particularly severe in people whose immune systems have been suppressed by drugs, including people with AIDS, chemotherapy patients, and those with autoimmune disorders such as rheumatoid arthritis.
Such as is the case with eczema, digestive problems (inflammatory bowel diseases such as crohn's disease, ulcerative colitis and diverticulitis) may precede psoriasis; this could be due to abnormal absorption, into the bloodstream, of foreign compounds from the digestive tract. Foreign compounds within the bloodstream provoke immune hypersensitivity and can affect the skin in many negative ways.
Other contributing factors to psoriasis development include the use of certain medications, viral or bacterial infections, too much or too little sunlight, obesity, excessive alcohol consumption, stress and friction against the skin.
Click here for psoriasis risk factors and skin wellness tips.
HOW IS PSORIASIS TREATED?
The goal of psoriasis treatment is to reduce inflammation and to control flaking of the skin. Psoriasis treatment is based on the affected person's health, age, lifestyle, and the severity of the psoriasis. A number of different psoriasis treatments are normally employed to determine which is the most effective.
UNDERSTANDING PSORIASIS TREATMENTS
Topical Steroids.
Topical steroid medications are one of the most common treatments for mild to moderate psoriasis. They reduce inflammation and itching and stop the rapid build-up of dead skin cells.
Weaker preparations should be used on sensitive areas of the body such as the face, groin and genitals. Stronger preparations will usually be needed to control psoriasis lesions on the scalp, elbow, knees, palms and soles, and parts of the torso. Side effects of the stronger cortisone preparations include thinning of the skin, dilated blood vessels, bruising, and changes to skin colour. Stopping these medications suddenly may result in a flare-up. After many months of treatment with steroids, the psoriasis may become resistant to the preparation that has been prescribed. Cortisone is often injected into areas that remain resistant to treatment.
Anthralin.
This medication works well on stubborn, thick patches of psoriasis. It may cause irritation in some individuals and can also stain the clothes. Recently introduced anthralin preparations and methods of treatment have reduced the likelihood of experiencing these side effects.
Retinoids.
Prescription vitamin A is often utilized for treatment of localized psoriasis either alone or in combination with topical steroids. Women who are pregnant or likely to become pregnant should not use topical retinoids.
Vitamin D.
A synthetic form of vitamin D, calcipotriene, is helpful for people with localized psoriasis. Calcipotriene is now available by prescription as an ointment, cream and solution in the US and Canada. Ordinary Vitamin D from a drug or health food store is of no value in treating psoriasis.
Coal Tar.
This topical preparation has been used to treat psoriasis for over 100 years. Today's formulations are greatly improved over older products. Stronger prescriptions may be necessary to treat difficult areas.
Light Therapy.
Ultraviolet (UV) light, including sunlight, slows down the rapid growth of skin cells. Since exposure to UV light can skin wrinkles, eye damage and skin cancer, UV light therapy should be carried out under medical supervision. People who have widespread psoriasis may require treatment in a medically approved center equipped with light boxes for full body exposure.
PUVA.
This treatment (the name is derived from the drug psoralen + UVA), is effective when psoriasis has not responded to other treatments or is widespread. PUVA is effective in 85 to 90 percent of cases. The treatment involves taking psoralen, followed by a carefully measured amount of a special form of ultraviolet (UVA) light. Clearing of lesions normally requires 25 treatments or so, over a two to three-month period. Between 30 - 40 treatments a year are normally required to keep psoriasis under control.
PUVA treatments increase the risk of skin aging, freckles, and skin cancer.
Goeckerman Treatment.
This combination treatment is named after the Mayo Clinic dermatologist who developed it in 1925. Both coal tar dressings and ultraviolet light are used for people with severe psoriasis. Goeckerman treatment must be performed on a daily basis in specialized centers.
Methotrexate.
This oral anti-cancer drug produces significant clearing of psoriasis when other treatments have failed. Since it may produce undesirable side effects, particularly liver disease, regular blood tests must be performed. Chest x-rays and occasional liver biopsies may be required. Other side effects include upset stomach, nausea and dizziness.
Retinoids.
These prescription oral vitamin A-related drugs may be given alone or in combination with ultraviolet light to treat severe psoriasis. Side effects of retinoid treatment include dry skin, lips and eyes, elevation of fat levels in the blood, and formation of tiny bone spurs. Oral retinoids should never be used by pregnant women or women of childbearing age who intend to become pregnant within three years of discontinuation of therapy. (Retinoids can cause birth defects.) Close monitoring and regular blood tests are required during this treatment.
Cyclosporine.
This immune-suppressing drug is for treatment of widespread psoriasis when other methods have failed. Due to cyclosporine's potential impact on the kidneys and blood pressure, close medical monitoring and regular blood tests are required when taking cyclosporine.
Scalp Treatment
The treatment for psoriasis of the scalp depends on the severity of the disease, the person's lifestyle and the length of hair. A variety of prescription and non-prescription shampoos, sprays, oils, and solutions are available. Most of these contain coal tar or cortisone.
SUBSTANCES THAT IMPROVE QUALITY OF LIFE
- NUTRICOL®
Nutricol®, available as Recovery® in many pharmacies and health retailers, is a food-based non-drug supplement produced to improve quality of life*.
Nutricol® (Recovery®) may be safely combined with psoriasis drugs. Recovery® is designed to improve circulation and healing and to minimize damage, inflammation and spasm. It does not produce unpleasant side effects. Since Recovery® works to modify and improve your body's own responses, it may take up to three to five weeks for you to experience relief.
Click here to view feedback from health professionals and users about the results noted from Recovery® with Nutricol®.