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What Is Psoriasis?
Psoriasis is a chronic immune
system-related disease that causes inflammation and damage to involved
tissues, primarily the skin. Though it can affect skin anywhere on the
body, psoriasis most often appears on the scalp, elbows, knees, lower
back, and the palms and soles of the feet. It can also affect
fingernails and toenails, the soft tissues of the genitalia and inside
The five forms of psoriasis are:
- Plaque psoriasis, which accounts for about 80
percent of cases. Patches of skin, often on the elbows, knees, scalp
and lower back, are raised, red and covered with silvery scales that
shed; they are usually very dry, and may itch, burn or crack.
- Guttate psoriasis,
which occurs in less than 2 percent of patients, often starts in
childhood, and can be triggered by bacterial or viral infection, such
as strep throat, chicken pox, tonsillitis or even a cold. Patients
develop spots of red skin on the abdomen, chest, back, arms, legs and
- Pustular psoriasis, which occurs in
less than 3 percent of patients. It appears as blisters on the skin,
which become reddened and may appear in specific spots, mainly on the
hands and feet or on the tips of the fingers, or in widespread patches
on the body.
- Erythrodermic psoriasis, which
also occurs in less than 3 percent of patients and usually covers most
of the body’s surface. The skin becomes fiery red and may be extremely
itchy and painful. This form can be very serious and may occur suddenly
or, in people with plaque psoriasis, come on more gradually.
- Inverse psoriasis,
another rare form of psoriasis, which produces smooth, dry areas of
skin, mainly in the armpits, groin, under the breasts, and in skin
folds around the genitals and buttocks. Affected areas become very red
and inflamed. Rubbing and sweating can irritate these patches, which
can become painful and itchy.
psoriasis, skin cells move up from below the surface and pile up on the
outer layer before they have a chance to mature normally. Usually, it
takes about a month for cells to move to the surface. But in psoriasis,
it may occur in only a few days, leading to the characteristic plaques.
Psoriasis is an inflammatory disorder in which a certain type of cell
called a T lymphocyte becomes overactive and initiates a series of
biochemical events leading to inflammation.
About a third of those who develop psoriasis have a family history of
the disease. While it can develop at any age, psoriasis often first
appears between ages 15 and 35. Only about 10 to 15 percent of people
with psoriasis get it before age 10, and occasionally it appears in
infants. The severity of psoriasis varies for each individual. Some
people may have such mild cases that they escape notice. In others, the
flare-ups are disabling. Mild cases are those that involve less than 2
percent of the body. Moderate cases affect between 3 percent and 10
percent, and severe cases involve more than 10 percent of the body.
Doctors rely on two methods to make a diagnosis of psoriasis:
- Physical examination, which involves a careful examination of the skin and taking a medical history.
- Biopsy, which involves taking a small sample of skin and submitting it for examination under a microscope.
Psoriasis is a
disease that lasts a lifetime. In some people, psoriasis completely
clears up for months or even years at a time. This is called remission.
For others, the disease is active in cyclical patterns. In one common
pattern, psoriasis is better in the summer and worse in the winter.
Psoriasis can be uncomfortable both physically and emotionally, and
severe cases can be disabling. But the disease does not affect a
person’s life expectancy, and most people who have psoriasis are able
to lead active lives.
Usually, psoriasis flares up after people experience what’s called a “trigger,” such as:
- An injury to the skin, such as severe sunburn, scratches or a reaction at a vaccine injection site
most notably beta-blockers, which are used to treat high blood
pressure, and lithium, which is used to treat depression
- Change in climate or weather
- Infections, such as streptococcus infection
There is no cure for
psoriasis, but there are treatments to help relieve symptoms. Doctors
usually treat psoriasis in a series of steps, depending upon the
severity and type of psoriasis a patient has. This is sometimes called
the "1-2-3" approach, where:
Step 1 includes topical treatment – patients apply medicines to their skin.
Step 2 includes phototherapy – patients use exposure to light.
Step 3 includes systemic treatment - patients take medication.
psoriasis is chronic and unpredictable, patients often experiment
before they find a treatment – or combination of treatments – that
works for them.
people can clear up psoriasis by applying medications to their skin.
The most commonly used topical treatments include:
- Steroids, which slow the growth of excess
skin cells and decrease inflammation, though they rarely clear
psoriasis for long periods of time. Doctors may prescribe short-term
treatment with high-potency steroid ointments, such as Diprolene
(betamethasone topical) or Temovate (clobetasol) for use on thicker
areas of skin, such as the knees, elbows and feet. Patients often use
medium and low-potency ointments on more delicate skin areas. (I deffinatly tried that!)
- Dovonex (calcipotriene),
a synthetic form of vitamin D3 that can control excessive growth of
skin cells and is most often prescribed for patients with mild to
moderate psoriasis. (This stuff didn't do anything.)
- Coal tar, available both
with a prescription and over the counter, coal tar preparations have
been used to treat mild to moderate plaque psoriasis for centuries.
They have fewer side effects than steroids, but are messy and less
effective. (This stuff smells.)
- Anthralin, one of the older
medications for psoriasis, it is derived from Goa powder from the bark
of the araroba tree. Anthralin can be effective on mild to moderate
plaque psoriasis and has no known long-term side effects, but it can
irritate the skin, and stain skin, clothing and even sinks and tubs.
- Tazorac (tazarotene),
a topical retinoid; a medication derived from vitamin A, for people
with mild or moderate plaque psoriasis; in some patients, it can
produce long-term remissions.
- Salicylic acid, a
chemical that helps remove scales, which allows topical medications to
penetrate the skin more successfully. Patients often use it in
combination with anthralin, coal tar or topical steroids. (Good for Acne but not much else.)
- Bath solutions,
such as oil, tar solution, oiled oatmeal, Epsom salts or Dead Sea salts
that are added to bath water to reduce itching and removes scales. (Felt good but didn't clear anything up.)
usually thick, greasy varieties, which work best to soothe psoriasis
because they hold water in the skin and reduce scales and itching.(My best friend!!!)
light kills T cells in the skin, which reduces inflammation and excess
skin cell growth. Phototherapy can be in the form of sunlight or
controlled treatments with artificial light administered in a doctor's
office or in a psoriasis day clinic. Phototherapy treatments include:
- Sunlight: Short doses of sunlight help clear psoriasis, but sunburn can worsen it, so patients must monitor their time outdoors closely.
- UVB phototherapy:
In this treatment, patients expose their skin to ultraviolet light B. A
newer source of the light, called narrow-band UVB, emits the part of
the ultraviolet spectrum that may be most helpful for psoriasis. It
often takes at least two or three months of regular exposure before
psoriasis clears up. Doctors may prescribe UVB phototherapy in
combination with topical treatments. (This would make me ill afterwards.)
This treatment combines a medication called psoralen with exposure to
ultraviolet light A, or UVA, which makes the skin more sensitive and
responsive to UVA. According to the National Psoriasis Foundation,
about 75 percent of people using the treatment find that their
psoriasis clears up for as long as a year. On average, it takes about
25 treatments to clear the skin. PUVA has more short-term side effects
than UVB, including nausea, headache, fatigue, burning and itching.
Long-term treatment may increase risk of skin cancer.
The FDA recently approved laser treatment for psoriasis. The laser
emits a high-intensity beam of light similar to narrow-band UVB. The
treatment is usually used by people with mild to moderate psoriasis
that affects less than 10 percent of the body. Evidence suggests that
it takes eight to 10 laser sessions for psoriasis to clear up. These
treatments also reduce exposure to potentially harmful UV radiation.
Doctors may prescribe the following systemic drugs for people who have moderate to severe psoriasis or psoriatic arthritis:
- MTX or Rheumatrex (methotrexate), oral or
injectable drugs that slow down the production of skin cells by
suppressing the immune system. It's prescribed for psoriatic arthritis
and severe psoriasis, especially for serious cases of pustular or
erythrodermic psoriasis. More than 80 percent of patients see some
change within two to three months. Methotrexate can cause liver damage,
however, and it can also inhibit the production of red and white blood
cells and platelets. (It didn't do anything.)
- Neoral, Sandimmune (Cyclosporine),
an oral drug that works by suppressing the immune system in a way that
slows skin cell growth. It's usually prescribed for patients with
severe psoriasis who aren't responding to other treatments or can't use
them. It usually clears up psoriasis within six weeks, but is generally
only effective while patients take it. Side effects include impaired
kidney function and high blood pressure.
- Soriatane (acitretin),
a retinoid, which is a class of compounds related to vitamin A that
affect how quickly cells grow. They are used to treat plaque,
erythrodermic and pustular psoriasis, especially if patients don't
respond to other therapies. Patients usually see improvement within two
to four months. Retinoids can clear up psoriasis for a few weeks to
more than a year, but they can also cause birth defects, so women of
child-bearing age must use contraception while taking the drug.
therapies are systemic medications that target specific proteins in the
body. Traditional drugs affect all the cells in the body, but biologics
target only specific cells or specific proteins and therefore may be
more effective and cause fewer side effects. Biologics used for
- Amevive (alefacept): Amevive blocks the
action of overactive immune cells (T cells) that eventually cause
excessive growth of skin cells. Amevive is indicated for adults with
moderate to severe chronic plaque psoriasis who are candidates for
systemic therapy or phototherapy. It is injected into the muscle once a
- Enbrel (etanercept): Enbrel blocks the
action of a protein that causes inflammation (TNF). It has been
approved for treatment of adults with chronic moderate to severe plaque
psoriasis who are candidates for systemic therapy or phototherapy.
Enbrel is also indicated in psoriatic arthritis. It is injected under
the skin once a week. (This made the enjection site extreamly itchy, swollen, hot, red.... it was basically a welt. I think I may have been allergic to this.)
- Humira (adalimumab):
Humira blocks the action of a protein called TNF that causes
inflammation. Humira is indicated for the treatment of adult patients
with moderate to severe plaque psoriasis who are candidates for
systemic therapy or phototherapy, and when other systemic therapies are
medically less appropriate. Humira is also indicated for the treatment
of psoriatic arthritis. It is injected under the skin once every two
weeks. (Best thing on earth! Who ever invented this needs to be kissed! It worked for me!!!)
- Raptiva (efalizumab): Raptiva is
indicated for the treatment of adult patients (18 or older) with
chronic moderate to severe plaque psoriasis who are candidates for
systemic therapy or phototherapy. Raptiva works under the skin and
prevents the T cells that cause psoriasis from becoming activated and
entering the skin. It is injected under the skin.
- Remicade (infliximab):
Remicade is indicated for the treatment of adult patients with chronic
severe (i.e., extensive and/or disabling) plaque psoriasis who are
candidates for systemic therapy and when other systemic therapies are
medically less appropriate. It is also approved for the treatment of
psoriatic arthritis. Remicade blocks the action of a protein that
causes inflammation (TNF). It is given by intravenous infusion either
in a doctor’s office or in an infusion center.