A Guide for Health Care Professionals on Psoriasis

Psoriasis is a skin condition characterized by inflamed, red areas on the skin that develops as silver-like scales which are referred to as psoriatic plaque. These red skin patches are commonly itchy. They affect any area of the body. Most common are the scalp, knees, elbows, and even the genital areas. These are the best two lotions to moisturize psoriasis.

Psoriasis is a chronic disease and is often times genetic. The cause of the disease is not yet known but experts believe that psoriasis develops when the skin experiences excessive reproduction. Certain factors can trigger the disease like excessive alcohol intake, stress, and cigarette smoking.

According to the Medical Center of the University of Maryland, nearly 6 million people in the United States are affected by the disease.

Psoriasis is distinguished into different types according to its severity: Discoid Psoriasis is the most common. Also known as plaque psoriasis, tits symptoms include red patches on the skin which may appear as raised. They can be found in the arms, trunk, legs, scalp, or the genital areas. It may also cause a patient’s nails to thicken and be separated from the nail beds. Guttate Psoriasis on the other hand mostly affects children. Patients will have red, raised patches on the skin. They may also experience sore throat before the illness is triggered. Pustular Psoriasis is common to the hands and feet, and is also referred to as palmoplantar pustulosis. This type of psoriasis is characterized by bumps that are filled with pustules or pus, which are non-infectious with the skin around each pus colored red.

Once the slightest symptoms of psoriasis show up, a doctor can diagnose the illness through a medical examination of the nails and skin. Once the condition is confirmed, the attending physician will perform a skin biopsy or scraping to rule out any other skin disorders. In this process, the doctor will take a sample of the skin and examine it under a microscope.

Of all the population which is infected with the disease, 65 percent has mild psoriasis, 25 percent are moderate, and 8 percent has severe psoriasis. The remaining 2 percent are patients with mild psoriasis and are undergoing systematic medication, as according to the National Psoriasis Foundation.

No one is entirely safe from this disorder. Psoriasis affects people from both sexes and can occur at any age. It mostly appears between the ages of 15 and 25. according to a survey conducted by the National Psoriasis Foundation, psoriasis is widespread in 2.1% of adult Americans. It also showed that 35% of the people affected by the genetic disease can be classified as having moderate to severe psoriasis. The disease is also common to 2 to 3 % in Western populations and the prevalence of the illness among 7.5 million people who were registered with a general practitioner in the United Kingdom was 1.5 percent.

It is also believed that around one-third of those who are infected has a relative previously diagnosed with psoriasis. There is also a 70% chance of a monozygotic twin of developing psoriasis if the other twin has it. Chances for dizygotic twins are around 20%. There is a greater genetic inclination for those who are under 40 years of age and a more severe case of psoriasis.

As there are factors that can lead to the development of psoriasis, there are known triggers of the disease which people must be wary of. According to the American Academy of Dermatology, infection is number one. There have been studies that directly link infection to the development of psoriasis. Those who have a family history of psoriasis that experiences strep throat (streptococcal pharyngitis ) develop their first psoriasis in one to two weeks after the infection. Types of infection that can trigger psoriasis are candida albicans or thrush, human immunodeficiency virus more commonly known as HIV, streptococcal pharyngitis or strep throat, staphylococcal skin infections or boils, and viral upper respiratory condition.

Another trigger for the skin disease is when the body experiences reactions to certain medications. Those that trigger psoriasis are anti-malarial drugs, beta-blockers (used to treat high blood pressure), corticosteroids, indomethacin (used to treat arthritis and other inflammation), and lithium (used for treatment of manic depression).

For some people who had their skin cut, scratched, or burned, psoriatic lesions usually appears in about 10 to 14 days after, according to the Koebner phenomenon. Named after Dr. Koebner, in 19th century when he observed that a patient who was bitten by a horse developed psoriasis in the area that was bitten. Today, there are several skin conditions that are considered to trigger Koebner’s phenomenon. Some of them are bites, bruises, burns, chafing, skin irritation, cuts, scrapes, pressure on the skin, shaving, sunburn and peeling, and other skin traumas.

For those who already have psoriasis, it is most likely that their number one trigger is stress. It is confirmed by studies that stress not only triggers the skin disease but can also increase itching. When asked, some can say that they had their first outbreak during a stressful event in their lives. Having psoriasis causes stress already, as well as treating it because of all the hassles one has to endure in the whole process. It is advised by dermatologists that psoriasis patients tell them if they feeling an overwhelming amount of stress. There are ways that can be utilized to alleviate stress.

Lastly, weather is found to trigger the skin disease. Winter climate is said to worsen the condition of psoriasis for patients. It is during this time when the weather is dry and indoor heat robs the skin of its moisture.
In treating psoriasis, the main objective is to reduce the inflammation and to slow down the excessive reproduction of skin cells. There is no found cure for psoriasis yet. An attending physician may identify which type of treatment best suits a patient after considering factors like: over-all health, age, medical history, the severity of the illness, tolerance on specific medications, and the patient’s preference. Oftentimes, dermatologists utilize a trial-and-error approach to find the type of treatment that will best work for the patient because psoriasis is an idiosyncratic disease, meaning it is distinct to a certain individual. The case may worsen or improve for various patients. The treatment found to have the least potential for adverse reactions are used.

Treating psoriasis can follow what is called a psoriasis treatment ladder. As a first step, topical treatment is utilized. Here, the attending physician will use ointments and creams to apply on the skin of the patient. Moisturizers and bath solutions are also used. These will help minimize the itchiness and swelling of the plaques. Creams and ointments that contain coal tar, dithranol, and corticosteroids such as Topicort Desoximetasone are used through out the treatment. Other medications are those that have Vitamin D3 analogues like calcipotriol, and retinoids. One that also shows promising results is argan oil. Each medication works differently but they all have the same effect in normalizing skin cell production.

One important thing to note is that sudden withdrawal from topical treatments (especially corticosteroids) will result to an aggressive repetition of the condition, referred to as rebound. Using topical treatments because it can be time-consuming, can irritate the skin, or stain clothing, or even have a pungent smell may discomfort some people which may be the reason for people to stop this type of treatment.

When using topical treatment fails to work for a patient, phototherapy can be used next. This entails exposing the skin to ultra-violet rays. Note that it is advised to expose the skin to only short, non-burning sunlight to improve psoriasis. Undergoing this method for several times per week over a period of weeks will aid in the remission of the disease.

When still resistant to phototherapy, psoriasis can be treated by means of systematic treatment. This uses medications that are taken as pills or injections. Patients who are undergoing this type of method must be regularly subjected to liver function and blood tests. In case of pregnant patients, it is strongly advised to avoid pregnancy because a sudden stop in the treatment will result to a recurrence of psoriasis.
Methotrexate, cyvlosporine, and retinoids are main traditional systematic treatments available. The first two are what is considered as immunosuppressant drugs or anti-rejection drugs while retinoids are synthetic forms of Vitamin A. There are also medications that are found to be effective against psoriasis but not licensed for the disease. Some of them are antimetabolite tioguanine which is required for noram biochemical reaction and does not interfere with normal cell function, an anti-inflammatory medication called sulfasalazine and hydroxyurea, an antineoplastic drug (prevents the formation of tumor).

For those wishing to go on a different route, alternative treatment for psoriasis is also available. Among these methods are antibiotics and climatotherapy. Antibiotics are not included in routine treatment of the skin disease but these may be used when an ifection triggers psoriasis. There have been certain beliefs that a particular disease can be cured successfully depending on the climate of a particular place.

To sum it up, equally important in treating psoriasis is the person’s ability to overcome the emotional toll brought about by the disease. With the help of family and friends, a person afflicted with psoriasis can get over the emotional roller coaster of having to deal with humiliation, depression and stress throughout the whole process. That person’s life can be devastated by the effects of psoriasis. What is important is that they are educated about the condition so that they will have a better chance of accepting the disease and a stronger will to fight it. If things get worse or more difficult to handle, there is always the option of getting professional help.