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PSORIASIS
Last updated:
3/13/00
Psoriasis is a chronic
recurrent skin disorder without any known cause or
cure. It is a non-contagious, possibly inherited
condition that may be related to a deficiency of the
immune system. Dry, thick, scaly, silvery,
well-defined papules and plaques of various sizes
characterize psoriasis. These plaques are due to the
proliferation of the skin cells. The onset of
psoriasis is usually gradual in nature, and may have
remissions and exacerbations. The exacerbation may
be acute and can be severe in nature. Psoriasis
usually will not affect the patient's general
health, but can have a serious impact on their well
being. The appearance of the psoriasis plaques will
affect them in social situations, and interactions
with others.
Psoriasis affects the skins
protective functions, causing loss of fluids,
nutrients and control of the body temperatures. Very
often the patient will feel cold and at times hot
due to the imbalance of the body's thermostatic
control. The psoriatic eruptions can be induced by
trauma. The site of the trauma will exhibit the
psoriatic plaques. Sunburn can be such a traumatic
agent and this type of trauma is known as the "Koebner
phenonomen" . Other causes can be any sort of
irritation to the skin, such as tight clothing,
topical medications, such as in anti-malarial
treatment, beta-blockers, lithium and indomethicin.
Withdrawal of corticosteroids given in other
conditions can precipitate the psoriatic flare-up.
Stress and anger suppression
can be a causative factor. Alcohol could be a
trigger, as could high blood sugar levels and high
cholesterol levels. Smoking could also be a trigger,
as well as being exposed to second hand smoke for
extended periods of time. Diet, although not well
defined may be a trigger that triggers or possibly
worsens the lesions of psoriasis when they are
already present.
Eruption of the psoriatic
lesions is probably due to the proliferation of the
epidermal cells. Normally these epidermal cells will
turnover in 14 days. In psoriasis, activated T-cells
will cause these to turnover in 2 days as opposed to
the normal 14. It is this rapid turnover that is the
classic result of scaling in psoriasis.
Characteristically, psoriasis will involve the
extensor surfaces of the extremities, particularly
the elbows, knees and soles of the feet. Other sites
are the scalp, eyebrows, back, buttocks, navel area,
genitals and the anal region. It can also be
generalized and effect the entire body.
The lesions of psoriasis
generally are sharply defined and are usually non-pruritic
(itchy), reddened, raised or flattened plaques that
are covered with silvery or opalescent, shiny
scales. If the scales are forcibly removed, there
can be bleeding at the site. During some stages of
the disorder, there can be itching of a severe
nature, due to extreme dryness of the skin. The
lesions heal without scarring, and will usually not
affect the re-growth of hair. When psoriasis affects
the nails of the hand and/or feet, they will appear
as if they have a fungus infection. They become
thickened, pitted and stippled. They can become
discolored, and separate from the nail bed.
Psoriasis affects
approximately 9 million people in the United States
and one million in Canada, and many millions
throughout the world. It affects women slightly more
than men. Blacks are less affected than whites.
Average age of onset is 28, but can affect the
newborn, and as late as age 90. Of the 9 million
affected, 10 to 15 % will have onsets under age 10.
The degrees or seriousness of psoriasis can be rated
as mild, moderate, or severe.
A side effect of psoriasis can
be joint arthritis and is called "Psoriatic
Arthritis", and can affect 10% of psoriatic
sufferers. This form of arthritis closely resembles
rheumatoid arthritis and can be equally as
crippling. The blood serum does not show the
rheumatoid factor that is found in rheumatoid
arthritis. There are other forms of psoriasis. These
are: exfoliative psoriatic dermatitis (common or
plaque type), guttate, pustular, and erythrodermic
flexural psoriasis. Each form can exhibit mild,
moderate or severe symptoms. Treatment is usually
geared to the severity of the condition.
Topical steroids are generally
used to treat mild psoriasis. It is the prolonged
use of these steroids that causes thinning of the
skin, making the individual prone to purpura, which
is bleeding and bruising under the skin caused by
the slightest trauma to the skin. Systemic steroids
are at times taken orally, or injected
intramuscularly. At times the steroids are injected
into the psoriatic site itself. Coal tar has been an
age-old remedy and is used in soaps, shampoos and in
combination with other medications. Coal tar is also
used in a bath as a soak for the entire body.
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