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Psoriasis Definition Psoriasis is a chronic, inflammatory skin disease. Knees, elbows, scalp, trunk, and nails are the most commonly affected areas. There are several types of psoriasis. * Erythrodermic - intense sloughing and inflammation of the skin * Guttate - small dot-like lesions * Plaque - inflamed patches of skin topped with silvery, white scales (most common type) * Pustular - weeping lesions and intense scaling Causes The cause of psoriasis is unclear. It may be related to a defect in the immune system that causes the immune system to send signals that result in an overgrowth of skin cells. Because the cells grow faster than they can be shed, they ‘pile up' on the skin's surface. The excess skin cells are thought to cause the silvery white scales that are characteristic of plaque-type psoriasis. Risk Factors A risk factor is something that increases your chance of getting a disease or condition. * Bacterial infections * Certain medications, including oral steroids, beta blockers, and lithium * Cold climates * Family history of psoriasis * Rheumatoid arthritis * Sex: Female * Stress * Suppression of the immune system, including AIDS Symptoms * Arthritis or joint pain * Patches of red, raised skin * Pitted or dented fingernails and/or toenails * Rough, dry, thick areas of the skin * Silvery white scales Diagnosis The doctor will ask about your symptoms and medical history, and perform a physical exam. Your skin and nails will be examined. There are no special blood tests or diagnostic procedures for psoriasis. Sometimes a skin biopsy will be done to confirm the diagnosis. Treatment Treatment is based on: * Responsiveness to the treatment * The extent and location of the areas involved * The severity of the disease Topical treatment Many patients respond very well to treatments applied directly to the skin. Topical treatments include cortisone creams, synthetic forms of vitamin D and retinoids, coal tar preparations, bath solutions, and moisturizers. Photo (light) therapy Daily, short, nonburning exposure to sunlight clears or improves psoriasis in many people. Sunlight is often included among initial treatments. A more controlled form of artificial light treatment is often used in mild psoriasis (UVB phototherapy). More severe psoriasis can be treated with ultraviolet A (UVA light) and psoralen. Psoralen is an oral or topical medication that makes the body more sensitive to light. This treatment is known as PUVA. Phototherapy can be very effective in controlling psoriasis but it requires frequent treatments. It may cause side effects such as nausea, headache, fatigue, burning, and itching. Both UVB and PUVA may increase the person's risk for squamous cell and melanoma skin cancers. Systemic Treatment For more severe types of psoriasis, doctors may prescribe a number of medications, including: * Cyclosporine - suppresses the immune system to slow the turnover of skin cells. * Hydroxyurea - less toxic than methotrexate or cyclosporine. * Methotrexate - should not be taken by pregnant women, women planning to become pregnant, or by their male partners. * Retinoids - compounds with vitamin A-like properties, may be prescribed for severe cases of psoriasis that don't respond to other treatments. Because retinoids can cause birth defects, women must diligently protect themselves from pregnancy. Prevention Although the condition of psoriasis cannot be prevented, people with a family history of psoriasis should try and prevent physical trauma to the skin, infections, extremes of outdoor temperature, and stress. However, in people who have psoriasis, if certain food appear to make the psoriasis worse, those foods should be avoided to prevent flare-ups.
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