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General Information
Related Risks: Fact or Fiction
Skin Care
Treatment
Who gets psoriasis?
Psoriasis occurs in both children and adults and may appear at any age,
although it is most commonly diagnosed between the ages of 15 and 35.
Both men and women of any race may be affected.
How common is psoriasis?
It is estimated that over seven million Americans (2.6%) have psoriasis,
with more than 150,000 new cases reported each year. According to the
National Psoriasis Foundation, 20,000 children under 10 years of age are
diagnosed with psoriasis annually.
What causes psoriasis?
The exact cause of psoriasis is unknown; however, researchers suspect
that whether a person develops psoriasis or not may depend on a
"trigger." Possible psoriasis triggers include emotional stress, skin
injury, systemic infections, and certain medications. Studies
have also indicated that a person is born genetically
predisposed
to psoriasis, and multiple genes have been discovered over the past 5
years confirming this fact. Even so, not everyone with psoriasis will
have a family history of the disease.
What is parakeratosis, and what does
it have to do with psoriasis?
Parakeratosis is a word you may have come across when you read about
psoriasis, especially plaque-type psoriasis. It is a term that describes
the process by which psoriatic skin continuously forms and scales off.
In normal skin, the outer layer, made
up mostly of cells called keratinocytes, is replaced every 27 to 28 days
with newly formed keratinocytes. The replacement usually occurs without
a person noticing it; if it takes place unusually quickly or in unusual
amounts, we may notice flakes and scales on our skin, clothing, bedding,
etc.
In psoriasis, the process of
keratinocyte production is sped up. New keratinocytes are formed and
moved upward to the skin surface faster than they can be incorporated
into skin. Some are moved upward so fast that they are not yet mature
cells. The keratinocytes accumulate and are scaled off. Parakeratosis is
the word used to describe the entire process.
Psoriatic plaque has other features
also, including inflammatory cells and dilated small blood vessels that
contribute to both the appearance and the symptoms of a psoriatic
lesion.
In general, the cycle of psoriasis can
best be described as the body's immune system triggering
excessive skin-cell reproduction. In healthy skin, cells mature and are
shed in about 28 days. In people with psoriasis, this process is
accelerated to only 3 or 4 days. This excessive reproduction causes skin
cells to build up and form abnormal scaling seen on
lesions in
psoriasis.
Can psoriasis occur on the sole of
the foot and be mistaken for a plantar wart?
Psoriasis can and does occur on the sole of the foot. The psoriatic
lesion can be painful to walk on, as can a plantar wart. It can be
mistaken for a plantar wart by both the patient and the physician or
podiatrist.
Psoriasis on the sole of the foot is
usually of the plaque type. A person who has had psoriasis for
some time may recognize the lesion as psoriatic plaque. Psoriasis may
not be the first thing that comes to mind in a person who has no
previous experience with the disease. Failure to recognize the lesion as
psoriasis may lead to a long period of incorrect treatment, and failure
to institute treatment for a developing case of psoriasis.
There are some diagnostic tips for
differentiating psoriasis on the sole of the foot from plantar wart:
If psoriasis is developing on the sole
of the foot, there is a good probability it is also developing on other
parts of the body. Likely places to look for developing psoriatic
lesions are the knees, elbows, hands and scalp.
Is it possible to have psoriasis
and eczema at the same time?
The biology of skin limits the number of ways in which it can manifest a
disease process—by redness, flaking, swelling, etc. Thus, many skin
conditions can superficially resemble one another and a dermatologic
examination is necessary to establish a diagnosis. Self-diagnosis of a
troublesome skin condition can delay proper treatment.
Psoriasis and eczema are two skin
problems that seem to be mutually exclusive to a degree, although this
is not a hard and fast rule. In persons with psoriasis the incidence of
allergic contact dermatitis and atopic dermatitis—two major forms of
eczema—appears to be substantially lower than in the general population.
A suggested reason is that the immune system dysregulation believed to
be a factor in psoriasis is not the same as dysregulation of immune
pathways in these forms of eczema.
Other skin diseases that superficially
resemble psoriasis can coexist with psoriasis. These include fungal and
yeast infections, scabies, cutaneous (skin) lymphoma, and cutaneous
manifestations of syphilis. Many skin lesions that superficially
resemble psoriasis lack the unique appearance of psoriasis:
- Psoriatic lesions have well-defined
borders.
- The surface of a psoriatic lesion has
silvery scales that easily flake off.
- The skin under the scales has a shiny
red appearance.
Can psoriasis be cured?
No. The tendency to develop psoriasis is inherited through a person’s
genes. We hope to be able to safely modify these genes in the future,
but the technology is not yet developed. We do foresee a time, when we
will have more specific and more effective therapies for the various
forms of psoriasis. Also, while psoriasis cannot be cured, it can often
be completely cleared for periods of months or even years. Occasionally,
it never returns at all. In most patients, however, it is a chronic,
life-long condition with alternating periods of flaring and clearing.
Is risk for skin infections higher
in people with psoriasis than in people with normal skin?
Studies have shown that psoriatic plaques and adjacent normal skin
usually have the same type of bacteria, but the number of bacteria per
square millimeter is higher in the psoriatic plaques. This, in itself,
is usually not an increased risk for secondary infections.
Risk is increased when skin and/or
plaques or guttate pustules are colonized by the highly invasive
Staphylococcus aureus, a species of bacteria capable of causing serious
skin and systemic infections.
Risk for secondary infections may also
be increased by hard scratching that abrades the skin and opens it to
bacterial invasion. Hard scratching should be avoided for this reason,
and also because abrasion of the skin can be a
trigger for
formation of new psoriatic lesions.
A skin hygiene program recommended by
a dermatologist is usually adequate to keep bacterial populations in
check. Specific anti-bacterial measures may be prescribed by a
dermatologist when such measures are warranted.
Symptoms of secondary infection are
redness of skin around a psoriatic lesion or increased redness of the
lesion, increased warmth in the skin and/or pus in the skin in the area
of a lesion. Fever, malaise and light-headedness can be symptoms of more
serious, systemic infection.
Will psoriasis shorten my life?
Psoriasis itself does not appear to shorten a person’s life. Patients
with psoriasis should be able to live full lives into their senior
years.
Will psoriasis cause my hair to
fall out?
Psoriasis itself will not cause the hair to fall out. However, very
thick scales in the scalp can entrap hair and as you attempt to remove
the scales, you can loose hair in the process. In addition, some
medications such as salicylic acid can temporarily damage the hair.
Should I change my psoriasis skin
care regimen during the winter?
It’s important to increase your use of moisturizing creams and ointments
during the winter, applying heavy layers, especially over the skin
affected by psoriasis. It is helpful to apply the moisturizing cream
while your skin is damp. Also, be sure to pat yourself dry after
bathing—don’t rub yourself with the towel.
During the winter months, the humidity
is generally lower, especially in homes with forced air heating. This
tends to cause dry, itchy skin. Scratching affected skin will worsen
your psoriasis and can even cause new lesions to form. Thus, it is
important not to scratch, pick, or scrub psoriasis lesions.
Is it true that getting a skin
scrape can lead to a psoriatic lesion?
Yes. Psoriasis patients can develop lesions at the site of significant
skin trauma, especially during a period of active disease. Psoriasis
worsens in areas of skin scrapes, scratches, and cuts (such as surgical
wounds). That’s why it is so important not to pick, scratch, or scrub
the lesions and scales. The development of a psoriatic lesion at the
site of skin trauma is called Koebner’s phenomenon.
Can you control psoriasis with
diet?
Unfortunately no. However, the healthier the diet the better. Especially
a diet that includes regular exercise. For more information about
exercise and psoriasis, visit the web site of the
National Psoriasis
Foundation.
For African-Americans and other
darker-skinned people, is the treatment for psoriasis different than for
people with light-colored skin?
The immunologic dysfunctions that are a major predisposing factor in
psoriasis are believed to be the same in all persons regardless of skin
color. The patterns of genetic inheritability for the predisposing
factors may vary in different groups.
The pigmentation of skin is controlled
by hormonal processes that are unrelated to the immune and inflammatory
processes that underlie psoriasis. It is interesting to note that all
humans, regardless of skin color, have about the same number of
melanocytes (pigment-containing cells) at any given site on the skin.
Variations in skin color are due to differences in hormonal regulation
of pigment formation within the melanocytes, and transfer of the pigment
from melanocytes to keratinocytes (the cells that make up the majority
of the outer layer of skin). A principal hormone in the regulation of
human skin color is melanocyte-stimulating hormone (MSH).
The incidence of psoriasis is much
lower in dark-skinned West Africans and African-Americans than in
light-skinned people of European ancestry. Incidence is also low in
Japanese and Eskimos, and is extremely low to non-existent in Native
Americans in both North and South America. The reasons for this
epidemiologic disparity are not known, but are believed to involve
genetic, geographic and environmental factors.
The treatment of psoriasis in
African-Americans is largely the same as treatment in light-skinned
patients. An adjustment is therapy is made in the use of
photochemotherapy (PUVA) and
phototherapy. In PUVA, both the
chemical photosensitizer and the ultraviolet dose are adjusted for skin
type and pigmentation.
Are homeopathic treatments
effective for psoriasis?
There is no scientific evidence that homeopathic treatments are
effective for treating psoriasis. However, it’s not impossible that some
of these treatments might be helpful. Scientific studies need to be done
in order to resolve this issue.
Is there a way to curb scratching?
I have had psoriasis for 20 years and my husband has been very
supportive, but recently he has started to complain about my constant
scratching. He knows I need to scratch to relieve itching, but it seems
to bother him more now. I’m afraid we’re heading for marital problems
unless I can stop scratching or he can stop letting it bother him. Any
suggestions?
Psoriasis in a spouse can be difficult for both marriage partners. The
spouse with psoriasis not only suffers from the disease and perhaps from
problems with self-image, but also may be acutely aware of the partner’s
struggles to be supportive. Over time, it is the ”little things” that
can come between partners—for example, flaked-off skin that must be
shaken from bed sheets every morning, or in this case the spouse’s
constant scratching that becomes a “last straw” for an otherwise
supportive husband.
The husband’s growing irritation may
actually be a message worth heeding, however. While scratching is
effective in temporarily relieving pruritus, hard scratching can also be
a trigger for formation of new psoriatic lesions or worsening of
existing lesions. Especially during active phases of psoriasis, abrasion
of the skin is one of the causes of Koebner’s phenomenon—the induction
of psoriatic lesions by injury to the skin. Hard, constant scratching
can cause the type of skin injury that leads to development of Koebner’s
phenomenon.
Since pruritus has become a major
issue for both husband and wife, the issue should be discussed with the
patient’s dermatologist. Pruritus control should perhaps be made a focus
of psoriasis treatment, along with educational counseling of both
marriage partners. As discussed in May’s Update, general measures for
control of pruritus include keeping the skin cool and moisturized and
avoiding irritating fabrics. Ice packs may help stop the itching. A
heavy moisturizing cream applied twice daily will help control scaling
and pruritus. Specific pharmacologic measures should be prescribed by
the dermatologist on the basis of the patient’s history of psoriasis and
overall medical condition.
What should I look for in an OTC
psoriasis shampoo?
There are numerous shampoos available at most drug stores. Look for a
shampoo that contains tar or salicylic acid. Be sure to treat your scalp
gently, as harsh shampoos, scalp massages or scratching can aggravate
psoriasis.
Is Skin-Cap® effective for
controlling psoriasis?
Skin-Cap® is an over-the-counter zinc spray preparation that contains a
prescription-strength corticosteriod (clobetasol propionate). It was
marketed without disclosing this ingredient on the product label.
Numerous potentially harmful side effects of clobetasol propionate
include stretch marks, thinning skin and dilation of tiny blood vessels.
The U.S. Food and Drug Administration (FDA) cautioned that users should
not stop treatment with this product without a dermatologist’s help
because an abrupt halt could cause serious, even life-threatening,
flare-ups.
What effect does the sun have on
psoriasis?
Natural sunlight can have a positive effect on psoriasis. The long-known
benefits of sunlight provided the basis for the development of
ultraviolet light therapy for treating psoriasis and other skin
diseases. However, you should never get enough sun exposure to turn your
skin red or cause a sunburn, which can actually cause psoriasis to flare
and worsen.
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