What is Psoriasis?
Psoriasis is a non-contagious chronic skin disorder that is seen as scaly plaques on the skin. The Psoriasis appears as an elevated red plaque that is covered by a silvery dry scale. It affects one to two percent of the world population.
A normal skin cell matures in 28 - 30 days. In Psoriasis, cells move to the top of the skin in three days. The excessive skin cells that are produced "heap up" and form the elevated red, scaly plaques that characterize Psoriasis. The white scale that covers the red plaque is composed of dead cells that are continually being cast off. The redness of the plaques is caused by the increased blood supply necessary to feed this area of dividing skin cells.
Different Types of Psoriasis
Discoid or Plaque Psoriasis
This is the most common type of Psoriasis. Well defined, coin-shaped patches of skin that are usually red and covered in white, waxy scales that appear on the knees and elbows. They can be itchy and may bleed if scratched.
Guttate Psoriasis (Latin gutta, meaning drop)
Guttate Psoriasis usually develops after a severe throat infection. The "drop-like" patches are mostly found on the stomach, back, legs and arms. It generally occurs in children or young adults and often disappears by itself after several weeks/months.
Flexural (inverse) Psoriasis
Flexural Psoriasis is found in "skin folds" such as the armpits, groin, buttocks or beneath the breast. The skin is red but not scaly.
Well defined glazed areas in nappy area of babies
Scalp Psoriasis is common in Psoriatic patients. About 50% of all Psoriasis patients suffer from scalp Psoriasis. It is similar to plaque Psoriasis, with red and scaly patches. The scales look similar to dandruff and can be embarrassing.
Sebopsoriasis is usually seen on the scalp and also the face (glabella, eyebrows and nasolabial folds), postauricular and pre-auricular areas and sometimes on the central chest. It overlaps with seborrhoeic dermatitis but is distinguished by having more well-demarcated plaques.
May only effect palms and or soles. Well-cemarcated plaques on palms of hands or soles of feet. More hyperkeratotic types (thickening of skin) tend to form painful fissures. It can be difficult to distinguish palmoplantar Psoriasis from:
Tinea (scrapings for fungal culture should be routinely ordered)
Dermatitis eg. Allergic contact dermatitis
In 50% of patients with Psoriasis, the nails are affected. The nail becomes discoloured and/or pitted and may separate from the nail bed.
10% Of patients get arthritis before any skin changes
Generalised Pustular Psoriasis
In this rare from of Psoriasis, patches of skin are so inflamed that blisters develop all over the body. It can also make you feel unwell, itchy and febrile with a temperature. It may be precipitated by concurrent infection or rapid withdrawal of systemic or ultra potent topical corticosteroids.
90% Or more of skin is inflamed. It may be a slow worsening of chronic plaque Psoriasis or an explosive form of unstable psoriasis. Erythroderma can be precipitated by rapid withdrawal of a systemic or ultra potent topical corticosteroids; anti-malarial therapy and concurrent infections.
How is Psoriasis diagnosed
There are no blood tests diagnostic for Psoriasis; the diagnosis is made by the dermatologist' observation of the skin lesions and if necessary a skin biopsy specimen removed from the plaques can confirm the diagnosis. It is unusual to have nail Psoriasis without Psoriasis elsewhere on the skin.
Who gets Psoriasis
ANYONE! We detected a family pattern in one out of three cases. Chromosome 6 and 8 is usually suspect and is linked to Psoriasis. One gene is modified by other genes and when combined with certain environmental factors, can produce Psoriasis. This complex method of inheritance explains why several generations may be skipped before Psoriasis appears.
Men and Women are equally affected. In 75% of sufferers the onset is before age of 46 but there are two peaks of onset at ages 16 - 22 and 57 - 60. It is less common in children though usually Guttate type is diagnosed. Babies usually are diagnosed with napkin psoriasis and/or cradle cap.
Certain races seem to be more prone and Psoriasis is more common in Northern Europeans, less common in African blacks and Asians and rare in American Indians and Aboriginal Australians.
How serious is Psoriasis?
Our skin is the means by which we initially define ourselves to others. This coupled with the fact that we live in a society that places a high value on physical appearance, causes people with Psoriasis to feel uncertainty as to their acceptance socially and/or in the job.
The severity of the disease is measured in terms of both its physical and emotional impacts. If 10% of the body surface is involved the case is mild, 10% to 30% percent is moderate and more than 30% is considered severe. However, Psoriasis confined to the feet and hands only can be severe enough to be disabling. When the disease affects major body surfaces, various physical problems can occur such as intense itching, skin pain and cracking skin with swelling. Body movement and flexibility can be affected.
How does Psoriasis present itself?
The course of the disease is highly variable and unpredictable. Psoriases will go through cycles of improvement and flare-ups. For no reason there can be spontaneous remission. The disease can gradually improve on its own over time. In some cases it can worsen.
Is there a cure for Psoriasis? NO, BUT!
There are treatments which significantly improve a skins appearance. Treatment-induced remissions can last anywhere from a few weeks up to several years. The treatment of Psoriasis varies from being simple to a major challenge and a patient's response to therapy is unpredictable. Treatments are tailored to the patient depending on the extent of the disease, patient preference and practical issues, response to previous treatment and relative or absolute contra-indications.
Treatment of Psoriasis
Educating patients about their disease & encouraging them to take responsibility for self-care will lesson morbidity. The aim of the treatment is to slow down rapid cell division and return the skin to normality.
The type of treatment used will depend on:
Psoriatic skin tends to be very dry and this dryness can lead to a worsening of the psoriasis if it is not treated. Excessively dry skin can also cause itching. Regular lubrication of the psoriatic skin with Créme Classique Ointment and Créme Classique Anti-bacterial Cream is recommended to restore the moisture and flexibility of the skin. Topical corticosteroids, calcipotriol, coal tar derivatives and salicylic acid as well as dithranol can be used. They are usually used in combination and applied once or sometimes twice daily. The application of abovementioned topical agents must be used under strict supervision of Advanced Dermatology.
Topical steroids should be avoided as single agents as far as possible although the initial effects may be promising, plaques may become refractory to topical steroids with a resulting tendency to the use of a more potent preparation. A rebound effect is often seen on cessation of the therapy. Long term side affects include thinning of the skin, telangiectasia and super infection may occur. A severe postular form of psoriasis may be precipitated.
Tar ointments are highly effective in treatment of Psoriasis and helps reduce itching. Its efficiency is due to an antimitotic effect. Coal tar is a complex mixture of many substances produced from coal. It has been used as a treatment of Psoriasis for over 100 years. It can be used on the whole body and the scalp. Therapeutic tars are derived from either coal or tar or wood tar. It may be crude or refined and are available as paste, ointments or creams as well as a shampoo. We strongly recommend over the counter Créme Classique Coal tar cream and Créme Classique Coal tar shampoo. A useful inexpensive mixture is coal tar solution 5% and salicylic acid 3% in white soft paraffin.
Salicylic acid can be used for softening of scales and enhances the effectiveness of other emollients, eg corticosteroids as well as UVB rays which will be discussed later.
Cortisone (steroids) are a short term solution, you cannot use them forever! It is like a rubber ball, if you drop it, it will bounce back at you. This means if you suddenly discontinue use of a cortisone or steroid you can suffer the rebound effect. Your Psoriasis may suddenly get worse! Taper off, don't just QUIT! You cannot mix and match steroids! DON'T TRADE OR BORROW OTHER PEOPLES PREPARATIONS!
Dithranol is a potent topical compound that can be effective in clearing Psoriasis. Skin irritation and staining of skin and clothes often result in resistance of this very useful agent, therefore Dithranol must be used only under strict supervision of Advanced Dermatology. It is used in different concentrations. The combination of Dithranol and UVB Narrowband Treatment is highly effective. Dithranol is a synthetic form of a tree bark extract. Salicylic acid is included in this product to prevent oxidative degradation.
Dithranol treatment is highly specialized and sophisticated. At Advanced Dermatology we offer this specialized service as Dithranol is not readily available in South Africa.
UVB Narrowband (311 nm) Sun exposure and dead sea treatment was noticed to improve Psoriasis. UVB light slows the abnormal growth of normal skin cells which is associated with Psoriasis. Ultra violet light is defined as short wave light energy\ (ultra violet B light). Phototherapy works by a combination of anti-proliferative effects and local immune suppression. It is generally the treatment most physicians will begin with as it is most effective and less risky. The combination of Phototherapy and abovementioned topical treatments is highly effective and can put the Psoriasis in remission for a long period. UVB Narrowband treatment is available at Advanced Dermatology, Tel 012 809 6090. The treatment code for UVB is 0230. The diagnostic code for Psoriasis is L40.0
DEKA Excilite-µ benefits:
Multiple short exposures to natural sunlight can temporary clear Psoriasis. A slow and gradual tan is recommended for best results. Up to 95% of people will improve with regular exposure to sunlight. Sunburns should be avoided at all costs as it can trigger the Psoriasis. Be sure to apply a sunscreen before sun exposure on your normal skin. After 15-30 minutes exposure of Psoriasis lesions, put sunblock on lesions as well. Try Créme Classique Safari Sun block for ultimate protection.
These treatments should not be used systematically except under exceptional circumstances (most severe Psoriasis) and under strict Specialist Dermatologist supervision.
Methotraxate: Is a highly potent, anti-metabolite that is given in small doses to clear severe and or disabling Psoriasis. Best results are with extensive Psoriasis, physically disabling Psoriasis, Psoriasis of the palms and soles, Psoriasis in the elderly and psoriatic arthritis. BEWARE!! Methotraxate can damage the liver severely!!
Neotigason: Women must avoid this treatment due to the fact that they must avoid pregnancies for two years after the last capsule has been taken. It is a very expensive treatment. Dryness of lips and mucus membrane, hair loss may occur as well as thinning of the skin. Liver functions must be monitored during treatment.
General Hints during Psoriasis therapy
In treating Psoriasis there are different approaches. Rotate therapies over the long term to minimize side effects from any one therapy. It also reduces the possibility of the individual developing a resistance to the therapy. It can happen that the therapy ceases to be effective after prolonged use. Frequently people give up too soon! Results can take a long time to achieve. Persevere with treatments. It can only take 12 treatments to clear for one person while another may require 60 - 80 treatments. Be sure to discuss the variation of your treatments with your therapist at Advanced Dermatology. A commitment to a lengthy treatment may be necessary to achieve clearance. On some occasions, one's Psoriasis can get worse during treatment before suddenly getting better.
Apart from streptococcal infection, the following are often implicated as a trigger factor in Psoriasis:-
Q: Can Psoriasis itch?
Yes, Greek word Psora means itch. Keep skin moisturized to help control the itching.
Q: Can diet affect Psoriasis?
To date no specific dietary regime has been identified through scientific investigation that will clear or improve Psoriasis. Culprits are NICOTINE AND ALCOHOL!!
Q: What happens to the skin during and after the clearing process?
Scaling decreases once the Psoriasis clears, often there are white spots left which will gradually disappear.
Q: Can allergies, such as allergy to fragrances, cause Psoriasis to flare or worsen?
No evidence that allergies can directly cause Psoriasis.
Q: Does pregnancy and nursing have an effect on Psoriasis?
Sometimes remission occurs during pregnancy while other women experience a flare during pregnancy. Nursing generally has no effect on Psoriasis. Q: Does weather affect Psoriasis?
Psoriasis generally worsens during winter months and improves during summer as a result of exposure to sunlight. Sunlight obtained in regular doses can clear Psoriasis.
CAUTION: PROLONGED EXPOSURE TO SUNLIGHT IN SENSITIVE INDIVIDUALS CAN LEAD TO SKIN CANCER. PREMATURE SKIN AGEING CAN ALSO RESULT. A GOOD SUNSCREEN IS HIGHLY RECOMMENDED, EG. CRéME CLASSIQUE SAFARI SUNBLOCK.
Q: What can cause Psoriasis to worsen?
Physical and or emotional trauma. Lithium can also worsen Psoriasis.
Q: Does emotional stress cause Psoriasis to appear?
There is no evidence that stress is a direct cause of Psoriasis but studies have shown that Psoriasis can be aggravated by emotional stress. Psoriatic patients may be divided into ?stress reactors? and ?non-stress reactors?.
Q: What can I do to help my skin?
Keep your skin well lubricated. Take advantage of the sun shine if possible. Minimize contact with soap and chemicals. Minimize stress with a regular exercise programme. The relaxing effect of exercises enhances improvement. Protect your skin against injuries, eg. Shaving with dull razor, wearing too tight shoes, getting soap under your ring or watchband.
Q: Is Psoriasis contagious?
No not at all.
Living with Psoriasis
Do not let Psoriasis affect your confidence. Make peace and ensure you have a strong mind and body to deal with the everyday challenges. Empower yourself with knowledge of your condition to enable you to be in control of your condition.