What is Psoriasis?

Psoriasis is a dry, scaly skin disorder. Doctors believe that it is genetic and is caused by the immune system being mistakenly “triggered”, resulting in skin cells being produced too quickly. Normally, skin cells take about 21-28 days to replace themselves. However, in patients with psoriasis they take around 2-6 days. Psoriasis affects approximately 3% of people globally and usually develops in patients between age 11 and age 45. Despite the fact that it is not a contagious disorder, people with the condition can sometimes suffer from social exclusion and discrimination.

Risk Factors ?????

Gender – Male

Age – mostly from 10 – 20 years

An estimated 6.4 million Americans (about 2.5% of the population) have psoriasis, and it affects between 0.5 – 3% of the world’s population.

Family History

About 35% of those with psoriasis have one or more family members with the disorder. One study reported that the lifetime risk for psoriasis is 4% in someone with no afflicted family members, 28% with one affected parent, and 68% with both parents affected by psoriasis.

Climate

Climate plays a role in risk. Some studies have found that the disorder develops earlier and more frequently in colder climates. For example, psoriasis occurs more frequently in African Americans and in Caucasians who live in colder climates than in people of any ethnicity who live in Africa. Psoriasis is also common in Japanese individuals. It is uncommon in Native Americans of either North or South American descent.

Causes???????

The exact cause of psoriasis is unknown, but it is believed that a combination of several factors contributes to the development of this disease.

1)Genetic Causes

Researchers have found 9 gene mutations that may be involved in causing psoriasis. One of these mutations on chromosome 6, called PSORS-1, appears to be a major factor that can lead to psoriasis. Mutations on genes cause certain cells to function differently. With psoriasis, these mutations seem to largely affect T-helper cells.

2)Immune System Causes of Psoriasis

In a normally functioning immune system, white blood cells produce antibodies to foreign invaders such as bacteria and viruses. These white blood cells also produce chemicals that aid in healing and fighting infective agents. But with psoriasis, special white blood cells called T-cells become overactive. These T-cells “attack” the skin and set off a cascade of events that make the skin cells multiply so fast they start to stack up on the surface of the skin. Normal skin cells form, mature, then are sloughed off every 30 days. But in plaque psoriasis the skin goes through this whole process in 3-6 days.

3)Environmental Causes of Psoriasis

Not everyone who has these gene mutations gets psoriasis and there are several forms of psoriasis that people can develop. Certain environmental triggers play a role in causing psoriasis in people who have these gene mutations. Learn more about other psoriasis triggers.

Diagnosis?????

Physical examination —Your doctor will begin by carefully examining your skin, scalp, fingernails, and toenails for reddening or scaling skin that is characteristic of psoriasis. Small pits on the fingernails are also signs of psoriasis. Your doctor will also examine your joints for signs of psoriatic arthritis.

Skin biopsy —To confirm the diagnosis, your doctor may also take a small sample of skin (a biopsy) to test for psoriasis.

Severity of Psoriasis??????

Mild psoriasis —If the psoriasis covers less than 2% of your body, it is considered mild. Usually, people with mild cases develop isolated patches of psoriasis on the knees, elbows, scalp, hands, and feet.

Moderate psoriasis —If the psoriasis covers 2% to 10% of your body, it is considered a moderate case. Psoriasis may appear on the arms, legs, torso, scalp, and other areas.

Severe psoriasis —When psoriasis covers more than 10% of your body, it is considered severe. Large areas of skin may be covered with psoriasis plaques or pustules, or widespread erythrodermic psoriasis can cause severe peeling of the skin. People with severe psoriasis are more likely to develop psoriatic arthritis.

Treatment ????

There is no cure for psoriasis at this time, but there are various treatments that can, in most cases, temporarily clear the skin of psoriasis. Occasionally, psoriasis will go into spontaneous remission without treatment.

Topical Therapy (usually used to treat mild to moderate psoriasis):

Emollients (moisturizers) help soften scales and reduce discomfort

Steroid creams and ointments help reduce inflammation. They range in strength from very potent to mild. (See below)

Tazarotene (Tazorac) is a topical retinoid for treating mild to moderate plaque psoriasis

Anthralin or other coal tar preparations help to slow skin cell reproduction

Vitamin D3 or calcipotriene (brand name Dovonex)

Bath solutions, such as mineral salts or oatmeal additives, assist in soothing skin and encouraging healing

Phototherapy (used alone or in combination with other therapies to treat moderate to severe psoriasis):

Ultraviolet Light B (UVB), either outdoors or from a light box in a physician’s office, helps to heal lesions.

Psoralen and Ultraviolet Light A (PUVA) – involves the combined use of a photosensitizing medication, called psoralen and a long-wave ultraviolet light (UVA).

Excimer lasers may be used to treat a small, localized area of psoriasis. They are a way to deliver UVB light directly to the psoriasis without exposing normal skin.

Medications

Methotrexate (MTX) helps to slow down cell reproduction and decrease inflammation.

Retinoid Therapy, including acitretin (Soriatane), helps to reduce inflammation.

Cyclosporin A slows the immune system overall and may help decrease the inflammation of psoriasis.

What Qns to ask ur Doctor????????

What form of psoriasis is this?

How severe is the psoriasis?

Can it increase in severity or spread?

What are the chances that another rheumatic disease may develop?

What type of treatment will you be recommending?

What measures can be taken to help prevent reoccurrence?

If over-the-counter lotions are recommended, which ones seem to be most effective?

If a biopsy is recommended, what will the result tell you?