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Psoriasis Causes and Risks:
Psoriasis is very common, with approximately 3 million Americans affected (or about 8 out of 10,000 people). It can appear suddenly or gradually. It may affect any age but most commonly begins between 15 to 35 years old. It occurs most frequently in Caucasians. Psoriasis is characterized by frequent episodes of recurrences and remissions.
Psoriasis seems to be an inherited disorder, and it appears to be related to the immune or inflammatory response . It is most commonly seen on the trunk, elbows, knees, scalp, skin folds, or fingernails, but it may affect any or all parts of the skin. Normally, skin takes about a month for its new cells to move from the lower layers of skin up to the surface. In psoriasis, this process takes only a few days, resulting in build-up of dead skin cells and formation of thick scales .
Psoriasis may be aggravated by injury or irritation (cuts, burns , rash , insect bites ), and it may be severe in immunosuppressed people (such as with chemotherapy for cancer , or with AIDS ) or those who have autoimmune disorders ( rheumatoid arthritis ). Medications, viral or bacterial infections, excessive alcohol consumption , obesity , lack of sunlight, overexposure to sunlight ( sunburn ), stress , general poor health, cold climate, and frequent friction on the skin are also associated with flare-ups of psoriasis. Psoriasis is not contagious.
Prevention:
None is known. Minimize flare-ups by avoiding aggravating factors.
Symptoms:
Additional symptoms that may be associated with this disease:
Signs and Tests:
The diagnosis is usually based on the appearance of the skin.
Treatment:
Treatment is focused on control of the symptoms and prevention of secondary infections . It varies with the extent and severity of the disorder.
Severe or resistant cases, or cases involving large areas of the body, may require intensive treatment. Psoriasis lesions that cover all or most of the body are an emergency symptom that require hospitalization. The disorder may be acutely painful. The body loses vast quantities of fluid and is susceptible to severe secondary infections that can become systemic , involving internal organs, and can progress to septic shock and death. Treatment includes analgesics , sedation, intravenous fluids and antibiotics.
Mild cases are usually treated at home. Topical medications include: - prescription or nonprescription dandruff shampoos
- shampoos or lotions that contain coal tar
- cortisone or other corticosteroids
- lubricants
- antifungal medications
- antibiotics
- phenol
- sodium chloride
- other ingredients
Oral or injected immunosuppressive medications (such as corticosteroids or methotrexate) may be prescribed, but only in very severe cases. Other medications may include retinoids or cyclosporine.
Other treatments may include moderate exposure to sunlight or phototherapy. The skin is sensitized by the application of coal tar ointment or by taking oral psoralens (a medication that causes the skin to become sensitive to light). The person is then exposed to ultraviolet light. Avoid sunburn , which can worsen the condition.
Maintain good general health to reduce the risk of flare-ups. Obtain adequate rest and exercise , eat a well-balanced diet , and avoid stress (see stress management ). Treat respiratory and other infections promptly.
Maintain good skin hygiene to prevent secondary infections. Daily baths or showers are recommended. Avoid harsh scrubbing, which can irritate the skin and cause new outbreaks.
Oatmeal baths may be soothing and may help to loosen scales . Commercial preparations may be used, or mix one cup of oatmeal into a tub of warm water.
Support Groups:
The stress of illness can often be helped by joining a support group where members share common experiences and problems. See psoriasis - support group .
Prognosis:
Psoriasis is a chronic , lifelong condition that can be controlled with treatment. It usually does not adversely affect general health, unless it is neglected or occurs in the elderly or very young.
Complications:
- skin cancer
- rapid skin aging
- cataracts
- complications secondary to treatments
- secondary skin infections with spread to internal organs
Call Your Healthcare Provider:
Call for an appointment with your health care provider if symptoms indicate psoriasis.
Call for an appointment with your health care provider if psoriasis recurs frequently despite treatment.
Also call if pustules , fever , muscle aches , fatigue , or other new or unexplained symptoms develop.
Psoriasis is associated with changes in the nails of the hands and feet. Typical abnormalities include collection of debris under the nails, loosening of the nail from the nail bed (onycholysis), and pitting. Nail findings can be helpful in diagnosis (mild psoriasis in the scalp may resemble seborrhea while the presence of nail abnormalities would suggest psoriasis).
Psoriasis is associated with changes in the nails of the hands and feet. Typical abnormalities include collection of debris under the nails, loosening and splitting of the nail from the nail bed (onycholysis), and pitting of the nail plate. Nail changes can be helpful in diagnosis (mild psoriasis in the scalp may resemble dandruff (seborrhea), while the presence of nail abnormalities would suggest psoriasis).
This is a picture of a typical case of psoriasis, with small lesions over the extensor surfaces of the knuckles. Note the changes in the fingernails.
Psoriasis can occur anywhere on the body, but usually occurs scalp, outside (extensor) surfaces of the elbows and knees, around the navel, and on the genitalia. This is a typical appearing case of psoriasis in the crease above the buttocks (gluteal fold).
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