1. What Is Psoriasis?
Psoriasis is a chronic skin condition that affects 2 to 3 percent of the population. Though there are several types of psoriasis, the most common is psoriasis vulgaris, where red, thick scaly plaques develop on the skin and persist for months to years. Overactivity of the cells in the skin leads to discrete areas where the skin grows too quickly without shedding, leading to thick, white scale. The trigger for this overactivity is not clearly known, but is likely due to an underlying problem with the immune system, where signals for inflammation are inappropriately sent and white blood cells congregate in the skin.
2. What Are the Symptoms of Psoriasis?
Common psoriasis, or psoriasis vulgaris, appears as thick red, scaly areas. The most common places for the rash to develop are the elbows and knees, though other common areas include the scalp, belly button and buttocks. The rash is usually, though not always, itchy. Psoriasis also affects nails and can lead to thick, scaly toenails that look like they are infected with fungus (but often are not). Affected fingernails are often rough and have irregular pits or yellow spots (called oil spots).
3. What Causes Psoriasis?
Despite the fact that psoriasis has been known for millennia (it appears to be mentioned in the Bible), we still don't know exactly what causes it. There is certainly a genetic or hereditary component (about a third of people who have psoriasis have a family member with the disease), but there is also likely some exposure that triggers the disease. Psoriasis is not contagious, and it is not an allergy; eliminating allergens from your environment or restricting foods is not likely to have any effect on the disease at all. We know that psoriasis is worsened when the skin is dry. In San Diego, for instance, many psoriasis patients flare up in the fall when the air is particularly dry. Psoriasis is also worsened by stress but is certainly not caused by it. Finally, psoriasis is notorious for developing in areas where the skin is injured. For this reason, scratching the skin where you have psoriasis is a common way to make it worse.
4. How Do You Treat Psoriasis?
Because psoriasis varies dramatically from a few red spots to coverage over the whole body, the treatments vary dramatically. Most people with psoriasis have limited areas that are affected. An important and easy treatment is to moisturize the area very well. Apply petroleum jelly liberally to the skin when it is still moist after a shower. Another simple but effective treatment is to use sunlight, as it is particularly good at suppressing the overactive immune system in the skin. Be careful though--get sunlight for a few minutes everyday, but be extra cautious not to get sunburned, as this can make things worse.
Prescription steroids are also effective at treating psoriasis, but they must be used consistently (something that studies have proven is easier said than done). Other topical creams such as topical vitamin D (calipotriene) is also effective in controlling limited psoriasis.
When the disease is widespread (it affects 10 percent of the body or more), then systemic medications are used. There are many options for systemic medications, such as the anticancer drug methotrexate, vitamin A derivitives such as acitretin, and newer biologically engineered drugs that are often administered by home injections. They are all effective in treating psoriasis, but they all have side effects that must be discussed with your physician. The important thing to remember is that if you have bad psoriasis, there are excellent drugs available to help you if you see a dermatologist.
5. The Heartbreak of Psoriasis
This phrase was coined to describe how people often feel who have psoriasis. The rash can be ugly and embarrassing and seems never to go away, leaving its victims "heartbroken." We now realize that there is another heartbreak of psoriasis. Recent studies show that people with psoriasis are at higher risk to develop heart disease. Patients who have psoriasis should be even more vigilant about exercising, keeping their weight down, eating a healthy diet, and keeping their blood pressure and cholesterol low. Smoking not only significantly increases the risk of having a heart attack, but has also been shown to worsen psoriasis, giving two good reasons to quit if you have this disease.
