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Psoriasis is a persistent skin disease that got its name from the Greek word for "itch." The skin becomes inflamed, producing red, thickened areas with silvery scales, most often on the scalp, elbows, knees, and lower back.
In some cases, psoriasis is so mild that people don't know they have it. At the opposite extreme, severe psoriasis may cover large areas of the body. Doctors can help even the most severe cases.
Psoriasis cannot be passed from one person to another, though it is more likely to occur in people whose family members have it. In the United States two out of every hundred people have psoriasis (four to five million people). Approximately 150,000 new cases occur each year.
What Causes Psoriasis?
The cause is unknown. However, recent discoveries point to an abnormality in the functioning of key white cells in the blood stream triggering inflammation in the skin. Because of the inflammation, the skin sheds too rapidly, every three to four days.
People often notice new spots 10 to 14 days after the skin is cut, scratched, rubbed, or severely sunburned. Psoriasis can also be activated by infections, such as strep throat, and by certain medicines. Flare-ups sometimes occur in the winter, as a result of dry skin and lack of sunlight.
Types of Psoriasis
Psoriasis comes in many forms. Each differs in severity, duration, location, and in the shape and pattern of the scales. The most common form begins with little red bumps. Gradually these grow larger and scales form. While the top scales flake off easily and often, scales below the surface stick together. When they are removed, the tender, exposed skin bleeds. These small red areas then grow, sometimes becoming quite large.
Elbows, knees, groin and genitals, arms, legs, palms
and soles, scalp and face, body folds and nails are the areas most commonly
affected by psoriasis. It will often appear in the same place on both sides of
Nails with psoriasis have tiny pits on them. Nails may loosen, thicken or crumble and are difficult to treat.
Inverse psoriasis occurs in the armpit, under the breast and in skin folds around the groin, buttocks, and genitals.
Guttate psoriasis usually affects children and young adults. It often shows up after a sore throat, with many small, red, drop-like, scaly spots appearing on the skin. It often clears up by itself in weeks or a few months.
Up to 30% of people with psoriasis may have symptoms of arthritis and 5-10% may have some functional disability from arthritis of various joints. In some people, the arthritis is worse when the skin is very involved. Sometimes the arthritis improves when the condition of the patient's skin improves.
How Is Psoriasis Diagnosed?
Dermatologists diagnose psoriasis by examining the skin, nails, and scalp. If the diagnosis is in doubt, a skin biopsy may be helpful.
How Is Psoriasis Treated?
The goal is to reduce inflammation and to control shedding of the skin. Moisturizing creams and lotions loosen scales and help control itching. Special diets have not been successful in treating psoriasis, except in isolated cases.
Treatment is based on a patient's health, age, lifestyle, and the severity of the psoriasis. Different types of treatments and several visits to the dermatologist may be needed.
The doctor may prescribe medications to apply on the skin containing cortisone-like compounds, synthetic vitamin D, tar, or anthralin. These may be used in combination with natural sunlight or ultraviolet light. The most severe forms of psoriasis may require oral medications, with or without light treatment.
Sunlight exposure helps the majority of people with psoriasis but it must be used cautiously. Ultraviolet light therapy may be given in a dermatologist's office, a psoriasis center or a hospital.
Types of Treatment
Steroids (Cortisone) - Cortisone creams, ointments, and lotions may clear the skin temporarily and control the condition in many patients. Weaker preparations should be used on more sensitive areas of the body such as the genitals, groin, and face. Stronger preparations will usually be needed to control lesions on the scalp, elbow, knees, palms and soles, and parts of the torso and may need to be applied under dressings. These must be used cautiously and with the dermatologist's instruction. Side effects of the stronger cortisone preparations include thinning of the skin, dilated blood vessels, bruising, and skin color changes. Stopping these medications suddenly may result in a flare-up of the disease. After many months of treatment, the psoriasis may become resistant to the steroid preparations.