Psoriasis Q&A

    Questions and Answers about Psoriasis

    What Is Psoriasis?

    Psoriasis is a chronic (long-lasting) skin disease of
    scaling and inflammation that affects 2 to 2.6 percent of the United
    States population, or between 5.8 and 7.5 million people. Although the
    disease occurs in all age groups, it primarily affects adults. It
    appears about equally in males and females. Psoriasis occurs when skin
    cells quickly rise from their origin below the surface of the skin and
    pile up on the surface before they have a chance to mature. Usually this
    movement (also called turnover) takes about a month, but in psoriasis
    it may occur in only a few days. In its typical form, psoriasis results
    in patches of thick, red (inflamed) skin covered with silvery scales.
    These patches, which are sometimes referred to as plaques, usually itch
    or feel sore. They most often occur on the elbows, knees, other parts of
    the legs, scalp, lower back, face, palms, and soles of the feet, but
    they can occur on skin anywhere on the body.

    The disease may also affect the fingernails, the
    toenails, and the soft tissues of the genitals and inside the mouth.
    While it is not unusual for the skin around affected joints to crack,
    approximately 1 million people with psoriasis experience joint
    inflammation that produces symptoms of arthritis. This condition is
    called psoriatic arthritis.

    - How Does Psoriasis Affect Quality of Life?
    – What Causes Psoriasis?
    – How Is Psoriasis Diagnosed?
    – How Is Psoriasis Treated?
    – What Are Some Promising Areas of Psoriasis Research?
    – Where Can People Find More Information About Psoriasis?

    How Does Psoriasis Affect Quality of Life?

    Individuals with psoriasis may experience
    significant physical discomfort and some disability. Itching and pain
    can interfere with basic functions, such as self-care, walking, and
    sleep. Plaques on hands and feet can prevent individuals from working at
    certain occupations, playing some sports, and caring for family members
    or a home. The frequency of medical care is costly and can interfere
    with an employment or school schedule. People with moderate to severe
    psoriasis may feel self-conscious about their appearance and have a poor
    self-image that stems from fear of public rejection and psychosexual
    concerns. Psychological distress can lead to significant depression and
    social isolation.

    What Causes Psoriasis?

    Psoriasis is a skin disorder driven by the immune
    system, especially involving a type of white blood cell called a T cell.
    Normally, T cells help protect the body against infection and disease.
    In the case of psoriasis, T cells are put into action by mistake and
    become so active that they trigger other immune responses, which lead to
    inflammation and to rapid turnover of skin cells. In about one-third of
    the cases, there is a family history of psoriasis. Researchers have
    studied a large number of families affected by psoriasis and identified
    genes linked to the disease. (Genes govern every bodily function and
    determine the inherited traits passed from parent to child.) People with
    psoriasis may notice that there are times when their skin worsens, then
    improves. Conditions that may cause flareups include infections,
    stress, and changes in climate that dry the skin. Also, certain
    medicines, including lithium and betablockers, which are prescribed for
    high blood pressure, may trigger an outbreak or worsen the disease.

    How Is Psoriasis Diagnosed?

    Occasionally, doctors may find it difficult to diagnose
    psoriasis, because it often looks like other skin diseases. It may be
    necessary to confirm a diagnosis by examining a small skin sample under a
    microscope. There are several forms of psoriasis. Some of these
    include:

    - Plaque psoriasis–Skin lesions are red at the base and covered by silvery scales.
    -
    Guttate psoriasis–Small, drop-shaped lesions appear on the trunk,
    limbs, and scalp. Guttate psoriasis is most often triggered by upper
    respiratory infections (for example, a sore throat caused by
    streptococcal bacteria).
    – Pustular psoriasis–Blisters of
    noninfectious pus appear on the skin. Attacks of pustular psoriasis may
    be triggered by medications, infections, stress, or exposure to certain
    chemicals.
    – Inverse psoriasis–Smooth, red patches occur in the
    folds of the skin near the genitals, under the breasts, or in the
    armpits. The symptoms may be worsened by friction and sweating.
    -
    Erythrodermic psoriasis–Widespread reddening and scaling of the skin
    may be a reaction to severe sunburn or to taking corticosteroids
    (cortisone) or other medications. It can also be caused by a prolonged
    period of increased activity of psoriasis that is poorly controlled.
    – Psoriatic arthritis–Joint inflammation that produces symptoms of arthritis in patients who have or will develop psoriasis.

    How is Psoriasis Treated?

    Doctors generally treat psoriasis in steps based on the
    severity of the disease, size of the areas involved, type of psoriasis,
    and the patient’s response to initial treatments. This is sometimes
    called the “1-2-3″ approach. In step 1, medicines are applied to the
    skin (topical treatment). Step 2 uses light treatments (phototherapy).
    Step 3 involves taking medicines by mouth or injection that treat the
    whole immune system (called systemic therapy).

    Over time, affected skin can become resistant to
    treatment, especially when topical corticosteroids are used. Also, a
    treatment that works very well in one person may have little effect in
    another. Thus, doctors often use a trial-and-error approach to find a
    treatment that works, and they may switch treatments periodically (for
    example, every 12 to 24 months) if a treatment does not work or if
    adverse reactions occur.

    Topical Treatment

    Treatments applied directly to the skin may improve its
    condition. Doctors find that some patients respond well to ointment or
    cream forms of corticosteroids, vitamin D3, retinoids, coal tar, or
    anthralin. Bath solutions and moisturizers may be soothing, but they are
    seldom strong enough to improve the condition of the skin. Therefore,
    they usually are combined with stronger remedies.

    - Corticosteroids–These drugs reduce inflammation and
    the turnover of skin cells, and they suppress the immune system.
    Available in different strengths, topical corticosteroids (cortisone)
    are usually applied to the skin twice a day. Short-term treatment is
    often effective in improving, but not completely eliminating, psoriasis.
    Long-term use or overuse of highly potent (strong) corticosteroids can
    cause thinning of the skin, internal side effects, and resistance to the
    treatment’s benefits. If less than 10 percent of the skin is involved,
    some doctors will prescribe a high-potency corticosteroid ointment.
    High-potency corticosteroids may also be prescribed for plaques that
    don’t improve with other treatment, particularly those on the hands or
    feet. In situations where the objective of treatment is comfort,
    medium-potency corticosteroids may be prescribed for the broader skin
    areas of the torso or limbs. Low-potency preparations are used on
    delicate skin areas. (Note: Brand names for the different strengths of
    corticosteroids are too numerous to list in this booklet.)
    – Calcipotriene–This drug

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