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Understanding Psoriasis

    • What is psoriasis?

    • Psoriasis is a chronic inflammatory disease that affects the skin, nails and joints. Like many other autoimmune diseases, it results when the patient’s immune system overreacts, causing skin cells to be produced too rapidly – much faster than normal skin cell development. The out-of-control skin cells “stack up,” causing red, scaly patches on the body, scalp or nails.

      Psoriasis shows up in several different ways:

      • Plaque psoriasis is the most common form, resulting in rough, red scaly patches, most often on the knees, elbows, lower back and scalp.
      • Guttate psoriasis creates numerous small, red bumps on the skin, across the torso and the arms and legs.
      • Pustular psoriasis presents as reddish skin with pus-filled bumps, usually on the palms of the hands and soles of the feet.
      • Inverse psoriasis shows up as red areas where the skin folds on itself, such as the armpits or groin
      • Erythrodermic psoriasis makes large areas of the skin look bright red, like a burn.
      • Up to 40 percent of people with psoriasis also have inflammation of their joints and resulting arthritis, called psoriatic arthritis.

      Once diagnosed, psoriasis does not progress steadily, but waxes and wanes. Patients will have flare ups when their condition appears or worsens, often due to different physical and emotional stresses. Patients usually demonstrate just one of the different forms of psoriasis at any given time, but a new flare up can present in a different manner.

      People with this disease have a higher risk for other conditions, including inflammatory bowel disease, lymphoma, heart disease, diabetes, metabolic syndrome and depression. Depression can be the result of feeling socially rejected due to the very visible symptoms of psoriasis.

    • What causes psoriasis?

    • Psoriasis occurs when the immune system inappropriately stimulates skin cell production and causes them to be produced too rapidly. While skin cells normally replace themselves every month, in psoriasis, they reproduce every 3-5 days.

      Why this immune response happens is not widely understood. According to Dr, Cox, it is clear that that there is a genetic factor, with the disease running in families.

    • Who gets psoriasis?

    • Psoriasis is found equally in men and women. It occurs in all races, but is more common in Caucasians. It can happen at any age, but is often seen for the first time between 15 and 25 years of age.

    • How is psoriasis treated?

    • Treatment for psoriasis varies, based on the way it shows up in the body and the severity for each individual patient. Types of treatment include:

      • Topical creams and ointments. In this category are anthralin, coal tar, moisturizers, salicylic acid, tazarotene, Vitamin-D-like topical ointments and corticosteroids.
      • Light therapy – also called phototherapy. Exposure to sunlight, or exposure to UV rays from a light panel or box, can reduce the symptoms of psoriasis. Sometimes this light therapy is combined with a medication called Psoralen – PUVA treatment. Note that this light treatment should be done under a physician’s care, not by visiting a tanning booth.
      • Oral medications. For more severe cases, oral medications are used to slow down the immune system response. These include oral methotrexate, acitretin or cyclosporine. These medications should be used with medical supervision, as they can have serious side effects.
      • Biological agents. The latest treatments for psoriasis are biological agents that may block the immune system response at points closer to the starting point. This may offer advantages in effectiveness, frequency of dosing and decreased side effects. However, these agents tend to be expensive, and require close monitoring, since they impact the entire immune system.

    • What is the future for psoriasis treatment?

    • According to Dr. Cox, the future looks brighter for patients with psoriasis. Within the next 5-10 years, he foresees that additional biological agents will be developed to block the psoriasis process at an earlier point in the immunologic pathway. This should mean better results and fewer potential side effects for patients.

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