Psoriasis

Psoriasis... a heartbreaking disorder

WHAT IS PSORIASIS?

Psoriasis is a proliferation of the skin, which afflicts approximately 2% of the United States population, or more than 6,000,000 people. This condition results from the rapid turnover of skin. Normally, it takes approximately 28 to 42 days for skin to turn over in its entirety. With psoriasis, this can be 4 to 6 days. So, in essence, you are producing more skin than your body can eliminate.


Fig. 1 - Psoriasis Plaques

WHAT ARE SOME OF THE CAUSES OF PSORIASIS?

The exact cause is unclear, but it is probably an abnormality of the immune system, along with environmental concerns. In psoriasis, bacteria can accumulate and be a cause, or other influences, such as medications, trauma, stress or arthritis can also be associated with psoriasis. In some instances, ADAS providers may do blood testing to make sure that one is not prone to arthritis, other rheumatologic conditions or infectious causes. Establishing a potential cause for our patients in Jacksonville, Ponte Vedra Beach and Fleming Island is important so that any corrective measure can be implemented early on.

Several types of psoriasis exist. These include:

• Plaque psoriasis. The most common form, plaque psoriasis causes dry, red skin lesions (plaques) covered with silvery scales. The plaques itch or feel sore and may occur anywhere on your body, including your genitals and the soft tissue inside your mouth. You may have just a few plaques or many, and in severe cases, the skin around your joints may crack and bleed.
• Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails may become loose and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.
• Scalp psoriasis. Psoriasis on the scalp appears as red, itchy areas with silvery-white scales. You may notice flakes of dead skin in your hair or on your shoulders, especially after scratching your scalp.
• Guttate psoriasis. This primarily affects people younger than 30 and is usually triggered by a bacterial infection such as strep throat. It's marked by small, water-drop-shaped sores on your trunk, arms, legs and scalp. The sores are covered by a fine scale and aren't as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes, especially if you have ongoing respiratory infections.
• Inverse psoriasis. Mainly affecting the skin in the armpits, groin, under the breasts and around the genitals, inverse psoriasis causes smooth patches of red, inflamed skin. It's more common in overweight people and is worsened by friction and sweating.
• Pustular psoriasis. This rare form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips. It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters dry within a day or two but may reappear every few days or weeks. Generalized pustular psoriasis can also cause fever, chills, severe itching, weight loss and fatigue.
• Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely. It may be triggered by severe sunburn, by corticosteroids and other medications, or by another type of psoriasis that's poorly controlled.
• Psoriatic arthritis. In addition to inflamed, scaly skin, psoriatic arthritis causes pitted, discolored nails and the swollen, painful joints that are typical of arthritis. It can also lead to inflammatory eye conditions such as conjunctivitis. Symptoms range from mild to severe. Although the disease usually isn't as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity.

WHAT IS THE BEST WAY TO DEAL WITH THE STRESSES OF PSORIASIS?

There are several ways to handle this. Open communication with other people who have suffered with this disorder is important. You can contact the National Psoriasis Foundation to learn about many support groups. This organization also provides us with new information on psoriasis, and can be found via the web site www.psoriasis.org, or by calling 1-800-723-9166. An open and honest relationship with your physician is important, in order to understand the disease and to get the treatment that you need.

WHAT ARE SOME OTHER INFLUENCES THAT CAN CAUSE PSORIASES TO FLARE?

Besides medications, skin injuries, insect bites, infections, sunburns, can spark a flare up in those with psoriasis. Stress, alcohol and overweight conditions can also signal flare up. In winter months, because of dry skin, lack of sunlight, psoriasis can also tend to be aggravated. Although this gene process is cyclical, it is important to get a control of it early on, so as to prevent the unsightly condition from worsening or to cause the risk of the patient to such things as infection or pain. Other triggers include:

• Infections, such as strep throat or thrush
• Injury to the skin, such as a cut or scrape, bug bite, or a severe sunburn
• Stress
• Cold weather
• Smoking
• Heavy alcohol consumption
• Certain medications, including lithium, which is prescribed for bipolar disorder, high blood pressure medications such as beta blockers, antimalarial drugs and iodides

WHAT ARE SOME OF THE SIGNS AND SYMPTOMS THAT I WOULD LOOK FOR IN PSORIASIS?

Psoriasis appears as a red, raised, inflamed plaque on the skin, covered with silvery like scale. The scale, again, is a buildup of dead skin cells, and may appear on any skin surface. Elbows and knees can be more commonly affected. Other common affected areas include the scalp, the trunk and the upper portion of the posterior buttocks. Sometimes, psoriasis is very mild and people do not know they have it, or it may just affect the nails, where pitting of the nails or separation of the nail bed from the nail plate can occur. Many people confuse this with fungus. Approximately one in ten people go on to develop psoriatic arthritis, a condition in which the joints become inflamed and sore. In this case, it becomes hard for patients to do their daily activities. If your skin has a lot of scale or itches regularly, it is important to see your dermatologist as soon as possible, so as to make sure that you do not have a flare or condition that could possibly be treated.

WHAT ARE SOME OF THE TREATMENTS THAT CAN OFFER RELIEF?

Because there is no cure of psoriasis, at present, dermatologists place a great deal of emphasis on topical medications and therapies. Good nutrition habits, healthy lifestyle are also important to your treatment and care. Special tools such as topical oils and creams are used to help the psoriasis condition. If the condition is severe, sometimes oral medications or light therapy, or a combination of both, which can be done. Biologics such as Enbrel™, Humira™, Raptiva™, and Remicade™, are novel therapies which offer promise. Some of our providers our currently involved in several research studies for psoriasis using medications which interferes with the signals of the skin cells. Stay tuned for more details.

For more information on psoriasis or to set up a consultation, click here or call 904-285-7546. Thank you and we look forward to helping you.


Psoriasis under the microscope

For more information on psoriasis or to set up a consultation, click here or call 904-285-7546. Thank you and we look forward to helping you.