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Psoriasis
These lectures are not meant to replace your physician and are simply provided as
a free educational service to all our visitors. If you feel that you have a
skin problem, please see your doctor.
Psoriasis is a very common, chronic skin disorder. While we cannot show that
every individual has a family history of this condition, our present concept is
that it is genetically transmitted. At the present time, we are not able to
offer treatment which will "cure" psoriasis, but we can offer considerable help
in the relief of symptoms.
The information that we have at the present time shows that it is definitely
not caused by emotional problems. Although an outbreak of psoriasis can make
any individual emotionally more upset, there is not any real evidence that
getting "nervous" brings on the condition or makes it worse.
In normal skin, a new skin surface is produced every 28 days. When an area of
skin is cut or injured it certainly does not take that long to heal. Body
defense mechanisms are called into play and in 4 to 7 days the skin is healing
up. In patients with psoriasis, the "trigger" for this rapid healing rate seems
to be faulty. The many minor upheavals and irritations that the skin meets
every day seem to be interpreted by some kind of a "computer" in the skin to be
a call, in certain local areas, for this wound healing rate. As a result, in
areas of psoriasis, the skin is producing more skin at the fantastic rate of a
new skin surface once every 4 to 7 days.
Making more skin means that more raw materials for this production is needed.
The blood vessels to the area are more numerous and are jammed full of blood.
The skin, forming at a furious rate, cannot be shed off quickly enough, and
white scales are seen on the surface of the blood engorged patch. Most of the
time, psoriasis patients have enough body defenses to overcome the defect - but
when it fails we see one of the patches.
Even though the skin may look entirely normal to the eye and may show no signs
of psoriasis, microscopic examinations of the skin from the normal skin areas
of patients with psoriasis are not the same as the skin of normal people. The
fact that no "rash" is present in any particular area and at any particular
time is a tribute to the ability of the body to control the condition most of
the time and on most of the areas of the skin.
Psoriasis basically not only affects the skin but also the scalp and nails. The
scalp has scaling patches much as is seen in severe dandruff. The nails show
pitting and the piling up of debris under the free edges.
There are many types of psoriasis and all may vary according to location,
severity, and symptoms. A few of the common types of psoriasis include: plaque
type psoriasis, guttate psoriasis, pustular psoriasis and erythrodermic
psoriasis. Some forms of psoriasis may affect just the fingernails or just the
scalp.
Fingernail psoriasis is characterized by "pitting" which is small depressions
in the nailplate. Also, it may cause lifting of the nail plate from the nail
bed or yellow discoloration of the nail plate.
Plaque-type psoriasis is characterized by large confluent plaques that are red
and often covered with a silvery white scale. Common areas of involvement
include the scalp, knees, elbows and buttock.
Guttate psoriasis is characterized by small patches in a guttate or "raindrop"
appearance widely distributed on the skin. These lesions are also red and
scaly.
Pustular psoriasis is characterized by scattered small pustules on red bases.
In some cases, the pustules become confluent to form sheets of pus.
Erythrodermic psoriasis is characterized by widespread, total redness of the
body. This is a severe form of psoriasis that may require hospitilization.
The course of psoriasis is chronic and that is why it is often referred to as
"heartbreak". It can be emotionally distressing to the patient. Occasionally,
psoriasis can be associated with severe arthritis. Psoriasis will be
characterized by flares and remissions.
Treatment for psoriasis is varied. Mild psoriasis will respond to topical
treatments. Topical cortisones, topical vitamin A derivatives and topical
vitamin D derivatives have all shown success in controlling mild cases. Other
helpful adjuncts to treatment may include the use of anitibiotics for guttate
psoriasis or ultraviolet light therapy for various types of psoriasis. As
psoriasis worsens, topical therapy may not be enough to control the disorder.
There are several oral medications that are now being used quite successfully
to control psoriasis. These medications are powerful and require monitoring by
a skilled dermatologist.
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