Understanding Psoriasis

Many people with visible skin diseases in Africa are often shunned and ridiculed for their disease. They are either thought to be contagious or to have brought the disease on themselves because of unhygienic practices. This is not necessarily the case as we’ve seen with our April/May issue cover personality, former CNN anchorwoman, Zain Verjee.

There is no current research on how common psoriasis is among Nigerians. However, many Nigerians do suffer from this skin condition including Glory Edozien, editor-at-large of Bellanaija.com. Here’s what you need to know about psoriasis …

[MORE]: Slideshow Pictures of Psoriasis

Psoriasis is a chronic autoimmune disease appearing on skin. The immune system sends out signals against the body’s own tissues, speeding up growth of skin cells. It can affect any part of the body. It’s often linked to other serious health conditions, such as diabetes, and depression.

About one-third of people with psoriasis have a family member with the disease. It is believed that to develop psoriasis a person must have a combination of the genes and exposure to environmental triggers. Known triggers include:

• Stress: can cause the disease to appear for the first time or aggravate existing psoriasis.
• Trauma to skin: sunburn and scratches are known to trigger a psoriatic response. Early treatment can minimize a response.
• Medications: some are known to trigger psoriasis. Lithium, used to treat bipolar disorder, and antimalarials, such as chloroquine and hydroxychloroquine, may cause a flare. Inderal, for high blood pressure, will worsen psoriasis. It isn’t known if other medications in the same class (beta blockers) have the same effect. Quinidine, a heart medication, and indomethacin, used to treat arthritis, may worsen psoriasis. Infection, particularly with streptococcus (the bacteria which causes strep throat) can be a trigger. It is often associated with the first onset of guttate psoriasis in children. Some people report that allergies, diet, and weather trigger their disease.

Signs and Symptoms

A dermatologist assigns a diagnosis by visual inspection. There are five types of psoriasis:

• Plaque psoriasis is characterized by red patches with a silvery-white buildup of dead skin cells, appearing most often on the scalp, knees, elbows and lower back. They are often itchy, painful, and may crack and bleed.
• Guttate psoriasis often starts in childhood or young adults. It’s the second most common type of psoriasis.
• Inverse psoriasis shows up as very red lesions in body folds. It may appear smooth and shiny.
• Pustular psoriasis is characterized by white pustules, blisters of noninfectious pus surrounded by red skin.
• Erythrodermic psoriasis is a particularly inflammatory form that often affects most of the body surface. It’s rare, occurring in 3 percent of people who have psoriasis. There is widespread, fiery redness and exfoliation of the skin, with severe itching, and often pain. This form of psoriasis can be life-threatening.

[MORE]: Slideshow Pictures of Psoriasis

Psoriasis can be mild, moderate, or severe. Disease on less than three percent of the body is considered mild, and constitutes about 80 percent of cases. Twenty percent of cases are moderate to severe. The severity is also measured by how much the disease affects a person’s quality of life. Psoriasis can have a severe impact on daily activities.

Prevention

Psoriasis is not preventable, but it may be helpful to avoid the triggers which an individual has found to aggravate his/her particular case.

Treatment

With mild disease, such as patches on the scalp, knees, elbows, hands and feet, topical treatments are sufficient to manage the plaques. Moderate to severe disease usually involves a combination of treatments: topical, phototherapy, and systemic medications.

Topical treatments, medications applied to the skin, slow down, or normalize, excessive skin cell reproduction and reduce inflammation.

There are two active ingredients in topical preparations for the treatment of psoriasis: salicylic acid and coal tar. Salicylic acid is a peeling agent, which softens and removes psoriasis scales. Tar, derived from coal, can slow the rapid growth of skin cells and restores the skin’s appearance. It can also reduce inflammation and itching.

There are other products that contain substances such as aloe vera, jojoba, zinc pyrithione, and capsaicin, which are used to moisturize, soothe, remove scale or relieve itching.

Keeping the skin lubricated is important to reduce redness and itching. Use fragrance-free products. Apply moisturizers after showering and washing hands. Use moisturizing soaps. Limit lukewarm showers to 10 minutes or less. Baths with oil, oatmeal, Epsom salts or Dead Sea salts can remove scale and relieve itching.

Several ingredients for treating itch are calamine, hydrocortisone, camphor, diphenhydramine, benzocaine and menthol. They can cause irritation and dryness.

Physicians may recommend nonsteroidal topical treatments, including Taclonex, Tazorec, Vectical, and Zithranol-RR. Topical steroids can be used for mild psoriasis.

Phototherapy involves exposing the skin to ultraviolet light on a regular basis, under medical supervision. Treatments are done in a doctor’s office, psoriasis clinic, or at home with a phototherapy unit. The key to success is consistency. The National Psoriasis Foundation does not support the use of indoor tanning beds as a substitute for medically supervised phototherapy. The Centers for Disease Control and Prevention (CDC) discourages the use of tanning beds and sun lamps.

Ultraviolet light B (UVB)/Ultraviolet light A (UVA) treatments penetrate the skin and slow the growth of affected skin cells. The psoriasis may worsen temporarily before improving. Occasionally, temporary flares occur with UV light therapy. It can be combined with topical or systemic treatments, dramatically increasing effectiveness of the systemic agents, which can allow lowering doses of the systemic medications. UVA is used with the light-sensitizing medication – psoralens.

The eximer laser emits a high-intensity beam of UVB. The pulsed dye laser is approved for the same. It destroys the tiny blood vessels that contribute to the formation of plaques.

Systemic medications are taken by mouth in liquid or pill form, or given by injection. They include:

• Soriatane is a synthetic form of vitamin A.
• Cyclosporine suppresses the immune system.
• Methotrexate was initially used to treat cancer. It inhibits an enzyme involved in the rapid growth of skin cells. Its use must be monitored very closely; it carries many warnings of adverse effects and side effects.

Biologic drugs, also called “biologics”, are used for moderate to severe psoriasis. They are given by injection or intravenous (IV) infusion. Biologics work by blocking T cells, or by blocking proteins in the immune system that trigger the body to create inflammation. There are significant risks and side effects.

Living with Psoriasis

Stress can cause the immune system to send out chemicals that cause inflammation. In people with psoriasis, the immune system over-responds, sending out too much of the chemicals.

The itch of psoriasis can have a bigger impact on quality of life than visible lesions. It is a unique itch, often described as a burning, biting sensation. Some describe it as the feeling of being bitten by fire ants. At-home remedies for the itch include keeping skin moisturized. It reduces inflammation, itching, and helps the skin heal. Minimizing scaling and flaking are helpful. Cold showers and cold packs can help relieve itching.

Psoriasis can affect relationships in a number of ways. It can be difficult to talk to family and friends about the disease. Dating may be avoided due to poor body image. Genital psoriasis can have a significant impact on sex and intimacy.

Depression is the most common disease associated with psoriasis. It can have a significant impact on quality of life. People with psoriasis are more likely to have suicidal thoughts and attempts. A person with the symptoms of depression should be seen by a physician. The symptoms include:

• Inability to sleep
• Inability to get out of bed
• Loss of energy
• Lack of interests in things previously enjoyed
• Inability to focus

Working with psoriasis and psoriatic arthritis can be challenging. Meeting with a supervisor to discuss how psoriasis may affect job performance is helpful. It may be necessary to invent ways to perform routine work tasks. Learn about disability benefits and eligibility requirements before they become necessary.

For more information on psoriasis visit www.psoriasis.org

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