Psoriasis is a common, chronic and recurrent skin disorder, for which the cause is currently unknown. Psoriasis tends to run in families, due to its hereditary component. It can also skip generations and resurface in adult life. It occurs equally in men and women. Psoriasis can occur from the neonatal period to the 70’s. It is often seen in a setting of extreme emotional stress.
Psoriasis is caused by a hyper proliferative or speedy process in the skin, whereby the epithelial cells, normally migrating from the lower portion of the epidermis to the uppermost portion of the skin shed, taking approximately 22 days instead of the usual 45 days. The cells are retained at the skin’s surface in the form of a scale or plaque. The lesions can itch, burn or are painful.
Typically the lesions are thickened, pink, well demarcated, dry scaly plaques of different sizes. The lesions are often surmounted by white, silvery scales. The lesions commonly occur on the scalp, elbows, knees, bellybutton, and intergluteal cleft. The nails can be involved with distal lifting of the nail plates off the bed, subungal hyperkeratotic debris resembling fungal nails, pitting of the nail plates, or a brown-yellow discoloration “oil spots” on the nail plates. Psoriasis is not contagious, meaning you cannot get it by touching the skin of a person affected by this condition.
Psoriasis can be pustular, occurring on the palms and soles, or become generalized, which is often seen in the case of steroid withdrawal. It can appear as a chronic hand dermatitis with discrete well demarcated scaly patches, unresponsive to topical steroids, a chronic diaper rash in babies, unresponsive to antifungals, after a streptococcal infection of the throat, in a guttate or raindrop pattern, or in pregnancy, where the pattern is often pustular. Psoriatic arthritis which resembles rheumatoid arthritis can develop from chronic cases, causing inflammation and pain in the joints, and leading to permanent joint deformity. It is estimated that 10-30% of persons are affected by psoriatic arthritis.
The course of psoriasis can be unpredictable. It can remain localized for years, spread to other areas or disappear. It can remain localized to the nail plates alone. It can become generalized and involve the entire body. The lesions can develop in sites of trauma, such as a scratch, sunburn or incision, a response called the “Koebner phenomenon”.
Although psoriasis does not affect one’s general health, it can be very emotionally taxing, with feelings of despair, shame and depression.Your dermatologist can establish the diagnosis of psoriasis with a skin biopsy, if the diagnosis is not apparent or if the response to treatment is sub-optimum.
Treatment of psoriasis is geared to remedies that stop or decrease the cellular turnover of cells. These can take the form of topical, injectable, or oral medications. Certain lasers are beneficial for limited plaques. Phototherapy, which is a form of sunlight is effective for widespread disease. Injectable biological agents offer hope for widespread disease, but are costly.
There are many treatment options for psoriasis and psoriatic arthritis. It is important to contact your dermatologist, who can tailor a treatment plan specifically towards your individual skin needs.
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