17.12.07
Psoriasis is a chronic recurring disease of the skin, identified by the presence of thickened scaly areas and papules (small, solid, often inflamed bumps that, unlike pimples, do not contain pus or sebum). These bumps are usually slightly elevated above the normal skin surface, sharply distinguishable from normal skin, and red to reddish brown in color. They are usually covered with small whitish silver scales and, if scraped off, may bleed. The extent of the disease varies from a few tiny lesions to generalized involvement of most of the skin. Often the elbows, knees, scalp, and chest are involved. Psoriasis affects about 1% of people in the world, and for most it tends to be mild and unsightly rather than a serious health concern.
No one really knows exactly what causes psoriasis, although recent studies suggest it may be related to an immune system disorder. To put it simply, psoriasis is the recurring growth of too many skin cells. A normal skin cell matures in 28 to 45 days, while a psoriatic skin cell takes only 3 to 6 days. Both men and women can get psoriasis at any age. Psoriasis appears in several forms. The scaly, papule kind called plaque psoriasis is the most common. Other forms are guttate psoriasis, typified by small dotlike lesions all over the body; pustular psoriasis, with weeping lesions and intense scaling; and erythrodermic psoriasis, characterized by severe sloughing and inflammation of the skin. Psoriasis can range from mild to moderate to severe and disabling. On occasion, some people who have psoriasis experience spontaneous remissions, but no one knows why this happens, and remissions are unpredictable.
Sadly, there is no cure for psoriasis, but there are many different treatments, both topical and systemic, that can clear it for periods of time. Experimenting with a variety of options is essential if you wish to find the treatment that works for you, but all require a doctor's attention.
Of the various therapies available to treat psoriasis, it is generally best to start with those that have the least serious side effects, such as topical steroids (cortisone creams); coal tar creams, lotions, cleansers, or shampoos; and exposure to sunshine. If those methods are not successful, you can proceed to the more serious treatment involving oral medications. More often than not, successful treatment requires a combination of methods.
Natural sunlight can significantly improve, or even clear, psoriasis. Regular daily doses of sunlight taken in short exposures with adequate sun protection are strongly recommended. Sun protection is vital not only to prevent sunburn, which may make psoriasis worse, but also to reduce skin damage from the sun's ultraviolet radiation. This outdoor approach to treating psoriasis is often referred to as climatotherapy.
When you can't get to sunshine, medically supervised administration of UVB lamps may be used to minimize widespread or localized areas of stubborn and unmanageable psoriasis lesions. UVB light is also used when topical treatments have failed, or in combination with topical treatment. The short-term risks of using controlled UVB exposure to treat psoriasis are minimal, and long-term studies of large numbers of patients treated with UVB have not demonstrated an increased risk of skin cancer, suggesting that this treatment may be safer than sunlight. (Sunlight has both UVA and UVB radiation; UVA causes skin cancer, while UVB mainly triggers sunburn.) UVB treatments are considered one of the most effective therapies for moderate to severe psoriasis, with the least amount of risk.
Treating psoriasis with coal tar is a very old and effective remedy. These topical medications are available both over the counter and by prescription; the difference is in the potency and amount of coal tar the medication contains.
Coal tar can be combined with other psoriasis medications (e.g, topical steroids) or with sunshine (ultraviolet light). However, coal tar can make the skin more sensitive to ultraviolet light, and extreme caution is advised when combining its use with UV therapy (or exposure to the sun) in order to avoid getting a severe burn or causing skin damage.
Anthralin, another topical prescription medication, has been used to treat psoriasis for over a hundred years. It has few serious side effects but can irritate or burn the normal-appearing skin surrounding psoriasis lesions. Anthralin also stains anything it comes into contact with. It is prescribed in a range of concentrations and there are a variety of regimens for its use, but the negative side effects make it a less than desirable option.
Calcipotriene, a synthetic vitamin D3 analog, is used to treat mild to moderate psoriasis. It is a prescription medication with few side effects. It is not the same compound as the vitamin D found in commercial vitamin supplements.
Calcipotriene is sold as a topical, odorless, non-staining ointment and cream under the prescription brand name of Dovonex.
More serious systemic medications such as Methotrexate, Tigason, Accutane, Cyclosporin, and oral steroids are also used to treat psoriasis, but each has pros and cons that need to be researched and discussed at length with your physician.
Discovering whether any of these will work for you, alone or in combination, takes patience and a systematic, ongoing review and evaluation of how your skin is doing. As is true with all chronic skin disorders, success requires diligent adherence to the regimen and a realistic understanding of what you can and can't expect. It is also important to be aware of the consequences of the varying treatment levels. For example, continued long-term use of topical cortisone creams can cause skin thinning, stretch marks, and built-up resistance to the cortisone medication itself, so that it actually becomes an ineffective treatment. Exposure to sunlight without adequate protection (particularly from UVA radiation) can cause skin cancer. Oral steroids can have serious withdrawal effects, including increased bouts of psoriasis. Accutane causes birth defects if a woman becomes pregnant while taking it.
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