Some say that beauty is only skin deep, but many of us know that appearance
speaks a lot especially during a first impression. Many women who have
psoriasis say it does not just affect their skin, it also affects their
quality of life. According to the National Psoriasis Foundation, it can
have a big social and psychological impact on daily life with 60% of sufferers
reporting their skin disorder interferes with their ability to enjoy life
causing issues such as embarrassment, stress and depression.
Psoriasis is a chronic skin disorder characterized by raised, reddened, round circumscribed
plaques covered by silvery white scales. These lesions may be itchy or
painful and sometimes will crack and bleed. It is unpredictable and irritating
and often occurs on the knees, elbows and scalp and can also affect the
upper body, palms and soles of the feet. As with any chronic illness,
the skin manifestations may occur and disappear throughout life, with
no predictable pattern of recurrence.
“Psoriasis can occur in different forms,” says Pa Lee, BSN, FNP of
Catawba Valley Family Medicine – Claremont. “The most common one is plaque psoriasis. This type of psoriasis
usually presents with symmetrically distributed cutaneous plaques most
commonly found on the scalp, elbows, knees and back. Initially, the lesions
are papules that form into a well-designed margin that are raised above
the surrounding normal skin. There is usually a thick silvery scale, although
recent bathing may remove the scale and lotion moisturizers may make the
scale temporarily invisible.”
The plaques can range anywhere from less than one to more than 10cm in
diameter. They can be asymptomatic or itchy, painful and irritated enough
to crack the skin. The plaques in darker-skinned people may appear purple.
Genes hold instructions for cells dictating how the body looks and control
how the body works. Normally, the keratinocyte cells migrate from the
innermost skin layer to the outer skin layer in about 14 days and slough
off after 14 days. However, with psoriasis, the genes that control the
immune system receive a mixed up signal resulting in promotion of inflammation,
turning the skins cells on overdrive. Due to the overdrive, the cells
have a shorter cycle of growth completing the journey in only four to
seven days instead of the typical 14 days. The shorter journey causes
the cells to be immature. These immature cells then produce an abnormal
keratin that forms thick, flaky scales on the skin’s surface. The
increased cell metabolism causes increased vascularity, which contributes
to the redness of the lesions.
Risk factors for psoriasis include genes, sunlight, stress, seasonal changes,
hormone changes, drugs and infections. About 40% of patients with a family
history of psoriasis in first-degree relatives get the disease.
Lee says, “Flare-ups are dependent on the person. What may cause
one person to flare-up may not trigger the other person’s flare-ups.
Permanent remission of psoriasis is rare. The prognosis depends on the
type, extent and severity of the attack. While there is no cure for psoriasis,
a variety of medications and treatments may be prescribed.”
Current Psoriasis Treatments
Topical medications may be used to decrease the inflammation and delay
psoriasis’ growth journey. Examples of topical medications include
steroid creams, tar preparations, anthralin and calcipotriene. Other treatments
include photochemotherapy and ultraviolet (UV) light therapy. In photochemotherapy,
the drug psoralen is combined with UV A light. This type of treatment
causes tanning, and direct sunlight must be avoided for eight to twelve
hours afterwards. Photochemotherapy has a high success rate; however,
it is used far less often today due to the increased risk of developing
skin cancer. UV B lights have been shown to decrease the growth rate of
skin cells. UV light therapy is given in gradually increasing exposure
times, until there is a subtle redness like a mild sunburn. Treatments
are usually given daily and measured in seconds of exposure. Patients
receiving UV light therapy are less likely to develop cancer and it is
considered almost as effective as photochemotherapy.
Newer treatments for psoriasis are biologic drugs derived from human or
animal proteins with the focus on controlling the body’s immune
response. Patients often find relief when combining these medications
with topical moisturizers or creams applied regularly to prevent dry skin
that becomes irritated and itchy. Bathing in lukewarm water with salt,
oil, or oatmeal added can also be helpful. Apply sunscreen with SPF of
30 or higher with zinc oxide to areas that do not have psoriasis. Smoking
and alcohol consumption have also been shown in studies to aggravate psoriasis.