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PSORIASIS
About Your Diagnosis
Psoriasis is a chronic skin disorder with frequent recurrences and remissions
characterized by silvery white, scaly plaques. Your psoriasis can vary from mild
to severe, depending upon the type of psoriasis and the extent of involvement.
The exact cause is unknown. Psoriasis is likely autoimmune (i.e., a condition
in which your immune system mistakenly attacks normal parts of the body,
resulting in tissue injury or disease).
This condition is common, affecting about 2% of individuals in the United
States. It is less common in individuals of African, Asian, and Native American
descent. It affects men and women equally. It typically begins in adolescence or
early adulthood and persists throughout life.
This condition is hereditary but is not infectious or cancerous. Other
members of your family may have psoriasis. Minor injury, including scratching or
rubbing, can provoke an outbreak of the lesions. Other factors that can increase
your risk for an episode of psoriasis include stress, infections, cold and dry
climates, obesity, and other autoimmune conditions.
Diagnosis is usually based upon the appearance of the skin lesions. Your
doctor may perform a skin biopsy (i.e., removal of a small piece of skin or
other tissue) for laboratory evaluation to assist in diagnosis.
Psoriasis is not curable. Psoriasis is a chronic condition in which episodes
may persist for days to months. Periods of remission occur between episodes. The
severity may decrease during pregnancy. Treatment aims to control symptoms and
lessen the severity and duration of skin lesions, but does not cure psoriasis.
Living With Your Diagnosis
Skin lesions are slightly raised, silvery white scales with red or pink
margins. The lesions can develop painful fissures (cracks). Lesions may be
single, localized to certain areas of the body, or generalized. They are
typically bilateral (i.e., involve both sides of the body). Psoriasis can affect
any part of the body. It most commonly involves the skin of the scalp, face,
elbows, hands, knees, feet, chest, lower back, and the folds between the
buttocks. Fingernails and toenails are frequently involved. Nails often show
discoloration and pitting.
Itching is common, particularly in the scalp. Joint pain occasionally occurs,
especially if psoriasis involves the fingernails and toenails. Rarely, you may
have fever, chills, arthritis, and a generalized pustular psoriasis.
Secondary bacterial infections can occur, especially if you scratch the
lesions. These infections often require antibiotic therapy. You may also
experience social embarrassment because of your skin's appearance: "the
heartbreak of psoriasis." Other complications include arthritis and
pustular psoriasis.
Treatment
Specific treatment depends upon the type, location, and severity of your
psoriasis, its impact on the quality of your life, and your response to therapy.
Treatment does not cure psoriasis, but it lessens the severity of your condition
and prevents complications. Treatment includes the avoidance of precipitating
factors, general measures, and medications.
Treatment of mild-to-moderate psoriasis includes topical creams, lotions, and
ointments to reduce inflammation, scaling, and itching. Shampoos and lotions are
frequently used to treat psoriasis of the scalp. Be cautious when using topical
medications because they may be absorbed through your skin into your
bloodstream, thereby causing toxic effects. Do not exceed prescribed doses of
your medicine.
General measures include:
- Maintaining good skin hygiene.
- Avoiding skin injury.
- Avoiding excessive skin dryness.
- Exposing your skin to moderate amounts of sunlight.
- Considering moving to areas with a warmer climate.
- Oatmeal baths to loosen scales, which can improve the appearance of your
skin and enhance the effects of topical medications.
Your doctor may prescribe a variety of medications to reduce inflammation,
scaling, and itching and to lessen the severity and duration of outbreaks of
psoriasis. These medications include:
- Ointments and shampoos containing coal tar. These medications are
effective for psoriasis of the scalp and for mild-to-moderate cases.
- Topical steroids and other topical anti-inflammatory agents. These agents
are effective in mild-to-moderate cases and as combination therapy for more
severe cases. Before using these agents, soak the affected areas in water to
loosen and to remove scales, which increases the effectiveness of the
topical medications. Your doctor may recommend placing occlusive dressings
over the topical medications to increase their effects. Side effects include
skin atrophy, formation of abnormal, small blood vessels, and absorption of
medication through the skin into the bloodstream, which can cause toxic
effects. To decrease the risk of side effects, do not exceed the recommended
dose prescribed by your doctor.
- Salicylic acid in mineral oil. This helps to remove plaques, thereby
maximizing the effects of topical medications.
- PUVA (combination of the medicine psoralen and exposure to ultraviolet
light wavelength A [UVA]).
- Combination of emollients or tar baths with ultraviolet light wavelength B
(UVB).
- In severe cases, immunosuppressive agents (i.e., medications that lessen
the effects of your immune system) such as methotrexate, isotretinoin, and
etretinate. These medications are effective but do carry the risk of toxic
effects to the liver and kidney. Therefore, your doctor will closely follow
laboratory tests to monitor your response to these medications and to check
for side effects. Isotretinoin can be toxic to a developing fetus and should
not be used in women who are pregnant or who may become pregnant.
- Antihistamines to relieve itching. They may cause drowsiness, so use these
agents cautiously when driving or performing other activities in which you
must be awake and alert.
- Antibiotics to treat secondary bacterial infections. A rare form of
psoriasis, known as guttate psoriasis, is caused by a strep infection.
Prompt antibiotic therapy is indicated for individuals with this type of
psoriasis.
The DOs
- Take medications as prescribed by your doctor.
- Inform your doctor of all other medications, including over-the-counter
medicines, that you are taking. Continue these medications unless your
doctor instructs you to stop them.
- Read the labels of medicines and follow all instructions. Consult your
doctor if you have any concerns or if you have possible side effects caused
by the medication.
- Frequently expose your skin to moderate amounts of sunlight.
- Maintain good skin hygiene to reduce outbreaks of psoriasis and to
decrease the risk of secondary bacterial infection.
- Oatmeal baths (one cup of oatmeal in a bathtub of warm water) loosens
scales, which can improve the appearance of your skin and enhance the
effects of topical medications.
- Consider moving to a warmer climate.
- Keep scheduled follow-up appointments with your doctor; they are essential
to monitor your condition, your response to therapy, and to screen for
possible side effects of treatment.
- Monitor your skin for healing and for evidence of secondary bacterial
infection. Signs and symptoms of infection include redness around the skin
lesions, purulent discharge (pus), increased pain or swelling of lesions or
lymph nodes, and fever.
- Individuals with psoriasis frequently become depressed or experience other
psychological conditions. If you feel depressed or are having difficulty
adjusting to your psoriasis, talk to your doctor about the best treatment
options, including psychological counseling.
The DON'Ts
- Do not stop your medicine or change the prescribed dose without consulting
your doctor.
- Do not exceed recommended doses of medicines, because higher doses can
increase the risk of toxic effects.
- Do not use potent topical steroids on the skin of the face or genitals,
because these areas are most prone to skin atrophy.
- Do not abruptly stop steroids or immunosuppressive therapy because you may
have a rebound worsening of your condition. In particular, do not suddenly
stop steroids because this action can have serious effects to your health.
Consult your doctor before stopping these medications.
- Do not drive or perform other potentially hazardous activities when taking
medications that cause drowsiness or sedation (e.g., antihistamines and pain
medications).
- Avoid skin injuries, including scratching, rubbing, or scrubbing, which
can trigger outbreaks.
- Avoid skin dryness to reduce the frequency of outbreaks.
- Avoid activities that can cause infection of skin lesions.
When to Call Your Doctor
- If you have any signs or symptoms of infection (see above).
- If you notice that lesions are becoming worse or if new lesions appear
despite appropriate therapy.
- If you notice pustules on the skin, especially if accompanied by fever,
fatigue, muscle aches, or joint pain/swelling.
- If you have new or unexplained symptoms.
For More Information
Contact the National Psoriasis Foundation
6415 Southwest Canyon Court
Suite 200
Portland, OR 97221
503-244-7404
Psoriasis. Note scaly plaques characteristic of this condition. (From Thibodeau
GA, Patton KT: The Human Body in Health & Disease, ed 2,St. Louis,
Mosby—Year Book, 1996. Used by permission.)
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