Psoriasis can be painful, but it shouldn’t be embarrassing

Red, flaky and dry, thickened patches of skin are the typical, visible symptoms of psoriasis. To help people understand more about this chronic disease, the month of August is designated as Psoriasis Awareness Month. Each year, one in five people with psoriasis report being discriminated against at a public pool, despite the noncontagious nature of this condition. So during this month, you are encouraged to increase your awareness of this disease and to educate your family and friends.
Psoriasis, a long-term, noncurable disease of the immune system, usually appears on the skin as thick, red or silvery scaly patches. Psoriasis begins when T cells, a type of white blood cell, which normally help protect the body against infection and disease, are mistakenly put into action. They then set off other immune responses, leading to inflammation and fast turnover of skin cells, forming the typical raised skin patches. As many as 7.5 million Americans have psoriasis, which can range from a nuisance condition to a life-altering disability. For some, the skin clears for years at a time and stays in remission, while for others it is consistently present and noticeable. Many psoriasis patients improve in the summer with increased sunlight exposure. A consequence of more severe, visible psoriasis may be social embarrassment, job and emotional distress, and other personal issues. Up to 30 percent of those with psoriasis develop psoriatic arthritis.
Psoriasis can occur on any part of the body, but commonly affects the skin of the elbows, knees, and scalp. The fingernails, toenails, and genitals may also be involved. Other health conditions, including diabetes, heart disease, hypertension, and depression can accompany psoriasis.
Typically diagnosed in the early adult years, it can be seen in babies and seniors alike. It affects both sexes equally and all races, although it is seen most frequently in Caucasians. Not everyone who inherits the genes for psoriasis develops the condition. About one in three persons with psoriasis has a close relative who is also affected.
It is not known exactly what causes the T cells to malfunction; however, in those who are genetically predisposed, environmental triggers may start or worsen the condition.
These triggers may include infections, such as strep throat, injury to the skin, stress, cold weather, smoking, heavy alcohol consumption, and certain medications — including lithium, which is prescribed for bipolar disorder; and high blood pressure medications such as beta blockers. Psoriasis can be associated with joint problems, which at times may be the only sign of the disorder, although skin symptoms typically occur before the onset of the arthritis. Psoriatic arthritis is an inflammatory, destructive form of arthritis often involving the hands, knees and ankles, and is typically treated with oral medications to inhibit the disease progression.
Dermatologists specialize in the diagnosis and treatment of psoriasis, and rheumatologists specialize in the treatment of joint disorders and psoriatic arthritis. Most patients will be treated by one or both of these specialists, or by their family physician or internist.
Psoriasis treatments may be topical, light-based therapy, or oral. Treatment is begun with the mildest and safest treatments, usually creams and ultraviolet light, progressing to oral treatments if necessary. Topical treatments may contain corticosteroids, synthetic vitamin D, vitamin A derivatives, calcineurin inhibitors (not FDA-approved for psoriasis, but may be used “off-label”), coal tars, salicylic acid, and other substances. Oral medications may include retinoids (related to vitamin A), immunosuppressant drugs such as methotrexate and cyclosporine, and a class of immunomodulating drugs called “biologics.” Oral drugs may have severe side effects, and are used with caution only when necessary. The goal is to find the most effective medication for each particular patient while minimizing adverse effects.
Although not “curable,” psoriasis is usually “controllable.” Patient education and partnership with a concerned and knowledgeable physician will go a long way toward the goal of living well with psoriasis.
Finally, whether or not one has psoriasis, it is a good idea to schedule an annual skin exam with either your primary care physician or dermatologist, especially if you have spent years in the sun, used artificial tanning, received light treatments for psoriasis, or have concerns due to a change in your skin.


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