Psoriasis is classified as a chronic immune-medicated disease and is a skin condition that effects the first layer of the epidermis [skin]. This condition is different than eczema with affects that outer side of the a joint.
It is important to understand that this is a condition that is chronic and reoccurring – which means that it can be difficult to treat. Even after improvement, return of symptoms or worsen of symptoms can occur.
Psoriasis can be caused by an Immune System sending out faulty signals that speed the growth of the skin cells
Between 10-40% of those having Psoriasis also has psoriatic arthritis which affects the joints like Arthritis. There is likely to be a genetic component, though psoriasis is not completely understood. Inflammation is a large aspect of what is happening both to the skin layers and Joints when involved.
– Commonly seen as red and white regions of scaly patches.
– Can be a silvery-white appearance
– Often found on elbows and knees
– Can also affect scalp, hands, fingers, legs, abdomen.
– Plaque-like psoriasis
– Affects 80-90% of those with psoriasis
– Raised areas of inflamed skin called plaques
– Widespread inflammation and exfoliation of skin
– Covers most of the body surface
– Severe itching
– Often swelling is associated
– Can be seen with abrupt stopping of systemic treatment
– This form of psoriasis can be fatal
– Appears as raised bumps that are filled with pustules. [Not infections]
– Skin around pustules is red and often tender
– Often seen on hands and feet (palmoplantar pustulosis)
– Can be seen on any part of the body
* Annular pustular psoriasis
* Acrodermatitis continua
* Generalized pustular psoriasis
* Pustulosis palmaris et plantaris
* Impetigo herpetiforms
– Smoothed inflamed patches of skin.
– Seen in skin folds – often around genitals, armpits, abdomen, folds of breasts
– Aggravated by friction and Sweat
– Many of small and scaly lesions
– Can be red or pink in color
– Often seen on back, trunk, limbs and scalp
– Often follows a streptococcal pharyngitis infection.
– Can affect any joint
– Most common joints affected: fingers and toes.
– Fingers can appear thick as sausages.
– Large changes in the appearance of finger and toenails
– Changes include: color, pitting, lines across nail, thickening of nail, crumbling of nail.
– Dry skin
– Plaques [rashes with silver or white appearance]
– Joint pain
– Flaky skin
– Redness on skin
– Nail changes
– Rashes in hair/scalp
– Elevated Blood pressure
– Physical Discomfort
– Typically done on appearance of skin
– No specific blood tests are done
– Skin biopsy can be helpful to rule out other disorders
– Auspitz’s sign – scraping of plaques causes pinpoint bleeding from the skin below
Help with Dryness
. Bath solutions
. Mineral oil
. Petroleum jelly
Help with plaques
. Coal tar
. Dithranol [anthralin]
. Desoximetasone [Topicort] – Steroid
. Flucinonide – Steroid
. Calcipotriol – Vitamin D3 analogues
. Topical Retinoids
This type of treatment is a form of sunlight that is done through a handheld machine. Wavelengths of 311-313 nm are most effective. Special lamps are used
. Psoralen and Ultraviolet A phototherapy
These type of medications are often used. However, it is important to remember that Pregnancy must be avoided in many of these treatments. Re-occurrence of psoriasis after medications are stopped are often seen
. Methotrexate – Immunosuppressant Drugs
. Cyclosporine – Immunosuppressant Drugs
. Retinoids – Synthetic form of Vitamin A
. Efalizumab – Target T-cells
. Alefacept – Target T-cells
. Infliximab – Monoclonal Antibodies
. Adalimumab – Monoclonal Antibodies
. Certolizumab pegol – Monoclonal Antibodies
. Golimumab – Monoclonal Antibodies
Other Treatments are being reviewed and studied.