Monday Medical: Psoriasis: More than skin deep


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August is Psoriasis Awareness Month. The National Psoriasis Foundation is sponsoring a psoriasis genetics research project. The foundation is seeking 1,000 participants who have the condition or related arthritis and 1,000 people without the disease and without psoriasis in their families. For details, visit

If you are the kind of person who remembers old television commercials, you probably recall the somber music and sad tone of voice as the announcer lamented "the heartbreak of psoriasis."

Psoriasis (pronounced sore-eye-a-sis) is a chronic skin disorder that affects up to 7.5 million Americans. Symptoms include rough, dry, thick patches of skin anywhere on the body. These patches itch, crack and bleed. They are not contagious, but they are difficult to treat.

The disorder varies in severity, and the onset can come at anytime in life. It often appears between the ages of 15 and 35 or between ages 50 and 60.

Psoriasis runs in families. The condition is believed to start beneath the skin, within the body's immune system. An outbreak usually is triggered by something specific such as a strep infection, trauma to the skin or emotional stress.

The most common type is plaque psoriasis, characterized by scaly patches ranging from 1 to 10 centimeters in diameter, typically on the elbows, knees, lower back and scalp. Other types cause small patches on the trunk, red, shiny patches in skin folds, noninfected pimples or boils on hands and feet or a generalized inflammation of the skin.

The flaky patches occur because of a rapid increase in the rate at which skin cells are replaced. Compared to a normal replacement time of about 27 days, skin cells affected by psoriasis turn over in only three to four days. White blood cells also build up in these areas, causing inflammation.

A physician - often a dermatologist - does diagnosis by visual observation. It is important to be diagnosed accurately so treatment can begin. There is no cure for psoriasis, but some treatments can clear the skin for periods of time.

Patients and their doctors may have to be persistent, trying different treatments or combinations. "No single psoriasis treatment works for everyone, but something will work for most people," the National Psoriasis Foundation notes.

Treatment traditionally has focused on slowing the production of skin cells, usually with compounds that are spread on the skin. Psoriasis is one of the few skin disorders that improves when the affected area is exposed to sunlight. As a result, most treatment plans include controlled doses of ultraviolet rays.

Newer medications targeting the immune system have emerged as first-line options for most moderate to severe cases. Patients taking these medications have shown marked improvement. Long-term effects of these medications are unknown, however, and they are to be used with caution by patients who are prone to infections or have a high risk of cancer.

Self-care measures to reduce flare-ups or their severity include avoiding skin injury and infections, reducing stress, getting regular exercise, avoiding harsh soaps and keeping the skin soft with moisturizing lotions.

A disorder that is more than skin deep, psoriasis can have a huge impact on a person's life. "The heartbreak of psoriasis" is not a melodramatic phrase - it is an accurate description of the damaging effect of this condition.

In one survey, 50 percent of patients with moderate to severe psoriasis reported feeling "ashamed," while 30 percent were "depressed" or "angry." As improved treatment options become available, people who have psoriasis may be able to live more pleasant lives.

Christine McKelvie is public relations director for Yampa Valley Medical Center.


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