Psoriasis

We've all seen the ads discussing the "heartbreak of psoriasis". Or the ads for the new biologic drugs like Enbrel. But how many of us know anything about a disease that affects approximately 5 million people here? That is 5x the patient population for lupus. Psoriasis affects mainly adults and is seen equally between the male and female population.

Psoriasis is an autoimmune disorder that causes the skin to pile up cells on the skins surface, where they typically thicken and harden in a matter of days, rather than the normal response of around a months time. In its most common form, silvery thick patches appear causing intense itching and burning. These reddened areas are seen over the legs, elbows, knees, scalp, lower back, soles of the feet, face and palms. It may also affect the fingernails and the genitals. In addition, a joint pain may develop known as psoriatic arthritis.

There are several forms of psoriasis:

Plaque- with reddened silvery scaling

Guttate- The scalp, trunk and limbs are affected by small drop shaped lesions. This is often triggered by an infection such as strep.

Pustular- Infections, medications or stress can trigger this form. It has watery filled blister like areas, filled with pus.

Inverse- Found in the moist folds of skin, such as in the genital areas, the groin or underside of breasts. sweat, tight clothing or friction can cause this to flare.

Erythrodermic- Widespread reddening of the skin, caused by sun exposure, corticosteroids or a prolonged psoriatic flare.

Psoriasis patients suffer a knee jerk reaction from people who are not aware of what it is. Some people recoil in horror, fearing contagion or simply appalled at what they are seeing. This, perhaps more than anything, is the most difficult thing for these patients to deal with. Forced into isolation because of their appearance and discomfort, many psoriasis patients become depressed. Even the simple act of dressing can drive a severely itching patient to tears. Counseling and emotional support from family and friends can prove to be a huge help for psoriasis patients.

With the advent of the new class of biologics like Humira, Enbrel and others, many patients are finally gaining a measure of relief from their suffering. There are serious risks to them though. The biologics all carry an increased risk of cancer, along with a big incidence of infection, due to their ability to seriously modify the immune system.

Phototherapy, using ultraviolet light, in conjunction with the use of retinoid compounds, seems to also help keep skin responses calmer and aids in healing. The Goeckerman Treatment uses a coal tar paste in conjunction with the UVB. Another, the Ingram Regimen, adds an acetylsalicyclic paste to a coal tar bath, in addition to the UVB.

When outbreaks are affecting the face and hands of patients like teachers or salesmen, a regimen known as P.U.V.A is often tried. This utilizes a UVA light, in conjunction with psoralen, a drug developed for psoriasis. The problem is in the side effects and increased risk of developing cancer or lymphomas. It is also deemed not as effective as the UVB regimens.

Ultimately, a much lower dose regimen utilising the best options available, may well prove to be the safest approach, carrying a lower risk of serious side effects. Meanwhile serious research continues into the question of how and why these disorders develop.

This is very serious non-contagious disease. But, as with all the autoimmune disorders, it can be handled. What cannot be handled easily, is changing peoples attitudes and reactions to psoriasis. At least without some major public education. Given proper information, coupled with definite information that this is not a public health disease, people may well become much more sensitive to those who have psoriasis.

Sources:

http://www.psoriasisconnect.com/learn/what-is-psoriasis.jsp

http://www.psoriasis.org/netcommunity/about_psoriasis

http://www.niams.nih.gov/Health_Info/Psoriasis/default.asp