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PsoriasisIntroduction Psoriasis is a skin condition, in which, skin cells reproduce too quickly. It affects approximately 2% of people in the UK. It can start at any age, but most often develops between 11 and 45 years old, often at puberty. Skin cells have a life cycle. Your body produces new cells in your lowest skin level and these skin cells gradually move up through the layers of your skin until they reach the outermost level. Then they die and flake off. This whole process normally takes around 21 to 28 days. In psoriasis, this process is speeded up, so it only takes 2- 6 days. As a result, cells build up rapidly on the surface of the skin causing red, flaky, crusty patches covered with silvery scales to appear on the surface. These patches are then shed easily. It can occur on any part of your body although it is most commonly found on the elbows, knees, lower back and the scalp. It can also cause intense itching and burning. The condition is not contagious and most people have only small patches of their body affected. The severity of psoriasis varies greatly from person to person. For some people it is just a minor irritation, but for others it has a major impact on quality of life. Psoriasis is a long-lasting disease (chronic) that can return at anytime. You may have times when you have no symptoms of psoriasis or times when you have very mild symptoms followed by times where the symptoms are severe. There is no cure for psoriasis but there are a range of treatments that can help improve your symptoms. Symptoms The symptoms of psoriasis vary from person to person. Most people find that their psoriasis goes through cycles - it causes problems for a few weeks or months, and then the symptoms ease or stop. There are several different type of psoriasis. Typically, people have only one form of psoriasis at a time, although sometimes two different types can occur together. One type may change to another type, or one type may become more severe. Common types of psoriasis are: Plaque psoriasis - the most common form of psoriasis. Around 80% of people with psoriasis have plaque psoriasis. Its symptoms are dry, red skin lesions - known as plaques - that are covered in silver scales. They normally appear on your elbows, knees, scalp and lower back but can appear anywhere on your body. The plaques are normally itchy, sore, or both. In severe cases the skin around your joints may crack and bleed. Nail psoriasis - this affects your nails causing them to pit, become discoloured and grow abnormally. Often nails can become lose and separate from your nail bed. In some severe cases, your nails may crumble. Guttate psoriasis - this normally occurs following a throat infection (streptococci) and is more common amongst children and teenagers. This causes small (less than 1 cm - one third of an inch) water-drop shaped sores on your chest, arms, legs and scalp. There is a good chance that guttate psoriasis will disappear completely, but some young people go on to develop plaque psoriasis. Scalp psoriasis - this normally affects the back of your head, but it can occur in other parts of your scalp, or on the whole scalp. This causes red patches of skin covered in thick silvery-white scales. Some people find scalp psoriasis, extremely itchy, while others have no discomfort. In extreme cases it can cause hair loss, but not permanent balding. Inverse psoriasis - this affects areas of the skin that are in folds or creases, such as the armpits, groin, and the skin between the buttocks and under the breasts. This can cause large smooth red patches to occur in some or all of these areas. Inverse psoriasis is made worse by friction and sweating, so it can be particularly uncomfortable in hot weather. Inverse psoriasis is more common in overweight people. Pustular psoriasis There are rarer types of psoriasis known as pustular psoriasis. These cause pus filled blisters (pustules) to appear on your skin. Different types of pustular psoriasis affect different parts of the body: von Zumbusch psoriasis - this causes pustules to appear across a wide area of your skin. The pustules develop very quickly. The pus consists of white blood cells and is not infected. The pustules dry and peel off within a couple of days, leaving the skin shiny and smooth. The pustules may reappear every few days or weeks in cycles. During the start of these cycles Von Zumbasch psoriasis can cause fever, chills, weight loss, and fatigue. Palmaplanter pustular psoriasis - this causes pustules to appear on the palms of your hands and the soles of your feet. The pustules gradually develop into circular, brown, scaly spots, which then peel off. Pustules may reappear every few days or weeks. Acropustulosis - this causes pustules to appear on your fingers and toes. The pustules then burst leaving bright red areas that may ooze or become scaly. These may lead to painful nail deformities. Erythrodermic psoriasis Erythrodermic psoriasis is the rarest form of psoriasis. This can cover your body with a widespread red rash that causes intense itching or burning. Erythrodermic psoriasis can cause your body to lose proteins and fluid. This can lead to serious illnesses such as dehydration, heart failure, hypothermia and malnutrition. Causes The exact cause of psoriasis is unknown but it is known that your immune system plays a part. Your immune system is your body's defence against disease - it produces proteins (antibodies) that attack germs and viruses. For some reason, if you have psoriasis, one of these antibodies called T cells start attacking healthy skin cells by mistake. This triggers other immune responses that cause an increase in the production of new skin cells and also T cells. This results in a cycle of skin cell production becoming faster and faster - skin cells are created and then die in the space of 5-6 days, rather than the normal 28 days. The dead skin cells then build on the surface of your skin in thick scaly patches. Psoriasis runs in families - one in three people with psoriasis has a close relative who also has psoriasis. However, the exact role that genetics plays in causing psoriasis remains unclear. There are three genes that are linked to psoriasis- known as SLC9A3R1, NAT9 and RAPTOR. However a large proportion of people with these genes never develop skin problems. Streptococcal throat infections are involved in guttate psoriasis developing, usually in children and young adults, however again, most people with who have streptococcal throat infections do not develop psoriasis. Diseases of the immune system such as the HIV infection can cause psoriasis to flare up or to appear for the first time. Psoriasis triggers Many people with psoriasis find that symptoms start or become worse because of a certain event - a trigger. Identifying a trigger may allow you to avoid a flare up of psoriasis. Common triggers include: alcohol, smoking, an injury to your skin such as a cut, scrape, insect bite, or sunburn (this is known as 'the Koebner response'), stress, and certain medicines like lithium, antimalarial medicines, anti-inflammatory medicines including ibuprofen, and ACE inhibitors (used to treat hypertension), and beta blockers (used to treat congestive heart failure). Diagnosis There is no blood test for psoriasis. Usually your doctor will make the diagnosis from the appearance of your affected skin. Rarely, a sample of skin scrapings or a small sample of skin will be sent to the laboratory for examination under a microscope. This will determine the exact type of psoriasis and to rule out other skin disorders such as seborrheic dermatitis, lichen planus, neurodermatitis and pityriasis rosea. If your doctor suspects you have psoriatic arthritis (see complications), you should be referred to a rheumatologist, who specializes in arthritis. Blood tests may be taken to rule out other conditions and x rays of the affected joints may be taken. Treatment There is no cure for psoriasis. However, treatment is usually effective and will control the condition by clearing or reducing the patches of psoriasis. Most people with psoriasis can be treated by their GP. Your GP may refer you to a dermatologist (skin specialist) and their team based in a hospital if symptoms are particularly severe or have not responded well to previous treatments. Treatments are based on the type and severity of your psoriasis and the area of the skin affected. Your GP will probably start with a mild treatment - such as topical creams - and then move on to stronger treatments if necessary. There are a wide range of treatment options for psoriasis but identifying what treatment is most effective can be difficult. You should talk to your GP if you feel a treatment is not working, or you are experiencing uncomfortable side-effects. Treatments fall into three categories: topical - creams and ointments are applied to your skin phototherapy - your skin is exposed to certain types of light, and oral and injected medication - medicine is used to reduce the production of your skin cells. Different types of treatment are often used in combination. Topical treatments Topical treatments are creams and ointments you apply to the affected areas of your skin. They are used to treat mild to moderate psoriasis. Topical psoriasis treatments include: Topical corticosteroids - these are the most commonly used medicines for treating mild to moderate psoriasis. The treatment works by slowing the production of skin cells; this reduces the inflammation and relives the symptoms of itching. Topical corticosteroids range in strength from mild to very strong. Stronger topical corticosteroids are normally only used on small areas of your skin or on particularly thick patches. You should only use topical corticosteroids when instructed by your GP. Over-use can lead to you developing a tolerance to the cream and it could damage your skin. Vitamin D analogues - the Vitamin D in the cream has a suppressing effect on your immune system, slowing the production of skin cells. The most widely used Vitamin D analogue is calcipotriol, which is used to treat mild to moderate psoriasis. Calcipotriol has no side-effects, provided you do not use more than the amount recommended by your GP. Dithranol - this has been used for over 50 years in the treatment of plaque psoriasis. It is effective in suppressing the production of skin cells and has no side-effects. However, it is typically only used as a short-term treatment under hospital supervision, as it stains everything it comes into contact with including your skin. It is normally only applied to your skin for five minutes before being washed off to reduce the risk of staining your skin. Dithranol is often used in combination with phototherapy. Tazarotene - this cream contains a chemical similar to Vitamin A - a retnoid - this slows the production of skin cells. It is used in the treatment of moderate plaque psoriasis. The most common side effect is skin irritation. Tazarotene can cause birth defects so it should be strictly avoided during pregnancy or if breastfeeding. It is not recommended for children or teenagers. Coal tar - this is a thick heavy oil and is probably the oldest treatment for psoriasis. How it works is not exactly known, but it reduces scales, inflammation and itchiness. Coal tar does cause staining of clothes and bedding but it has a very strong smell. It is often used in combination with phototherapy. Phototherapy Phototherapy uses natural and artificial light to treat psoriasis. Sunlight - brief, daily exposure to small amounts of sunlight can improve symptoms, but too much sun can cause a worsening of your condition and cause skin damage. Consult with your GP about the safest way to make use of the sun. UVB phototherapy - this uses a wavelength of light that is invisible to human eyes - ultraviolet B light. The light slows down the production of skin cells and is an effective treatment against guttate or plaque psoriasis that has not responded to a tropical procedure. Treatment takes place at a hospital under the supervision of a dermatologist. You will normally need between 10 and 30 sessions. Psoralean plus ultraviolet A (PUVA) - for this treatment, you will first be given a tablet called psoralean. This makes your skin more sensitive to light. Your skin is then exposed to a wavelength of light called ultraviolet A. This light penetrates your skin more deeply than ultraviolet B light. This treatment may be used if you have severe psoriasis that have not responded to other treatment. Common side-effects of the treatment include nausea, headaches, burning and itchiness. Long-term use of this treatment is not encouraged as it can increase your risk of developing skin cancer. Combination light therapy - combining phototherapy with other treatments often increases the effectiveness of phototherapy. Some doctors use UVB phototherapy in combination with coal tar, as the coal tar makes the skin more receptive to light. Combing UVB phototherapy with Dithranol cream has also proved effective. Oral and injected medication You will normally only be prescribed tablets or injections if your psoriasis is severe and is resistant to other treatments. Oral medications can be very effective in treating psoriasis but they all have potentially seriously side-effects - so they are only used for short periods of time. Methotrexate - methotrexate is a medicine that decreases the production of skin cells and suppresses inflammation. It is useful in treating pustular psoriasis, psoriatic erythoderma and extensive plaque psoriasis. It has no short-term side effects, but long term use can cause serious liver damage. People who have previous liver disease should not take methotrexate. You should not drink any alcohol when taking methotrexate. Methotrexate can cause serious birth defects. Women should take adequate contraceptive precautions to avoid falling pregnant during therapy and for three months afterwards. Methotrexate can affect how sperm cells develop, so men should avoid fathering a child during therapy and for three weeks afterwards. Aciterin - aciterin is an oral retnoid that reduces the production of skin cells. It is used to treat severe psoriasis that has not responded to other treatments. It has a wide range of side effects including dryness and cracking of the lips, dryness of the nasal passages, loss of hair, and in rarer cases, hepatitis. Acitretin causes serious birth defects, and women should avoid pregnancy during treatment, and for two years after. Ciclosporin - ciclosporin is an immunosuppressant - a medicine that suppresses your immune systems. It has proved effective in the treatment of all types of psoriasis, but as it stops your immune system from working normally, it can make your more at risk from infection. Ciclosporin also increases your chances of kidney disease and high blood pressure. All of the oral and injected medicines for psoriasis come with both benefits and risks. Before starting a treatment of oral medication, your GP or dermatologist should clearly explain the benefits and risks of the treatment, both verbally and in writing Non-conventional medical approaches include traditional herbal medicine, aromatherapy and others. Lavender oil has a multitude of uses, one of which is in relation to the skin where it is reputed to be calming, soothing, and can help in the treatment of conditions such as acne and eczema. Lavender is reputed to have a generally calming effect which can benefit an eczema sufferer especially when the cause is emotional or stress related. Chamomile Roman essential oil is one of the most helpful oils in the great majority of cases although Melissa is an alternative which suits some people better. Juniper has been used since ancient times and has come to be considered one of the best oils for use in skin conditions. Eczema, dermatitis and psoriasis are amongst these conditions especially if the eczema is weepy. It combines wonderfully with other oils and the addition of Sandalwood with its reputed benefits for dry and dehydrated skin and Cypress which again is widely used in skin care. Juniper, Sandalwood and Cypress all have a woody scent and as such can be used comfortably by both men and women. Bergamot has been reported to be especially good for psoriasis. Also try altering your diet and eating lots of fruit and vegetables. Exclude alcohol and coffee, red meat and all food additives and try to take increased levels of Vitamin C, B and E together with zinc and Evening Primrose oil. |
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