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Psoriasis is a very common skin disorder and affects about one percent of the population. It is a bothersome and chronic inflammatory skin condition. It consists of different size round patches of dry silver-white plaques, which appear thickened with red seen amongst the lesions. Many patients hide it for fear of ridicule. Psoriasis has a genetic basis and is inherited. How well expressed the genes become, as measured by the lesions, is determined by many factors. We know that it is an autoimmune condition in which immune cells called T-lymphocytes release an overabundance of signals, which stimulate a proliferation of skin producing cells. The outer layer of our skin is a dead layer and sloughs off regularly. Believe it or not, it is the main cause of house dust in clean homes. In people with psoriasis, the normal layer of skin turnover growth rate is sped up to at least four times the normal speed, thus it appears thickened. Thickening of the skin in response to adverse environmental conditions may have been a helpful survival strategy at one time.
There are several types of psoriasis. The majority of sufferers are afflicted with the plaque-type, usually on the knees, elbows, scalp and back. Guttate psoriasis is seen in children, and sometimes it is triggered by an infection. It has groups of small and thin plaques. Flexural psoriasis is seen in the armpits, groin creases, and any part of the body where excess skin folds rub. It can be a source of great discomfort for the obese. There is a rare but life-threatening form of psoriasis called "exfoliative psoriasis", which covers over 90% of the body. The normal temperature and hydration control mechanisms of the skin are compromised and can lead to death.
Because psoriasis is a genetic trait, there is no permanent solution. There are triggers that make it worse, such as cold weather. Certain medications, infections and even skin trauma can make it worse. The treatment used to quell the stimulation is varied. In most cases, it is a matter of applying topical agents. Topical steroids are the most common. Coal tars are an excellent treatment choice, but can stain clothing and have an odour. Keratolytics are creams containing lactic or salicylic acid, which pharmacologically soften and remove the excess skin. Emollients are simple creams that help moisturize the skin and soften plaques. Another effective cream is derived from Vitamin D, and is called Calcipotriene.
One of the most effective treatments for psoriasis is sunshine, as Florida snowbirds well know. However, we don't advocate that patients roast in the sun, for fear of skin cancer. Instead, the beneficial ultraviolet rays can be safely applied in an artificial environment. Portable home units are even used by some.
For the resistant cases, potent oral medications are used in a carefully monitored manner. Accutane, Methotrexate and Imuran are some of the potent oral candidates employed. The potency varies greatly amongst topical steroids, a point often ignored by patients. Most family doctors have met with the experience of a patient appearing with an ancient, carefully squeezed out tube of medication, with a barely readable label, asking for a renewal, thinking that a cream is a cream. Potency and side effects can vary by hundred-fold differences. For this reason, it is my feeling that the treatment of severe psoriasis should be performed with the partnership of a dermatologist.
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