Sean Foley, B.Pharm MPSI, MCPP
Chronic disease can affect both skin and joints
Psoriasis can be a very debilitating disease, and affects about 2.5 percent of the population or roughly 7.5 million Americans. You may not suffer from psoriasis, but probably know someone who does. In Florida alone it is estimated that almost 500,000 people suffer from psoriasis. In spite of major advances in medical research and science there is still no effective cure for psoriasis.
What is Psoriasis?
Our skin is the largest single organ of the human body. The palm of your hand represents about one percent of the total skin area of the body. This natural protective barrier contains everything else in your body. Your skin is a living, breathing organism and needs hydration to moisturize it to maximize its barrier capability and remain pliable and healthy.
We shed our skin cells once every month as old cells are replaced by new. This natural process is on autopilot as we go about our daily business. However, in certain circumstances, the causes of which are not understood, the monthly process of skin replacement abnormally accelerates significantly over two or three days and the mature skin cells rise to the surface. Instead of falling off or shedding they pile up under one another and form thick lesions. It’s almost like stacking wet dinner plates on top of each other, making them difficult to separate.
The most common form of psoriasis is manifested by patches of inflamed skin, known as lesions, covered with white silvery scales. This is generally known as plaque psoriasis. These scales can be limited to a few lesions or can cover large areas of the skin, and are uncomfortably itchy and inflamed.
Psoriasis most commonly appears on the elbows, knees, scalp and torso, but it can develop anywhere, including the face, nails, palms, soles of the feet and genital area. Very often lesions appear symmetrically on the left and right side of the body. While psoriasis can develop at any age, it is most common between the ages of 16 and 40. Psoriasis in children is rare, and only a small percentage will get Psoriasis before their 10th birthday. It occurs equally in men and women, may have a genetic origin and is prevalent equally across all socioeconomic/ethnic groups.
If less than 3 percent of the body is affected (that’s 3 times the size of the palm of your hand) the condition is considered to be mild. If between 3-10 percent of the body is affected the psoriasis is considered moderate, and anything above that level is severe. For most people, psoriasis tends to be mild.
Types of Psoriasis
- Plaque Psoriasis (most common).
- Pustular Psoriasis is rare and manifests intense inflamed scaling on the skin and wet weeping lesions.
- Guttatte psoriasis is a form of psoriasis that often starts in childhood or young adulthood, resembles small, red, individual spots on the skin, which commonly appear on the trunk and limbs, but are not usually as thick as plaque lesions.
- Erythrodermic psoriasis is characterized by intense shedding and redness of the skin.
- Inverse psoriasis produces severe inflammation.
- Psoriatic Arthritis is an inflammatory disease causing pain, stiffness and swelling around the joints. It affects up to 30 percent of Psoriasis sufferers.
The most common form of psoriasis is manifested by patches of inflamed skin, known as lesions, covered with white silvery scales. This is generally known as plaque psoriasis.
Causes of Psoriasis
Emotional stress, alcohol, trauma, injury to the skin, some types of infection and reaction to certain drugs may trigger psoriasis. Stress can cause psoriasis to flare up for the first time or aggravate existing psoriasis. Certain medications such as anti-malarial drugs, lithium, and certain beta-blockers have been known to cause flare-ups.
Itching is the most common symptom and usually is caused when certain chemicals stimulate nerve fibers just below the outer layer of the skin. The best way to control itching is to keep the skin moisturized at all times. If the skin is too dry it will induce and aggravate the itch. Other treatments include antihistamines, steroids, capsaicin, topical anesthetics, immunomodulators and aspirin. However, several of these treatments can have nasty side effects, particularly if they contain steroids, which should be avoided, if possible.
Treatment of Psoriasis
There are many treatments for Psoriasis, both topical (on the skin) and systemic (medications). While many of these treatments may give relief, there is still no cure. Many people will try a variety and combination of products to find which works best for them.
Moisturizing and hydrating the skin helps soothe the affected areas and reduce redness and dryness that accompanies the build up of skin on psoriatic plaques. As the mainstay of topical psoriasis therapy, these topical agents help lubricate the affected area and work by reducing scaling, cracking, soreness and itching. Hydrating products can be added to the bath or used directly on the skin.
Medicated creams and ointments, applied directly to the psoriatic plaques, can help reduce inflammation, remove built up scales, reduce skin turnover and clear the plaques. Ointments and creams containing coal tar, steroids, vitamin D analogues and retinoids are commonly used. Medicated creams and ointments can be applied to the skin after washing or on top of moisturizing products. While some people find it difficult to apply creams a number of times each day, those that do are more likely to get relief.
Moisturizing and hydrating products prepare the skin for and render other topical treatments such as coal tar, which can be used as a soap replacement and de-scaling agent, more effective.
Some products have pleasing textures and do not stain clothes. There are many pharmaceutical products available in retail pharmacies and online that lay claims to their effectiveness. Ultimately treatment success will depend on the severity of each person’s condition and identifying which psoriasis agent or combination of agents works most effectively for that individual.
Because psoriasis is very often misunderstood by the public, social interaction can be embarrassing and difficult, and some may experience low self-esteem. If it is visible, psoriasis can even affect the type of work people can do. In some cases, this leads to emotional reactions such as anxiety, anger, embarrassment and depression. Nevertheless, with the appropriate management and a good understanding of the condition, most people with psoriasis can function normally.
Sean Foley, B.Pharm MPSI, MCPP is a graduate of University College Dublin, Ireland. After graduation he served at St. Vincent’s University Hospital in Dublin, Ireland. He is a member of the Pharmaceutical Society of Ireland and The College of Pharmacy Practice. He is the founder of Mushatts, which manufactures and markets a range of psoriasis skin care products in Ireland, Japan and the United States under the Mushatts No. 9 brand. Mushatt’s US operation is located in Brevard County, Florida. For further information go to www.Mushatts.com
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