Psoriasis: More than skin deep
HCS 245
January 10, 2010

Psoriasis is a noncontagious common skin condition that causes rapid skin cell production resulting in red, dry patches if thickened skin. Although, psoriasis is classified as dermatologic disease, it doesn’t start in the skin, and its damage may be more than skin deep. In fact, the very name is borrowed from an ancient Greek word meaning an itchy or scaley condition. Psoriasis is a chronic condition that strikes both male and female from infancy to the elderly. It can range from mild to severe. Environmental factors play a role; psoriasis has been linked to psychological stress, obesity, smoking, alcohol, strep throat, viral infections, lack of sunlight, and certain medications (antimalarial drugs, lithium, beta blockers, etc.) Psoriasis comes in many forms and about 90% of patients have the plaque type, which is sharply demarcated salmon-pink plaque of inflamed skin covered by silvery scales(July, 2010). Other types of psoriasis include:
• Guttate psoriasis- The second most common form of psoriasis. Gutta means droplet. Patients have numerous small, red, scaley spots scattered on the arms and legs. The trigger to the disease is usually a streptococcal (bacterial) infection. The eruption of the lesions on the skin usually happens about 2-3 weeks after the person has strep throat. The outbreak can go away and not reoccur. Outbreaks may also go away and come back, particularly if the person is a strep carrier (always carries streptococcal bacteria in his respiratory system) (July,2010).
• Erythrodermic psoriasis- It’s a rare but serious form of psoriasis. It is characterized by most (over 80%) of the skin surface becoming covered with redness and inflammation. Erythrodermic psoriasis is an extremely inflammatory type of psoriasis. Most of the skin surface will be continuously scaling - becoming red and hot (erythema) and then shedding. This scaling will usually be accompanied by severe pain, itching, and possibly swelling. Hospitalization is required for this form of psoriasis) (July,2010) .
• Pustular psoriasis- This psoriasis is an uncommon but potentially very serious type of psoriasis. Pustular psoriasis can appear as if there are small boils all over the body. The most common places these pustules appear are the anal and genital area and bends and folds in your skin. Pustules may appear on the face, but this is unusual. Pustules can appear on the tongue, which may make it difficult to swallow. They can also occur under your nails and cause your nails to come off.
Psoriasis is more than skin deep. Psoriasis shows up in the skin and nails, but the immune system abnormalities cause the disease and can damage the internal organs as well. Psoriasis is known to cause other conditions, diseases, and disorders. ) (July,2010).

Up to 25% of patients with psoriasis develop joint inflammation. Psoriatic arthritis can strike small joints of the fingers, in larger joints elsewhere in the body, or the spine. When the spine is affected, the symptoms are stiffness, burning, and pain, most often in the lower spine and sacrum. The cause of psoriatic arthritis is not known, but genes may play a role. In general, people who have psoriasis have a higher rate of arthritis than the general population. New research has established a link between psoriasis and heart attacks. The risk of cardiovascular complications is highest in patients with severe psoriasis that developed at a relatively young age. The association remains valid even after scientists account for risk factors that are common to both psoriasis and heart disease, such as smoking, obesity, and stress. Psoriasis patients are also at high risk for peripheral artery disease and stroke. Researchers believe that inflammation is the thread that ties psoriasis to atherosclerosis) (July,2010) . Like other chronic disease, psoriasis can cause emotional distress and disrupt social interactions and productivity. Physical discomfort and disfigurement combine to make severe psoriasis a disabling disease. Patients with psoriasis have an increased risk of diabetes, high blood pressure, Crohn’s disease and other metabolic syndrome, a dangerous constellation of risk factors involving blood pressure, insulin resistance, obesity, and abnormal blood lipids. Patients who receive aggressive psoriasis therapy may also have a heightened risk of certain cancers. ) (July,2010) Patients with mild cases of therapy may be able to get help from self-treatment with little more than a skin moisturizer, antidandruff shampoo, and some sunlight. Although no treatment will cure psoriasis, many medications can control the disease) (July,2010).
• Topical therapy- These include ointments, gels, and lotions for mild to moderate cases of the disease. Coal tar and anthralin were widely recommended in the past. But since these two treatments stained clothing and skin they have been replaced with topical therapy. Newer topical therapy include two forms of vitamin D and A; both of these are prescription drugs) (July,2010).
• Phototherapy- Doctors use carefully controlled exposure to ultraviolet (UV) radiation to treat moderate to severe psoriasis. UVB can be administered alone or with other combinations of topical agents. UVA is usually reserved for patients with extensive psoriasis that has not improved with other treatment options.
• Systemic therapy- The toughest cases of psoriasis call for the toughest treatments. Oral vitamin A-like drug acitretin, the antimetabolite methotrexate, and the immunosuppressant drusant drug cyclosporine. These different drugs can produce serious side effects and all require careful monitoring by experienced physicians) (July,2010). Managing psoriasis therefore hinges on customizing a very large number of drugs and a great deal of therapeutic strategies to a particular patient with a view to improving his or her quality of life. Such adjustments cannot be successful without training doctors in the techniques of global management and without giving the patient genuine information, allowing him or her to become a full-part facilitator in the struggle against his or her illness.
In the years ahead, medicine would be wise to confine itself to prescribing more and more efficacious and, let us hope, ever better tolerated drugs. Given time, medicine will increasingly be a health training facility, tailored to each patient and allowing all patients, little by little, to set themselves free from the disability represented by their illness.

References (2010, July). Psoriasis: More than skin deep. Harvard Men's Health Watch, 14(12), 4-5.