What are scientist doing to solve the problem of psoriasis?
Psoriasis is an immune-mediated disease , which is abnormal activity of the body's immune system, in which the T-cells behave abnormally this then affects the skin.(1) Psoriasis happens when the skin replacement process speeds up, taking just a few days to replace skin cells that usually take 21-28 days, the skin cells build up , instead of shedding the extra skin cells they form raised areas on the skin, which can be flaky, scaly or red. (2)There is not a fully understood cause of psoriasis, but it is believed to have a genetic component, and is believed to be triggered by stress and/or injury to the skin.(3)It’s also believed that people with psoriasis have an increased risk of cardiovascular disease.
The main solution, have you heard of phototherapy?
Evaluation of reference one: Reference one is a reliable source because it is registered charity, this is updated by medical trustees who are qualified in dermatology. This information is not biased either, this is also because of the fact that it is from a medical point of view so there are only facts stated. This information is up to date too because the charity needs to keep people updated regularly with any new information that may occur.
Evaluation of reference 4: Reference four is a reliable source because it is a national foundation which means lots of people will be viewing what they are saying so they must have their facts correct. Their information is updated regularly through dermatologists who are qualified and work within the medical profession to investigate ways of making psoriasis easier to live with; this shows that is up to date.
Evaluation of reference one: Reference one is a reliable source because it is registered charity, this is updated by medical trustees who are qualified in dermatology. This information is not biased either, this is also because of the fact that it is from a medical point of view so there are only facts stated. This information is up to date too because the charity needs to keep people updated regularly with any new information that may occur.
Evaluation of reference 4: Reference four is a reliable source because it is a national foundation which means lots of people will be viewing what they are saying so they must have their facts correct. Their information is updated regularly through dermatologists who are qualified and work within the medical profession to investigate ways of making psoriasis easier to live with; this shows that is up to date.
Phototherapy involves exposing the skin to ultraviolet light on a regular basis and under medical supervision. The light slows down the production of skin cells , this means it’s an effective treatment for psoriasis. Skin cells are formed through mitosis at the basal layer, cell division is the process by which a parent cell, divides into two or more daughter cells, each daughter cell is genetically identical to the parent cell, mitosis happens in the eukaryotic cells. There are 5 stages in mitosis prophase, prometaphase, metaphase, anaphase and telophase. During mitosis the pairs of chromatids shorten down and attach to fibers that pull the sister chromatids to opposite sides of the cell. The cell then divides in cytokinesis, to produce two identical daughter cells which are still diploid cells, protein keratin is then released. They eventually reach the corneum (outer layer of the epidermis) and slowly the skin falls off. This process is called keratinization and takes place within about 27 days, in psoriasis this process takes up to 3-5 days, and instead of shedding off, the cells pile up on the surface of the skin. Phototherapy involves exposing the skin to an artificial UVB light source for a set length of time on a regular schedule. There are two types broad band and narrow band.(3) The difference between them is that narrow band UVA light bulbs release a smaller range of ultraviolet light. Several studies indicate that narrow-band UVA clears psoriasis faster and produces longer remissions than broad-band UVA. (4) When you are having phototherapy treatment, you will first be given a tablet called psoralens, or psoralen may be applied directly to the skin. (5)Psoralen is a natural product known as furocoumarins, organic chemical compounds produced by a variety of plants. The psoralen is applied first to sensitise the skin, or a tablet is taken, then UVA light is applied to clean up the skin problem. Wavelengths of 311–313 nm are most effective and special lamps have been developed . The exposure time should be controlled to avoid over exposure and burning of the skin. (6)The UVA lamps should have a timer that will turn off the lamp when the time ends. The amount of light used is determined by a person's skin type. Increased rates of cancer from treatment appear to be small.

Does phototherapy work? (source: http://www.daavlin.com/phototherapy-effectiveness/) This graph shows that out of all of the other treatments psoriasis is working better with nearly a 100% rate of success, and the other two bars aren’t far behind the two 100% ones. Phototherapy has more of a success rate than biological drugs, this means that phototherapy is working and is showing a difference. “Some individuals have been afflicted with 125% or more of their psoriasis symptoms” this means that it is proven to work and people are seeing a big difference when using phototherapy (7). This shows that phototherapy works, it remains one of the most safe and effective treatment for psoriasis. It exposes the T-cells, causing them to die, the light therapy reduces inflammation, and slows the rate of skin cell production. This means that it works because if it slows down the production of skin cells, the less they can build up, which means there will be less plaques and inflammation. When safety and cost are considered in addition to effectiveness it is easy to see why phototherapy is the number one choice, it’s one of the most effective and safest ways to get rid of psoriasis.

This also shows phototherapy’s effectiveness and it also shows that it is more effective on women. These two graphs show you how much phototherapy works and how effective it can be in using Ultraviolet radiation to suppress the immune system and block the signal to the T cells. I think seeing the graphs and data that phototherapy does work, I believe that it will give you at least a 75-100% rate of stopping/ preventing psoriasis. It is defiantly the treatment I would most likely have with all the facts and figures it the most effective solution I can see in supervising the immune system sending signals to the T cells to reduce the rapid skin production.

Somebody before phototherapy somebody after phototherapy (source: http://www.natbiocorp.com/psoriasis-phototherapy-research.htm)

Advantages and disadvantages
Advantages and disadvantages of phototherapy. One advantage is it is able to target the lesion, and only the lesion. which means possible damage to surrounding unaffected area of the skin is very low. (8)This also means that if it only affects the lesions and not any other area of the skin then you can have a higher dosage , and fewer treatments. Also the treatment only lasts for a few minutes each time you have treatment. One disadvantage of phototherapy is there is a slight risk of skin cancer. (9)Another disadvantage of phototherapy is that it is normally given three times a week and this means its normally hard to fit into someone’s busy life if they have a full time job. Another advantage of phototherapy is that you can have a home kit which is cheaper and easier to fit into someone’s life. Another advantage is that knowing that the episodes and pain are manageable and that less pain and fewer drugs means better health.(10) And the light is like sunlight, the therapy itself often proven to have a calming effect.

Benefits and risks
A risk is long term exposure to artificial ultraviolet light is likely to increase you’re risk of skin ageing and skin cancer. However,” preliminary studies of the long term risks of UVB have, to date, shown no significant association with skin cancer in patients treated with UVB alone”. Phototherapy can potentially cause skin cancer. It can cause skin cancer because of the intensity and duration over which it may be given, people that are treated are at greater risk to develop cell skin cancers in treated skin.(11) In addition, excessive aging of the skin and a mottled sort of pigmented appearance is likely to occur in the areas treated, so when phototherapy is undergoing doctors take swabs of the skin and keep checking for cancerous cells In the treated area .
Implications of solution?
There is a few implications with phototherapy and using psoralen as drug to help phototerapy, because psoralen makes your skin more sensitive to light, after taking it you need protect your eyes and skin against ultraviolet light, like the sun. Normally tissue is relatively resistant to the effects of ultraviolet light alone, this changes when psoralens are taken and become present in the skin tissue, the most obvious thing is when there is a burning of the skin like sunburn so you have to be careful in the sunlight after phototherapy . If you do burn then the implications of sun burn arise like nausea, exhaustion, headaches, and itching. This could cause social problems as people won’t want to go out with bright red patches over there skin and socialise with people if they think they look horrible , also if the sunburn makes them ill then they might have to have time off work. (Ref5)
Alternative solution 1?
Another treatment is topical agents which include Bath solutions and moisturizers, mineral oil, and petroleum jelly which may help soothe affected skin and reduce the dryness and redness where the skin has plagued . The creams and ointments applied to the plaques can help reduce inflammation, remove built-up skin, reduce the amount of skin produced , and clear affected skin of plaques. Its considered as a long term treatment, and one of the safest treatments for psoriasis, there isn't one topical drug that is best for everyone with psoriasis. The only problem with this is that each ointment becomes less effective over time, so they get rotated or combined together.(12) Keratolytics are often used as they are used to break down excess skin. Keratolytic therapy thins the skin on and around the lesion, causing it to shed away quicker . (13)
Alternative solution 2?
Another treatment is Systemic agents, this is used when skin becomes resistant to phototherapy and topical agents. It is taken by a pill or injection. The three main traditional systemic treatments are methotrexate and cyclosporine. Methotrexate works by slowing down the skin cells that are dividing so rapidly in psoriasis, and also reduces the inflammation.(14) It is often prescribed for moderate plaque psoriasis. If a patient suffers from extreme nausea whilst taking methotrexate, the doctor may split the dose over two days, methotrexate is never taken daily. Methotrexate is an immunosuppressive, meaning when you are taking it you are more at risk of infection .Cyclosporine works as it reduces the activity of the immune system by interfering with the activity and growth of T cells. cyclosporin is an immunosuppressive, meaning those taking it are more at risk of infection, rising of cholesterol and high blood pressure can occur when taking cyclosporine which doctors will monitor. Patients undergoing systemic treatment are required to have regular blood and liver function tests because of the toxicity of the medication.

Phototherapy is appropriate to psoriasis because the therapy in a hospital is carefully controlled in terms of both the dose that is delivered to your skin and the wavelength of the light used. Both of these will be recorded as your treatment is gradually increased. This means you can be given the most effective light treatment in the safest way. Ultraviolet radiation is known to suppress the immune system and reduce inflammatory responses. All your cells have special tags to help your immune system recognise them. Sometimes, the immune system over-reacts. In psoriasis, T cells are put into action by mistake and become so active that they trigger other immune responses, which lead to inflammation and to the rapid production of skin cells which pile up on the surface of the skin, forming raised red scaly plaques. phototherapy is based on trying to correct the faults within the immune system, by trying to control and kill the T cells. It can treat a stubborn patch or widespread psoriasis.

Bibliography
1: The Psoriasis Support Trust (PST)-(2001),organisation set up by Chris peel, with assistance of medical trustees , (1/28/13 updated) resources: about psoriasis http://www.papaa.org/resources/about-psoriasis ( accessed on 30th march 2013) 2: psoriasis written by M. Alan Menter MD, Benjamin Stoff MD (both dermatologists) (2010) published in united kingdom
3: UCDavis department of health system, department of dermatology (23/10/12) Health System : Dermatology: Psoriasis http://www.ucdmc.ucdavis.edu/dermatology/patient_information/psoriasis.html
4: national psoriasis foundation- ( 4/12/12) psoriasis: about psoriasis: treatments: phototherapy (http://www.psoriasis.org/about-psoriasis/treatments/phototherapy (accessed 25 march 2013)
5: yale school of medicine dermatology -(28/11/12) a-z index: dermatology: Services & Specialties: Phototherapy Center at Yale-New Haven Hospital: forms : Psoralen Plus Ultraviolet A (PUVA) Consent (accessed 23 march 2013)
6: Andrews' Diseases of the Skin: Clinical Dermatology, WILLIAM D BERGER, TIMOTHY ELSTON DIRK (2005) published in the USA
7: daavlin- (26/11/12) physicians: phototherapy: effectiveness xhttp://www.daavlin.com/phototherapy-effectiveness/ (accessed 23 march 2013) 8: British journal of dermatology ,written by Dr Tanya O Bleiker volume 168 issue 3 (2013)published in united kingdom 9: fountia -(10/12/12) psoriasis: treatments: light therapy http://www.fountia.com/psoriasis-light-therapy (accessed 24 march 2013) 10: national biological (31/10/12) psoriasis: phototherapy http://www.natbiocorp.com/psoriasis-phototherapy.htm (accessed on 29 march 2013) 11: psoriasis institute (2/12/12) Home: Treatments : Phototherapy : http://psoriasisinstitute.com.au/treatments/phototherapy ( accessed on the 23 march 2013) 12: psoriasis rx (20/10/12) Psoriasis: Treatment : bath solution http://www.psoriasisrx.com/Psoriasis_Treatment.asp (accessed on the 27 march 2013) 13: psoriasis for life (14/11/12) http://treatmentsofpsoriasis.com/bath-solutions-for-psoriasis/ (accessed on the 24 march 2013) 14: national psoriasis foundation- ( 4/12/12) psoriasis: about psoriasis: treatments: systemic agents http://www.psoriasis.org/about-psoriasis/treatments/systemics (accessed on the 23 march 2013) 15: dremnet (12/11/13)psoriasis: systemic therapy http://dermnetnz.org/doctors/scaly-rashes/systemic.html (accessed on the 25march 2013)