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PSORIASIS

There are several forms of psoriasis, which usually appear as patches of silvery scales on top of areas of crimson skin.  The scales are easily shed or scratched off.  It is a distressing condition, which can lead to a reduced self-esteem.  It should be remembered that everyone needs to shed their skin, unfortunately in psoriatics there is visible shedding. Apart form the visual discomfort the average psoriatic is not troubled by psoriasis but in rare instances it may affect the entire body resulting in internal complications. Psoriasis usually occurs between the ages of 10 and 45 years, although there are exceptions.  It is an inherited condition, which does not necessarily recur in successive generations. 

Causes

Psoriasis is caused by the over production of skin cells.  The development of skin cells to replace those naturally sloughed off occurs at up to seven times the normal replacement rate.  Hence, raised red patches are produced.  These can be covered with scaly, dead skin.  Trigger factors for a psoriasis flare-up include: infection; damage to skin (burns, sunburn and scratching for example) and, certain medications (eg. Anti-malarial, anti-depressant and beta receptor blocking drugs).  Very commonly, stressful events such as death, divorce, examinations and work pressures may precipitate a flare-up.  In women, hormonal changes can affect the condition.  The basic cause of the condition remains unknown and is subject to ongoing research.

 Types and Symptoms

Chronic plaque psoriasis (psoriasis vulgaris) – This is the most common type, appearing on elbows and knees, or sometimes more extensively over the trunk and limbs.

Pustular psoriasis (palms and soles)- Pustules on the soles of the feet and palms of the hand, which go brown and develop scales.  The skin often cracks.  More often seen in middle age.

Flexural psoriasis – This type appears in the armpits, groin and under the breasts.  It is fiery, shiny red, with little or no scaling.

Guttate psoriasis – This is quite common in children and teenagers, often occurring after a streptococcal throat infection.  Lesions appear as small ‘raindrop’ patches.

Psoriasis of the scalp and nails – Scalp psoriasis affects the majority of people who develop the condition.  Scaling occurs, especially around the hairline.  It is often itchy and can sometimes lead to a temporary loss of hair.  Nail involvement is less common.  Nails may show pitting, flaking and ridges.  This can be an early indication of psoriatic arthritis (see section of Psoriatic Arthritis).

The lowering of self-esteem is one of the most profound aspects of psoriasis.  With such an emphasis on appearance is society, the incidence of psoriasis can cause a great deal of distress.  One of the most difficult aspects is its effects on everyday life.  A reduced self-esteem can affect the freedom to sunbathe or swim, visit the hairdresser or try on new clothes in a store and sometimes the choice of career.  Having to cover up in warm weather and feeling unable to pursue the activities of people who are unaffected by the condition, add to the debilitating features of living with psoriasis.

Temperature regulation is affected and people with the condition can feel hot when others feel cold, and vice versa.  Sleep can be difficult.  Itching and soreness can exacerbate the condition, leading to a general feeling of being unwell.

It is important to recognize that psoriasis is a non-contagious condition and cannot be spread by touch to unaffected areas of the skin or to other people.

Treatments

Mild to moderate psoriasis is treated with topical applications containing coal tar, dithranol, or the novel Vitamin A and D derivatives.  Ultra violet light therapy and immunosuppressants are used in more resistant cases. 

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