Some say that beauty is only skin deep, but many of us know that appearance speaks a lot especially during a first impression. Many women who have psoriasis say it does not just affect their skin, it also affects their quality of life. According to the National Psoriasis Foundation, it can have a big social and psychological impact on daily life with 60% of sufferers reporting their skin disorder interferes with their ability to enjoy life causing issues such as embarrassment, stress and depression.
Psoriasis is a chronic skin disorder characterized by raised, reddened, round circumscribed plaques covered by silvery white scales. These lesions may be itchy or painful and sometimes will crack and bleed. It is unpredictable and irritating and often occurs on the knees, elbows and scalp and can also affect the upper body, palms and soles of the feet. As with any chronic illness, the skin manifestations may occur and disappear throughout life, with no predictable pattern of recurrence.
“Psoriasis can occur in different forms,” says Pa Lee, BSN, FNP of Catawba Valley Family Medicine – Claremont. “The most common one is plaque psoriasis. This type of psoriasis usually presents with symmetrically distributed cutaneous plaques most commonly found on the scalp, elbows, knees and back. Initially, the lesions are papules that form into a well-designed margin that are raised above the surrounding normal skin. There is usually a thick silvery scale, although recent bathing may remove the scale and lotion moisturizers may make the scale temporarily invisible.”
The plaques can range anywhere from less than one to more than 10cm in diameter. They can be asymptomatic or itchy, painful and irritated enough to crack the skin. The plaques in darker-skinned people may appear purple.
Genes hold instructions for cells dictating how the body looks and control how the body works. Normally, the keratinocyte cells migrate from the innermost skin layer to the outer skin layer in about 14 days and slough off after 14 days. However, with psoriasis, the genes that control the immune system receive a mixed up signal resulting in promotion of inflammation, turning the skins cells on overdrive. Due to the overdrive, the cells have a shorter cycle of growth completing the journey in only four to seven days instead of the typical 14 days. The shorter journey causes the cells to be immature. These immature cells then produce an abnormal keratin that forms thick, flaky scales on the skin’s surface. The increased cell metabolism causes increased vascularity, which contributes to the redness of the lesions.
Risk factors for psoriasis include genes, sunlight, stress, seasonal changes, hormone changes, drugs and infections. About 40% of patients with a family history of psoriasis in first-degree relatives get the disease.
Lee says, “Flare-ups are dependent on the person. What may cause one person to flare-up may not trigger the other person’s flare-ups. Permanent remission of psoriasis is rare. The prognosis depends on the type, extent and severity of the attack. While there is no cure for psoriasis, a variety of medications and treatments may be prescribed.”
Current Psoriasis Treatments
Topical medications may be used to decrease the inflammation and delay psoriasis’ growth journey. Examples of topical medications include steroid creams, tar preparations, anthralin and calcipotriene. Other treatments include photochemotherapy and ultraviolet (UV) light therapy. In photochemotherapy, the drug psoralen is combined with UV A light. This type of treatment causes tanning, and direct sunlight must be avoided for eight to twelve hours afterwards. Photochemotherapy has a high success rate; however, it is used far less often today due to the increased risk of developing skin cancer. UV B lights have been shown to decrease the growth rate of skin cells. UV light therapy is given in gradually increasing exposure times, until there is a subtle redness like a mild sunburn. Treatments are usually given daily and measured in seconds of exposure. Patients receiving UV light therapy are less likely to develop cancer and it is considered almost as effective as photochemotherapy.
Newer treatments for psoriasis are biologic drugs derived from human or animal proteins with the focus on controlling the body’s immune response. Patients often find relief when combining these medications with topical moisturizers or creams applied regularly to prevent dry skin that becomes irritated and itchy. Bathing in lukewarm water with salt, oil, or oatmeal added can also be helpful. Apply sunscreen with SPF of 30 or higher with zinc oxide to areas that do not have psoriasis. Smoking and alcohol consumption have also been shown in studies to aggravate psoriasis.
If you have psoriasis, ask your healthcare provider about the latest treatments and how to manage the emotional stress that accompanies the condition. Pa Lee, BSN, FNP works at Catawba Valley Family Medicine – Claremont at 2890 South Lookout Street in Claremont. For more information, or to schedule an appointment at the practice, please call 828.459.7324.