Psoriasis: Itchy, Dry, and Sometimes Red and Painful

Getting Personal:

My first encounter with psoriasis is with a friend. I remember seeing dead skin flaking off of his scalp and ears, sometimes inflamed and bleeding. I carried the misconception that he just needed to take extra showers. One day, I saw ketoconazole (an anti-fungal) shampoo in his bathroom, and decided to bring up the topic. He informed me that he has psoriasis—I could see the emotional toll weighing in his eyes.

What is Psoriasis (“suh-rye-a-sus”)?

Psoriasis is not infectious, but is an autoimmune condition where the skin cells proliferate and surface quickly, causing a buildup of thickened, scaling skin patches called “plaques”. Usually, it occurs on (but is not limited to) elbows, knees, scalp, back, face, palms, or feet. Symptoms can range from feeling like you have excessive dandruff to lesions spanning the entire body. Roughly 30% of the people with psoriasis will develop psoriatic arthritis.

Psoriasis is usually classified into five types:

• Plaque: these are the buildup of dead skin cells/plaques that are flaky, itchy, and may bleed
• Guttate: these appear as little red dots
• Inverse: occur in places where friction and rubbing is frequent (armpits, etc.); these are red lesions that lack the typical scaly appearance
• Pustular: blistering pus with white blood cells
• Erythrodermic: a serious form of psoriasis that spreads throughout the whole body, it is severe, red, itchy and painful. Skin often slough off in sheets, and are often accompanied with unstable body temperature regulation.

Living with Psoriasis

People with the condition are often in discomfort from the physical symptoms such as itching, possible pain and temperature irregularities. This may lead to extra sick leave from work for doctors’ appointments. In addition, they carry emotional burdens from dealing with symptoms, which can make them prone to depression. People with psoriasis may also have difficulty establishing close relationships, as it may be difficult for others to relate or understand.

What causes Psoriasis?

While the exact cause is still being researched, the general consensus relates psoriasis to an autoimmune reaction of the body’s T lymphocytes (T-cells) to healthy skin cells. Think of T-cells as little body guards against foreign pathogens, and these body guards become overly stimulated and mistake healthy skin cells as pathogens. T-cells then mount an immune response, leading to chronic inflammation. When the inflammation occurs in joints or connective tissues, it could potentially lead to psoriatic arthritis.

What is known, are triggers that aggravate or cause symptoms to flare, such as:

• Cold weather
• Emotional stress
• Infection (for example, Strep throat often leads to guttate psoriasis)
• Smoking or heavy alcohol usage
• Skin injury: also known as the “Koebner phenomenon”, symptoms may flare in some individuals from trauma to skin, such as sunburns, scratches, and vaccinations. This can be treated if caught early
• Certain medications:
  • Lithium (used for treating psychiatric disorders)
  • Antimalarials
  • Inderal (blood-pressure medicine)
  • Quinidine (treats irregular heartbeats and malaria)
  • Indomethacin (anti inflammatory drug used for treating arthritis; other anti-inflammatory drugs may be substituted for treatment, or correcting the dosage)

In addition, at least 10% of the general population have inherited genes which increase their likelihood to developing the condition, and 2-3% of this population manifest the disease. Therefore, psoriasis is likely caused by a combination of environmental triggers and genetic predisposition.

Current Treatments:

There are a variety of treatments ranging from drugs, topical ointments, to holistic care:

• Systemic drugs, or drugs that affect the entire body, including:
  • Biologics, which are IV containing active protein components that serve to reduce inflammation associated with symptoms
  • Immunosuppressive drugs (In fact, psoriasis was first believed to be an autoimmune condition because Cyclosporine, a drug used for immune suppression after kidney transplants, was found to also help with psoriasis symptoms)
  • Synthetic vitamin A, which is believed to help regulate cell growth
• Light therapy to slow cell growth (note: this is not equivalent to tanning beds)
• Topical treatments, mainly designed to soothe symptoms. These mostly contain salicylic acid, coal tar, moisturizers, scale lifters, anti-itch solutions
• Alternative therapy, which involve nutrition, exercise, herbal supplements, and more (note: most evidence is anecdotal)

To summarize…

Psoriasis is a complex disease with more to be discovered. It has emotional, physical, and financial implications. As for my friend, being understanding and supportive while actively educating myself have been and will continue to be the greatest support.

Sources:
https://www.psoriasis.org/
http://www.mayoclinic.org/diseases-conditions/psoriasis/basics/symptoms/con-20030838
http://www.niams.nih.gov/Health_Info/Psoriasis/psoriasis_ff.asp
http://www.nature.com/jid/journal/v130/n5/pdf/jid2009319a.pdf
http://hmg.oxfordjournals.org/content/7/10/1537.full.pdf+html

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