Tag: American Academy of Dermatology

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Ailmemts & Remedies

Skin Cancer

basal cell carcinoma removal scar
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Definition:
Skin cancer is the uncontrolled growth of abnormal skin cells. If left unchecked, these cancer cells can spread from the skin into other tissues and organs.It is a malignant growth on the skin which can have many causes. Skin cancer generally develops in the epidermis (the outermost layer of skin), so a tumor is usually clearly visible. This makes most skin cancers detectable in the early stages. There are three common types of skin cancer, each of which is named after the type of skin cell from which it arises. Cancers caused by UV exposure may be prevented by avoiding exposure to sunlight or other UV sources, and wearing sun-protective clothes. The use of sunscreen is recommended by medical organizations as a measure that helps to protect against skin cancer (see sunscreen).

Unlike many other cancers, including those originating in the lung, pancreas, and stomach, only a small minority of those afflicted will actually die of the disease.[citation needed] Skin cancers are the fastest growing type of cancer in the United States. Skin cancer represents the most commonly diagnosed malignancy, surpassing lung, breast, colorectal and prostate cancer. Melanoma is the least common skin cancer but it is potentially the most serious: there are over 8,000 new cases each year in the UK and 1,800 deaths. More people now die of Melanoma in the UK than in Australia. It is the second most common cancer in the young population (20 – 39 age group). It is estimated that approximately 85% of cases are caused by too much sun. Non-melanoma skin cancers are the commonest skin cancers. The majority of these are called Basal Cell Carcinomas. These are usually localised growths caused by excessive cumulative exposure to the sun and do not tend to spread.

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Types:-
There are different types of skin cancer. Basal cell carcinoma is the most common. Melanoma is less common, but more dangerous.

More rare types of skin cancer include:
*Dermatofibrosarcoma protuberans
*Merkel cell carcinoma
*Kaposi’s sarcoma

The BCC and the SCC often carry a UV-signature mutation indicating that these cancers are caused by UV-B radiation via the direct DNA damage. However the malignant melanoma is predominantly caused by UV-A radiation via the indirect DNA damage.[citation needed] The indirect DNA damage is caused by free radicals and reactive oxygen species. It has been shown, that the absorption of three sunscreen ingredients into the skin, combined with a 60-minute exposure to UV, leads to an increase of free radicals in the skin.

Skin cancer as a group:-
Many laymen and even professionals consider the basal cell carcinoma (BCC), the squamous cell carcinoma (SCC) and the malignant melanoma as one group – namely skin cancer. This grouping is problematic for two reasons:

*the mechanism that generates the first two forms is different from the mechanism that generates the melanoma. The direct DNA damage is responsible for BCC and SCC while the indirect DNA damage causes melanoma.

*the mortality rate of BCC and SCC is around 0.3 causing 2000 deaths per year in the US. In comparison the mortality rate of melanoma is 15-20% and it causes 138001 deaths per year.

Even though it is rare, malignant melanoma is responsible for 75 % of all skin cancer related death cases.

While sunscreen has been shown to protect against BCC and SCC it may not protect against malignant melanoma. When sunscreen penetrates into the skin it generates reactive chemicals. It has been found that sunscreen use is correlated with malignant melanoma. The lab-experiments and the epidemiological studies indicate that sunscreen use causes melanoma.

Causes:
The outer layer of skin, the epidermis, is made up of different types of cells. Skin cancers are classified by the types of epidermal cells involved:

Basal cell carcinoma develops from abnormal growth of the cells in the lowest layer of the epidermis and is the most common type of skin cancer.
Squamous cell carcinoma involves changes in the squamous cells, found in the middle layer of the epidermis.
Melanoma occurs in the melanocytes (cells that produce pigment) and is less common than squamous or basal cell carcinoma, but more dangerous. It is the leading cause of death from skin disease.
Skin cancers are sometimes classified as either melanoma or nonmelanoma. Basal cell carcinoma and squamous cell carcinoma are the most common nonmelanoma skin cancers. Other nonmelanoma skin cancers are Kaposi’s sarcoma, Merkel cell carcinoma, and cutaneous lymphoma.

Skin cancer is the most common form of cancer in the Unites States. Known risk factors for skin cancer include the following:

*Complexion: Skin cancers are more common in people with light-colored skin, hair, and eyes.
*Genetics: Having a family history of melanoma increases the risk of developing this cancer.
*Age: Nonmelanoma skin cancers are more common after age 40.
*Sun exposure and sunburn: Most skin cancers occur on areas of the skin that are regularly exposed to sunlight or other

*ultraviolet radiation. This is considered the primary cause of all skin cancers.

Skin cancer can develop in anyone, not only people with these risk factors. Young, healthy people — even those with with dark skin, hair, and eyes — can develop skin cancer.

Symptoms:
Skin cancers may have many different appearances. They can be small, shiny, waxy, scaly and rough, firm and red, crusty or bleeding, or have other features. Therefore, anything suspicious should be looked at by a physician. See the articles on specific skin cancers for more information.

Here are some features to look for:

*Asymmetry: one half of the abnormal skin area is different than the other half
*Borders: irregular borders
*Color: varies from one area to another with shades of tan, brown, or black (sometimes white, red, blue)
*Diameter: usually (but not always) larger than 6 mm in size (diameter of a pencil eraser)

Any skin growth that bleeds or will not heal
Use a mirror or have someone help you look on your back, shoulders, and other hard-to-see areas.

Risk factors:-
Skin cancer is most closely associated with chronic inflammation of the skin. This includes:

1.Overexposure to UV-radiation can cause skin cancer either via the direct DNA damage or via the indirect DNA damage mechanism. UVA & UVB have both been implicated in causing DNA damage resulting in cancer. Sun exposure between 10AM and 4PM is most intense and therefore most harmful. Natural (sun) & artificial UV exposure (tanning salons) are associated with skin cancer.[citation needed] Since sunbeds cause mostly indirect DNA damage (free radicals) their use is associated with the deadliest form of skin cancer, malignant melanoma.

2.UVA rays affect the skin at a deeper level than UVB rays, reaching through the epidermis and the dermis to the hypodermis where connective tissues and blood vessels are located. UVA activates the melanin of the epidermis causing changes in pigmentation as well as loss of elasticity of the skin, which contributes to premature wrinkling, sagging and aging of the skin.

3.UVB rays primarily affect the epidermis causing sunburns, redness, and blistering of the skin. The melanin of the epidermis is activated with UVB just as with UVA; however, the effects are longer lasting with pigmentation continuing over 24 hours.
Chronic non-healing wounds, especially burns. These are called Marjolin’s ulcers based on their appearance, and can develop into squamous cell carcinoma.

4.Genetic predisposition, including “Congenital Melanocytic Nevi Syndrome”. CMNS is characterized by the presence of “nevi” or moles of varying size that either appear at or within 6 months of birth. Nevi larger than 20 mm (3/4″) in size are at higher risk for becoming cancerous.

5.Skin cancer is one of the potential dangers of ultraviolet germicidal irradiation.
Skin can be protected by avoiding sunlight entirely, or wearing protective clothing while outdoors. Skin cancer is usually caused by exposing skin to UV rays excessively.

Treatment:-
Most skin cancers can be treated by removal of the lesion, making sure that the edges (margins) are free of the tumor cells. These excisions provide the best cure for both early and high-risk disease.

For low-risk disease, radiation therapy and cryotherapy (freezing the cancer off) can provide adequate control of the disease; both, however, have lower overall cure rates than surgery.

Mohs’ micrographic surgery is a technique used to remove the cancer with the least amount of surrounding tissue and the edges are checked immediately to see if tumor is found. This provides the opportunity to remove the least amount of tissue and provide the best cosmetically favorable results. This is especially important for areas where excess skin is limited, such as the face. Cure rates are equivalent to wide excision. Special training is required to perform this technique.

In the case of disease that has spread (metastasized), further surgical procedures or chemotherapy may be required.

Scientists have recently been conducting experiments on what they have termed “immune- priming”. This therapy is still in its infancy but has been shown to effectively attack foreign threats like viruses and also latch onto and attack skin cancers. More recently researchers have focused their efforts on strengthening the body’s own naturally produced “helper T cells” that identify and lock onto cancer cells and help guide the killer cells to the cancer. Researchers infused patients with roughly 5 billion of the helper T cells without any harsh drugs or chemotherapy. This type of treatment if shown to be effective has no side effects and could change the way cancer patients are treated.

You may click to see Best herbs for skin.

Prognosis:-
The outlook depends on a number of factors, including the type of cancer and how quickly it was diagnosed. Basal cell carcinoma and squamous cell carcinoma rarely spread to other parts of the body. However, melanoma is more likely to spread. See the specific skin cancer articles for additional information.

Prevention :-
Minimizing sun exposure is the best way to prevent skin damage, including many types of skin cancer:

*Protect your skin from the sun when you can — wear protective clothing such as hats, long-sleeved shirts, long skirts, or pants.
*Try to avoid exposure during midday, when the sun is most intense.
*Use sunscreen with an SPF of at least 15. Apply sunscreen at least one-half hour before sun exposure, and reapply frequently.
*Apply sunscreen during winter months as well.
*Reapply sun block every 2 hours and after swimming

Although it is generally accepted that UV exposure is the greatest risk factor in melanoma development, some sceptics say that there is no proven data that links moderate sun exposure with the appearance of melanoma.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/001442.htm
http://en.wikipedia.org/wiki/Skin_cancer

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WHY CORNER

Why do Fingernails Grow Faster than Toenails?

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Dermatologists confirm that the rate of fingernail growth outstrips that of toenails, with the former lengthening anywhere from slightly faster to perhaps three times as fast. The American Academy of Dermatology puts the average rate of fingernail growth at about 0.1mm a day.

Click to see the pictures..>....(01).....(1)……...(2)…….(3)

The reason for the difference is uncertain but speculation is it is because of blood circulation which is better in the hands than in the feet. According to biopsy reports, the further down in the leg, the slower things are to heal, with an even slower cell turnover rate as you go further down to the toes.

Fingernail cells are formed in the matrix, under the cuticle, and are gradually extruded, dying, hardening and becoming mashed together as they are pushed out by the new cells. The root of the fingernail produces most of the volume of the nail and the nail bed beneath it. The bed contains the blood vessels, nerves and melanocyte cells responsible for skin colour. As the nail is produced by the root, it streams down along the nail bed, making it thicker. Nail growth is also affected by hormones, age, climate and time of year. Hair seems to grow a little faster in summer and the same is true for nails.

Sources: The Telegraph ( Kolkata, India)

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Ailmemts & Remedies

Bowen’s Disease

Definition:
Bowen’s disease (BD) is a sunlight-induced skin disease, considered either as an early stage or intraepidermal form of squamous cell carcinoma. It was named after Dr John T. Bowen, the doctor who first described it in 1912.

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Bowen’s disease is also called squamous cell carcinoma in situ (SCC in situ), is a form of skin cancer. The term “in situ” added on the end tells us that this is a surface form of skin cancer. “Invasive” squamous cell carcinomas are the type that grow inward and may spread. SCC in situ is also known as Bowen’s disease after the doctor who first described it almost 100 years ago.

Causes
Causes of BD include solar damage, arsenic, immunosuppression (including AIDS), viral infection (human papillomavirus or HPV) and chronic skin injury and dermatoses.

Like other forms of skin cancer, SCC in situ is mainly caused by chronic sun exposure and aging. There are two other less important causes which are unique to SCC in situ. The wart virus that causes cervical cancer (HPV 16) is often found to be infecting SCC in situ. It is thought that infection with this virus is one of the reasons why two people may have the same amount of sun damage, but only one keeps getting skin cancers. The other factor that causes SCC in situ is arsenic, the same poison made famous by the play “Arsenic and Old Lace” and the Russian villain Rasputin. Arsenic contaminated some old water wells, and also many years ago was used in some medical elixirs. People with mild Arsenic poisoning didn’t die, but tend to develop cancers, both of the skin and internally. For a time it was thought that SCC in situ was a sign that cancer was going to develop internally, until it was discovered that was a false impression caused by arsenic poisoning.

Signs and symptoms:
Bowen’s disease typically presents as a gradually enlarging, well demarcated erythematous plaque with an irregular border and surface crusting or scaling. BD may occur at any age in adults but is rare before the age of 30 years – most patients are aged over 60. Any site may be affected, although involvement of palms or soles is uncommon. BD occurs predominantly in women (70-85% of cases); about three-quarters of patients have lesions on the lower leg (60-85%), usually in previously or presently sun-exposed areas of skin. A persistent progressive non-elevated red scaly or crusted plaque which is due to an intradermal carcinoma and is potentially malignant. Atypical squamous (resembling fish scales) cells proliferate through the whole thickness of the epidermis. The lesions may occur anywhere on the skin surface or on mucosal surfaces. The cause most frequently found is trivalent arsenic compounds. Freezing, cauterization or diathermy coagulation is often effective treatment.

SCC in situ is usually a red, scaly patch. It tends to be seen on areas frequently exposed to the sun. Some itch, crust or ooze, but most have no particular feeling. SCC in situ may be mistaken for rashes, eczema, fungus or psoriasis. Sometimes they are brown and look like a keratosis or a melanoma. Because of this, a biopsy must usually be done to confirm the diagnosis.

Treatment:
Photodynamic therapy (PDT), Cryotherapy (freezing) or local chemotherapy (with 5-fluorouracil) are favored by some clinicians over excision. Because the cells of Bowen’s disease have not invaded the dermis, it has a much better prognosis than invasive squamous cell carcinoma.

The simplest and most common treatment for smaller SCC in situ is surgical excision. The standard practice is to remove about a quarter inch beyond the edge of the cancer. Larger ones can also be excised, but Mohs surgery may be needed. It offers the highest cure rate of all treatment methods.

For those not up to surgery, there are some choices. SCC in situ can be burned off by several methods. These are “curettage and electrodessication”, liquid nitrogen cryotherapy and laser destruction. These heal with similar scars.

X-ray or grenz ray radiation can be given to poor surgical candidates or patients with multiple sites. This is very expensive and requires multiple visits to the hospital. Efudex Cream applied for 1 to 3 months will often work, but leaves an uncomfortable raw area during that time. Aldara cream can also be used to treat Bowen’s, with a two to three month treatment period required.

The latest treatment approved by the FDA but not yet in common use, is photodynamic therapy (PDT). PDT is an alternative way to “burn off” SCC in situ using a drug that is absorbed only by cancer cells. A bright light is then applies causing the release of toxins and destruction of the tumor.

If you have had an SCC in situ, you have a higher risk of other skin cancers. For this reason, you will need a regular skin exam by a dermatologist. Untreated, SCC in situ grows larger over time and may spread out to be several inches. 5% of SCC in situ will eventually develop into invasive squamous cell carcinoma if not treated.

The dermatologist based on his experience, expertise and analysis of your personal situation is the one best equipped to decide your personal treatment plan.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.aocd.org/skin/dermatologic_diseases/bowens_disease.html
http://en.wikipedia.org/wiki/Bowen%27s_disease

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Healthy Tips

Aging

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Many people live well into their 80s — and beyond. As the body ages, however, various systems slow down, and the risk of disease increases. Even though you can’t stop time, you can forestall some of the negative effects of aging with a healthy lifestyle and well-chosen supplements.

Symptoms:
Slowing of cognitive processes: difficulty accessing memory and learning and remembering new people and events.
Sensory decline: delay in refocusing eyes and impaired ability to hear high-pitched sounds.
Weakened immune system: increased susceptibility to colds, the flu, and other illnesses.
Decline in muscle and bone mass.
Increased risk of developing heart disease and cancer.

When You Call Your Doctor: :
You need a complete physical every year after age 50. See your doctor right away, however, if you are concerned about the risk of age-related diseases.
Reminder: If you have a medical condition, talk to your doctor before taking supplements.

What It Is:
Put simply, aging is the process of growing old. Every part of the body is affected: Among other changes, hair turns gray, skin wrinkles, joints and muscles lose flexibility, bones become weak, memory declines, eyesight diminishes, and immunity is impaired.

What Causes It:
Cells in the body divide a set number of times; then they die and are replaced by new cells. With age, this process slows, and a progressive deterioration of all body systems begins. Though some of this decline is normal and inevitable, many researchers believe that unstable oxygen molecules called free radicals accelerate the process, making us old before our time. Some damage is unavoidable because free radicals are produced during the normal course of cell activity. But you may be able to slow aging by avoiding outside factors that foster free-radical formation — cigarette smoke, pollution, excessive alcohol, and radiation from X rays or the sun — and by enhancing your body’s own antioxidant defenses. Manufactured by the cells and obtained through diet, antioxidants are powerful weapons that can disarm free radicals.

How Supplements Can Help:
Some supplements should be used daily by everyone concerned about the effects of aging. Vitamin C and vitamin E are antioxidants that fight free radicals. Vitamin C and flavonoids work within the cell’s watery interior. Vitamin E protects the fatty membranes that surround cells; in addition, it improves immune function in older people and reduces the risk of some age-related conditions, including heart disease, some forms of cancer, and possibly Alzheimer’s. In a recent study from the National Institute on Aging, people who took vitamin E supplements were about half as likely to die of heart disease — the nation’s leading killer — as those not using vitamin E.
Green tea extract, long prized for its longevity-promoting properties, and grape seed extract (100 mg twice a day) are other antioxidants that may be more potent than vitamins C and E.

Folic acid, a B vitamin, maintains red blood cells and promotes the healthy functioning of nerves. Moreover, it protects the heart by helping the body process homocysteine, an amino acid-like compound that may raise the risk of heart disease. Folic acid is assisted by vitamin B12, which fosters healthy brain functioning. Taking this vitamin is important because many older people lose the ability to absorb it from food, and low B12 levels can cause nerve damage and dementia. The amino acid-like substance carnitine contributes to a healthy heart because it helps transport oxygen to the cells and produces energy. Evening primrose oil contains gamma-linolenic acid (GLA), which is essential to a number of body processes. As it ages, the body loses its ability to convert the fats present in foods to GLA.

In addition, certain supplements are vital to specific concerns. Glucosamine helps maintain joint cartilage and eases the pain of arthritis. Because it enhances blood flow, the herb ginkgo biloba may improve such age-related conditions as dizziness, impotence, and memory loss.

What Else You Can Do:
Protect yourself from excessive sun. Ultraviolet rays make skin age faster.
If you smoke, quit. Smoking speeds bone and lung deterioration.
Build and maintain bone and muscle mass with weight-bearing exercise, such as walking and weight training.
Eat a variety of fruits and vegetables — they’re rich in antioxidants.
Although more research is needed, some experts recommend people over age 50 take a coenzyme Q10 supplement to minimize the effects of aging. This substance helps transport energy throughout the body and acts as an antioxidant, but the body’s own production declines with age. If you want to add coenzyme Q10 to your regimen, take 50 mg twice a day (food enhances its absorption).

Supplement Recommendations:

Vitamin C/Flavonoids:
Dosage: 1,000 mg vitamin C and 500 mg flavonoids twice a day.
Comments: Reduce vitamin C dose if diarrhea develops.

Vitamin E
Dosage: 400 IU a day.
Comments: Check with your doctor if taking anticoagulant drugs.

Green Tea Extract
Dosage: 250 mg twice a day.
Comments: Standardized to contain at least 50% polyphenols.

Folic Acid/Vitamin B12
Dosage: 400 mcg folic acid and 1,000 mcg vitamin B12 once a day.
Comments: Take sublingual form for best absorption.

Carnitine
Dosage: 500 mg L-carnitine twice a day.
Comments: If using longer than 1 month, add mixed amino acids.

Evening Primrose Oil
Dosage: 1,000 mg 3 times a day.
Comments: Can substitute 1,000 mg borage oil once a day.

Glucosamine
Dosage: 500 mg glucosamine sulfate twice a day.
Comments: Increase to 3 times a day if you have osteoarthritis. Take with food to minimize digestive upset.

Ginkgo Biloba
Dosage: 40 mg 3 times a day.
Comments: Standardized to have at least 24% flavone glycosides.

This site may give you  little more knowledge about defending yourself from Aging.

Source:    Reader’s Digest

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Ailmemts & Remedies

Psoriasis

Psoriasis is a disease/disorder, where angry red lesions on the skin , multiply, and scale over with silvery patches, Of course this is an over simplification.

But Psoriasis is non contagious, Usually inherited. It is an Autoimmune disorder and very rarely life threatening.

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The word Psoriasis has come from ancient Greece and it means itch. Red eruptions appear on the surface of the skin and begin to eatch.These areas form plaques over the reddendend lesions. The plaques resemble multi-layered scales of skin. Psoriasis varies in intensity from a few random spots to a massive outbreak sometimes covering the entire body and requiring hospitalization too.

Psoriasis has a tendency to be genetically inherited.Recently it has been classified as being an autoimmune disorder.This disorder can originate in juveniles or not be evident until adulthood.It has been reported to initiate as early as birth or not occur until very late in life.Once Psoriasis begins, there are only remissions and replaces of varying degree of intesity..There is no known cure yet,only possible control over the severity.

Psoriasis reacts.It has triggers(such as systematic step infection) which can cause the body to go from mild to severe case within days.There are also other factors,such as sunlight,which may help to decrease the severity.

Psoriasis occurs in 2% of the total population.It can be mildly annoying problem or can destroy the self-esteem and life of the victim.Although it is not at al contagious, it definitely an ugly disease that can alenate coworkers and acquitances.

Arthritis can sometimes stem from psoriasis, attacking the joint spaces,giving the victim another disease to deal with.This disease can be consuming.The ugliness of the patches,the chronic eatching and flaking(although not life threatening) impact the self-esteem and life style of the victim.Time and money are spent to keep it under control.

Treatment Advances Improve Outlook
With the emergence of several new therapies, including the biologic agents, more people are experiencing substantial improvements and reporting a greatly improved quality of life.

References:
American Academy of Dermatology. “American Academy of Dermatology’s Psoriasis Public Awareness Campaign Provides Latest Information About this Skin Condition.” Available at: http://www.newswire1.net/NW2004/C_AAD_CH/111504/index.html. Accessed April 26, 2005. American Academy of Dermatology. Psoriasis. Available at: http://www.aad.org/public/Publications/pamphlets/Psoriasis.htm. Accessed April 26, 2005

Topical treatment

Bath solutions and moisturizers help sooth affected skin and reduce the dryness which accompanies the build-up of skin on psoriasis plaques. Medicated creams and ointments applied directly onto psoriasis plaques can help reduce inflammation, remove built-up scale, reduce skin turn over, and clear affected skin of plaques. Ointment and creams containing coal tar, anthralin, corticosteroids, vitamin D3 analogues (for example, calcipotriol), and retinoids are routinely used. The mechanism of action of each is probably different but they all help to normalise skin cell production and reduce inflammation.

The disadvantages of topical agents are variabily that they can often irritate normal skin, can be awkward to apply, cannot be used for long periods, can stain clothing or have a strong odour. As a result, it is sometimes difficult for people to maintain the regular application of these medications. Abrupt withdrawal of some topical agents, particularly corticosteroids, can cause an aggressive recurrence of the condition. This is known as a rebound of the condition.

Some topical agents are used in conjunction with other therapies, especially phototherapy.

Phototherapy

It has long been recognised that daily, short, nonburning exposure to sunlight helped to clear or improve psoriasis. Niels Finsen was the first physician to investigate the theraputic effects of sunlight scientifically and to use sunlight in clinical practice. This became known as phototherapy.

Sunlight contains many different wavelengths of light. It was during the early part of the 20th century that it was recognised that for psoriasis the therapeutic property of sunlight was due to the wavelengths classified as ultraviolet (UV) light.

Ultraviolet wavelengths are subdivided into UVA (380–315 nm), UVB (315–280 nm), and UVC (< 280 nm). Ultraviolet B (UVB) (315–280 nm) is absorbed by the epidermis and has a beneficial effect on psoriasis. Narrowband UVB (311 to 312 nm), is that part of the UVB spectrum that is most helpful for psoriasis. Exposure to UVB several times per week, over several weeks can help people attain a remission from psoriasis.

Ultraviolet light treatment is frequently combined with topical (coal tar, calcipotriol) or systemic treatment (retinoids) as there is a synergy in their combination. The Ingram regime, involves UVB and the application of anthralin paste. The Goeckerman regime, combines coal tar ointment with UVB.

A form of phototherapy called Grenz Rays (also called ultrasoft X-rays or Bucky rays) was a popular treatment of psoriasis during the middle of the 20th century. This type of therapy was superseded by ultraviolet therapy and is no longer commonly used.

Photochemotherapy

Psoralen and ultraviolet A phototherapy (PUVA) combines the oral or topical administration of psoralen with exposure to ultraviolet A (UVA) light. Precisely how PUVA works is not known. The mechanism of action probably involves activation of psoralen by UVA light which inhibits the abnormally rapid production of the cells in psoriatic skin. There are multiple mechanisms of action associated with PUVA, including effects on the skin immune system.

Dark glasses must be worn during PUVA treatment because there is a risk of cataracts developing from exposure to sunlight. PUVA is associated with nausea, headache, fatigue, burning, and itching. Long-term treatment is associated with squamous-cell and melanoma skin cancers.

Systemic treatment

Psoriasis which is resistant to topical treatment and phototherapy is treated by medications that are taken internally by pill or injection. This is called systemic treatment. Patients undergoing systemic treatment are required to have regular blood and liver function tests because of the toxicity of the medication. Pregnancy must be avoided for the majority of these treatments. Most people experience a recurrence of psoriasis after systemic treatment is discontinued.

The three main traditional systemic treatments are the immunosupressant drugs methotrexate and ciclosporin, and retinoids, which are a synthetic forms of vitamin A. Other additional drugs, not specifically licensed for psoriasis, have been found to be effective. These include the antimetabolite tioguanine, the cytotoxic agent hydroxyurea, sulfasalazine, the immunosupressants mycophenolate mofetil, azathioprine and oral tacrolimus. These have all been used effectively to treat psoriasis when other treatments have failed. Although not licensed in many other countries fumaric acid esters have also been used to treat severe psoriasis in Germany for over 20 years.

Biologics[4] are the newest class of systemic treatment for psoriasis. These are manufactured proteins that interrupt the immune process involved in psoriasis. Unlike generalised immunosuppressant therapies such as methotrexate, biologics focus on specific aspects of the immune function leading to psoriasis. These drugs are relatively new, and their long-term impact on immune function is unknown. Examples include Amevive®, etanercept (Enbrel®), Humira®, infliximab (Remicade®) and Raptiva.

Alternative Therapy

  • Antibiotics are not indicated in routine treatment of psoriasis. However, antibiotics may be employed when an infection, such as that caused by the bacteria Streptococcus, triggers an outbreak of psoriasis, as in certain cases of guttate psoriasis.
  • Climatotherapy involves the notion that some diseases can be successfully treated by living in particular climate. Several psoriasis clinics are located throughout the world based on this idea. The Dead Sea is one of the most popular locations for this type of treatment.
  • In Turkey, doctor fish which live in the outdoor pools of spas, are encouraged to feed on the psoriatic skin of people with psoriasis. The fish only consume the affected areas of the skin. The outdoor location of the spa may also have a beneficial effect. This treatment can provide temporary relief of symptoms. A revisit to the spas every few months is often required.
  • Some people subscribe to the view that psoriasis can be effectively managed through a healthy lifestyle. This view is based on anecdote, and has not been subjected to formal scientific evaluation. Nevertheless, some people report that minimizing stress and consuming a healthy diet, combined with rest, sunshine and swimming in saltwater keep lesions to a minimum. This type of “lifestyle” treatment is suggested as a long-term management strategy, rather than an initial treatment of severe psoriasis.
  • Some psoriasis patients use herbology as a holistic approach that aims to treat the underlying causes of psoriasis.
  • A psychological symptom management programme has been reported as being a helpful adjunct to traditional therapies in the management of psoriasis.
  • It is possible that Epsom salt may have a positive effect in reducing the effects of psoriasis.

Future Drug Development

Historically, agents used to treat psoriasis were discovered by experimentation or by accident. In contrast, current novel therapeutic agents are designed from a better understanding of the immune processes involved in psoriasis and by the specific targeting of molecular mediators. Examples can be seen in the use of biologics which target T cells and TNF inhibitors. Future innovation should see the creation of additional drugs that refine the targeting of immune-mediators further.

Research into antisense oligonucleotides is in its infancy but carries the potential to provide novel theraputic strategies for treating psoriasis.

Prognosis

Psoriasis is a chronic lifelong condition. There is currently no cure but various treatments can help to control the symptoms. Many of the most effective agents used to treat severe psoriasis carry an increased risk of significant morbidity including skin cancers, lymphoma and liver disease. However, the majority of people’s experience of psoriasis is that of minor localised patches, particularly on the elbows and knees, which can be treated with topical medication. Psoriasis does get worse over time but it is not possible to predict who will go on to develop extensive psoriasis or those in whom the disease may appear to vanish. Individuals will often experience flares and remissions throughout their life. Controlling the signs and symptoms typically requires lifelong therapy.

“The heartbreak of psoriasis”

The phrase “the heartbreak of psoriasis” is often used both seriously and ironically to describe the emotional impact of the disease. It can be found in various advertisements for topical and other treatments; conversely, it has been used to mock the tendency of advertisers to exaggerate (or even fabricate) aspects of a malady for financial gain. (In Bloom County, the character of Opus once considered the possibility of his suffering from “the heartbreak of nose hemorrhoids.”) While many products today use the phrase in their advertising, it originated in a 1960s advertising campaign for Tegrin, a coal tar-based medicated soap.

Partly extracted from: http://en.wikipedia.org/wiki/Psoriasis

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