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.
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.
American Academy of Dermatology. â€œAmerican Academy of Dermatologyâ€™s Psoriasis Public Awareness Campaign Provides Latest Information About this Skin Condition.â€ 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
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.
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 (380â€“315 nm), UVB (315â€“280 nm), and UVC (< 280 nm). Ultraviolet B (UVB) (315â€“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.
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.
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 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 AmeviveÂ®, etanercept (EnbrelÂ®), HumiraÂ®, infliximab (RemicadeÂ®) and Raptiva.
- 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.
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