Few people announce to the world that they have psoriasis. But if you think you're the only one with red, flaky patches of skin, look around the coffee shop or restaurant - chances are, whether or not you see visible signs of it, there are other psoriasis sufferers in your midst.
- What is psoriasis? Psoriasis is an incurable skin disease defined by acceleration of the skin's natural cellular life cycle. Skin cells are born in the deepest layer of our skin, and over the course of their lives they move outward toward the most external layer of skin, where they eventually die and our bodies shed them. The duration of this cellular cycle is typically a month. In contrast, psoriasis causes the skin cell cycle to last only a matter of days.
- The immune response behind psoriasis. At the root of psoriasis is a mysterious response from our immune system. T cells normally fight off unwanted elements like bacteria and viruses in order to prevent infection. But in the body of someone with psoriasis, the T cells also target healthy skin cells. This mistaken activity tells the body that it ought to replace the "bad" cells with new cells, thus leading to the accelerated cell cycle described earlier. Though the T cells' reason for attacking these skin cells isn't clear, scientists believe that some people are genetically predisposed to develop psoriasis.
- What prompts outbreaks? Psoriasis appears and disappears throughout a person's life. Many patients feel that there is no rhyme or reason to the occurrence of a psoriasis outbreak. However, suspected triggers include smoking, stress, the cold season, infection or skin traumas ranging from sunburn to a cut.
- Symptoms. Psoriasis is very common (affecting about three percent of Americans), but ranges in severity from mildly irritating to almost unbearably painful. The acceleration of the cell cycle causes cells to accumulate in thick patches characterized by redness, flakiness and itching. Sometimes the affected skin cracks and bleeds.
The size, appearance and location of these inflamed patches of skin vary from person to person. Some experience nail psoriasis as well, in which nails gain an altered appearance - thicker, sometimes discolored, cracked or pockmarked. Some psoriasis can even affect joints in painful ways akin to arthritis.
- Diagnosis. The symptoms of psoriasis are often difficult to distinguish from other skin diseases like eczema. In order to accurately diagnose psoriasis, schedule an appointment with a dermatologist.
- Treatment. Prescribed treatment depends on a patient's medical history and current condition, age, gender and the severity of the psoriasis. Generally, psoriasis treatment begins with options that cause the least amount of collateral damage, progressing toward more toxic treatment as necessitated by the severity of the psoriasis. The most commonly prescribed treatments are listed here in order of increasing potency and risk to health.
- Topical variety. The mildest form of treatments, topical remedies for psoriasis include corticosteroids (commonly applied twice daily), coal tar, anthralin, retinoid creams and moisturizers. Moisturizers soothe dry, cracking and itchy skin. In addition to these functions, the medicated ointments also aim to reduce the acceleration of the skin cell cycle. These ointments are not without their potential side effects, however. Extended use of corticosteroids, for example, can lead to thinning and/or discoloration of skin.
- UV therapy and photochemotherapy. The power of sunlight to fight psoriasis has been recognized for over a century. However, excessive exposure can lead to outbreaks of psoriasis, not to mention more serious health concerns like melanoma. Doctors often suggest that patients increase their exposure to natural UV (within safe limits, of course), and also prescribe artificial UV treatment focusing on the specific affected areas. Doctors not only prescribe UV treatment to some patients, but also prescribe it in tandem with oral drugs to create a synergistic effect. The result of photochemotherapy is the decreased production of skin cells in the skin experiencing the outbreak of psoriasis. However, since these treatments ultimately can lead to the development of skin cancers, they are generally recommended only for more serious cases of psoriasis or after other, less severe treatment options have been exhausted.
- Pills or injections. When less toxic treatment options do not yield results fighting psoriasis, doctors turn to various other medications to combat the psoriasis. Some, like retinoids, have a history of fighting skin disorders due to their ability to curb the production of skin cells. Immunosuppressant drugs are often used to combat psoriasis because of their ability to inhibit the immune system's mistaken attack on healthy skin cells. Doctors sometimes even rely on drugs whose historical use hasn't been dermatological, but whose application to psoriasis has been successful when other treatments have failed. However, these treatments are the final choice for a reason - toxicity. Blood and liver tests become routine when you rely on these medications.
If you suspect that you may have psoriasis, schedule an appointment with a dermatologist to determine whether or not psoriasis is indeed the cause of your discomfort and visible symptoms. Though the disease is incurable, it is also not life-threatening and successful treatments exist for those who are diagnosed. All of us living with psoriasis should remember that the disease is common. Support networks and online forums allow those with psoriasis to share their experiences and success.