Tuesday, July 2, 2013
A skin disorder called psoriasis
Types of psoriasis and symptoms
Psoriasis can form skin patches ranging from one to a few spots characterized by dandruff-like scaling, to major eruptions covering large skin areas in severe cases. While psoriasis symptoms may vary among sufferers, they generally include one or a combination of the following:
- Incessant itching that becomes sore or inflamed with scratched;
- Reddened skin patches covered with silvery scales
- Swollen and stiff joints
- Small discolored scaling spots
- Dry and cracked skin that may bleed with the slightest scratch
- Pitted, thickened or ridged nails
There are at least eight major types of psoriasis based on dermatological signs: plaque, inverse, pustular, guttate and erythrodermic, psoriatic arthritis, nail, and scalp psoriasis.
(1) Plaque psoriasis is the most common, characterized by dry, raised, red lesions or plaques topped with silvery scales. Occurring anywhere on your body, including genitals and tissues inside the mouth, the lesions itch, get inflamed or may be painful and in severe cases, the skin adjacent joints may bleed.
(2) Inverse psoriasis is characterized by smooth patches of inflamed reddened skin appearing mainly in the armpits, groin, and skin folds under the breasts and around genitals. It is prevalent among moderate to severely obese people whose skin between skin folds are constantly irritated with friction and sweat.
(3) Pustular psoriasis is relatively uncommon and is characterized by fast developing pus-filled blisters erupting just a few hours after the skin reddens and gets inflamed. The reddened skin may first appear as widespread patches or in limited areas on the hands, feet or fingertips. The blisters dry up eventually in a day or two, but often reappear with some regularity in a matter of days or weeks. Their appearance can also come with severe itching, fatigue, fever, and chills.
(4) Guttate psoriasis mainly affects people below 30 years of ages and is often triggered by bacterial infection like strep throat. The affected skin area is characterized by small, droplet-shaped sores appearing on your arms, legs, trunk, and scalp and are covered with a fine scaly skin, though not as thick as in plaque psoriasis. They can be single outbreaks that eventually goes away without treatment, but may recur repeatedly especially with repeated bouts of infectious respiratory ailments.
(5) Erythrodermic psoriasis is the least common, characterized by red, itchy or burning rashes over the entire body. The condition is often triggered by corticosteroids and other drugs, sunburn or another type of psoriasis that has not been managed.
(6) Psoriatic arthritis is the appearance of inflamed scaly skin and discolored pitted mails associated with swollen painful joints typical of arthritis. If left unmanaged, it could lead to conjunctivitis or other inflammatory eye conditions. The condition may affect any joint with symptoms that range from mild to severe, causing progressive joint damage that could lead to long lasting or permanent deformity.
(7) Nail psoriasis occur on fingernails and toenails, characterized by abnormal nail formation or growth, pitting, and discoloration. In severe cases, psoriatic nails may lead to onycholysis where the nails loosen and fall off from the nail bed.
(8) Scalp psoriasis appears as red, itchy areas with silvery-white scales on the scalp. This condition may initially appear to be dandruff where flakes of dead skin from your scalp fall off on your shoulders after scratching your scalp.
What triggers psoriasis is not fully understood, but is widely considered among medical circles to be an immune-mediated disease caused by the interaction of the body's immune system with the environment in people with genetic predisposition. The body's immune system, particularly the T lymphocyte or T cell roving the body to detect and fight off bacteria and foreign bodies, mistakes and attacks a normal skin cell like a pathogen and sends out erroneous signals to cause overproduction of new skin cells in an effort to fight infection or heal wounds.
More specifically, the overactive T cells trigger immune responses that include dilation of skin blood vessels and an increase in white blood cells that enter the outer dermal layers. These changes lead to increased production of both healthy skin cells and T cells that create an ongoing cycle where new skin cells move to the outer skin faster than dead skin cells can slough off so that the affect areas develops thick, scaly skin patches. The cycle won't end unless some treatment intervenes to halt or slow the process.
Triggers and risk factors
Psoriasis can be triggered, or if you already have one, worsened with the following factors that you be able to avoid:
- Injury to the skin that involves lacerations as well as severe sunburn and bug bites.
- Stress and oxidative stress which are known to affect the immune system;
- Withdrawal of certain medication such as systemic corticosteroid treatment;
- Prolonged cold or freezing weather;
- Heavy alcohol consumption;
- Smoking which not only increases risk of psoriasis but may worsen its severity;
- Use of certain drugs or medications which include anti-hypertensive drugs like beta blockers, bipolar disease medication such as lithium, as well as iodides and anti-malarial drugs;
- Family history of the diseases; some 40% of those afflicted with psoriasis have at least one other family member similarly afflicted which supports the hypothesis that psoriasis has genetic roots;
- Viral and bacterial infections; people diagnosed with HIV have been observed to be more susceptible than those with healthy immune systems while children with recurring infections such as strep throat have increased risk to psoriasis;
- Obesity increases risk of psoriasis in areas adjacent to skin folds where skin surfaces tend to rub each other when moving.
A scourge to a quality life
Psoriasis is a chronic persistent disease so that you could have weeks or months when its symptoms seem to improve or go into remission, then enter a period when it recurs or worsens. Depending on the type, severity and location of psoriasis, it can be just a simple annoyance for some people, but it can be quite disabling for others, both physically and emotionally. Severe cases can adversely affect the quality of home and work life. Pain and itching can interfere with routine self-care, walking, and sleeping. Plaques on hands can prevent you from performing well at certain jobs, sports or taking care of your kids. People with psoriasis often become self-conscious about their appearance, have poor self-esteem, inadequate sex life, and poor social relations, any of which could lead to emotional distress such as depression and social isolation.
Treating psoriasis generally target two objectives: (1) to interrupt the cycle that leads to overproduction of skin cells, thereby slowing or halting plaque formation and skin inflammation, and (2) to remove existing skin scales and smooth the skin. The treatment can be categorized into three methods: topical treatments, light or phototherapy and systemic medications, but they are not exclusive and depending on the severity, may call for a combined use of two or more therapies.
(1) Topical treatments involve the application of creams and ointments that include topical corticosteroids, Vitamin D analogues such as Calcitrol, Calcipotriene and Anthralin, topical Retinoids such as tazarotine, Calcinerium inhibitors, Salicylic acid, and coal tars. Moisturizers may help soothe inflamed skin but will not treat psoriasis.
(2) Light therapy or phototherapy involves artificial UV light or natural sunlight without overdoing it. Controlled UV phototherapy can treat mild to moderate symptoms of psoriasis. Several variations in the treatment include Goeckerman therapy, Photochemotherapy, Excimer laser, and pulsed dye laser therapies.
(3) Systemic medication involves injected or oral medication that includes the administration of Retinoids, Methotrexate, Cyclosporine, Hydroxyurea, thioguanine, and immunomodulator drugs.
Psoriasis is considered a lifelong disease and there is currently no known single treatment that lasts, but the several medical solutions listed above, taken singly or in combination, have shown their efficacies in providing significant relief from its symptoms. Often the best treatment is coping with psoriasis. This can be a challenge, especially when the skin disorder covers large areas of your body or appears in places readily seen in public. But there are coping mechanisms that make it easier for sufferers to deal with the realities of this ailment. Learning about the disease, finding support groups, altering your lifestyle, undergoing the prescribe treatment regularly, and using make-ups to cover the affected skin can go a long way in coping successfully.