Psoriasis

Dr. Ringpfeil: " If I had psoriasis I would remove all elements in my immediate environment that contribute to inflammation. Specifically, I would avoid animal protein and fat, as well as highly refined carbohydrates. I would also avoid

1. Smoking
2. Caffeine (Coffee, black tea, chocolate)
3. Alcohol (except an occasional glass of red wine) and
4. Stress (yoga, meditation, bio feedback, exercise are good for dealing with stress)

Reduce animal protein and fat in your diet! "

Overview

Psoriasis is a common disorder of the skin that affects 2-3% of all people in the United States. It is an inflammatory disorder associated with a number of environmental and genetic factors. When you have psoriasis, red patches or plaques form on the skin due an inflammatory process that stimulates accelerated skin production. The surface of the skin often shows a silver or white flaky scale. Psoriasis can affect any area of the body. The most frequent site of psoriasis is the scalp, elbows, knees, groin, penis and cleft of the buttock. Yellow-brown discoloration of the nail with pitting or brittle crumbling is not uncommon. One quarter of people with psoriasis may develop joint pain or arthritis (psoriatic arthritis). Even though all types of psoriasis involve excessive skin turnover, the appearance of the skin may differ depending on the body site or the speed of onset of the flare. Pustular psoriasis shows raised pus filled bumps on a patch of bright red or dusky skin. Psoriasis in skin folds appears as a smooth red patch with only a hint of scale, and plaque psoriasis, which is the most common variant, is the characteristic silver colored, dry, raised patch of skin.

Diagnosis

Most of the time, the diagnosis is simple if the rash of psoriasis is classical and localized to expected areas on the skin. A dermatologist should readily be able to distinguish it from similar rashes by physical examination. Sometimes, a skin sample is sent for microscopic evaluation to aide with the diagnosis, and to rule out other conditions that clinically resemble psoriasis. However, in very uncharacteristic presentations of psoriasis, the diagnosis can be difficult both clinically and under the microscope. In rare circumstances, several skin samples some time apart are needed for confirmation.

Prevention

Stress, obesity, alcohol, trauma and smoking as well certain infections and medications are thought to contribute to psoriatic flares. Once diagnosed with psoriasis you should monitor when outbreaks occur and determine if certain triggers promote them. Behavioral modification such as avoidance of alcohol, cessation of smoking, steady weight loss and stress control measures such as Yoga, meditation or biofeedback may help minimize the extent and duration of flares. Treatment of infections such as streptococcal infection of the throat (strep throat) is beneficial as is the replacement of any medication that has contributed to a psoriatic flare. Even when no triggers are present or when the skin appears entirely healed from a flare, regular skin care is very important when you have psoriasis. Avoid overly drying your skin and use a hydrating cleanser in the shower or at the end of a bath. Moisturize your skin ever day, preferably with a humectant like glycerin, propylene glycol, urea, lactic acid or alpha hydroxy acid. Massaging almond oil into the skin can be very effective for some. Covering the skin in the winter is important to prevent excessive drying or irritation. Suggested humectants: Neutrogena body lotion (glycerin); Cetaphil or Cerave cream (propylene glycol); Ureacin or Carmol 20% lotion or cream (urea); AmLactin 12% cream (lactic acid); Eucerin Plus Cream or Problem Dry Skin Cream by Neostrata (alpha hydroxy acid)

Social impact

Many who suffer from psoriasis experience depression and enormous loss of self esteem because of visible skin involvement. Support groups such as the Nation Psoriasis Foundation (www.psoriasis.org) are of great value for interaction with others who suffer. Sometimes, therapy and even medication must be considered.

Management

Psoriasis is assumed to have a complex genetic basis, and therefore complete elimination of the disease appears impossible at this time. While cure is not yet available, many treatments heal the rash and prevent inflammation. Avoidance of flares through a healthy, balanced lifestyle is most desirable. Covering affected areas with clothing whenever possible will aid in self confidence until a flare is controlled.

Home Treatment

Bath solutions containing tar, Dead Sea or Epsom salt decrease redness and soothe the irritation of an outbreak. Tar shampoos can do the same for the scalp if applied 5-10 minutes before shampooing and tar bath emulsions can even be massaged onto the dry skin. Research has shown that daily exposure to sunlight for short amounts of time helps heal the rash. The UV rays in sunlight can decrease the excessive skin production. Care must be taken to avoid sunburn as this may induce a psoriasis flare or even skin cancer. In addition to the common medications and lotions, many cultures utilize alternative treatments for psoriasis. Increasing the amount of vegetables, especially those rich in Vitamin A, like carrots and sweet potatoes, reducing the amount of pro-inflammatory nutrients by alkalizing the diet, and increasing the amount of exercise have all shown to improve the disease.

Medical Treatment

Topical and systemic treatments are available and are customized to the amount of skin involvement as well as to the area of involvement. The excimer laser is used to deliver a specific wavelength of UVB rays in localized psoriasis. Topical steroids with or without supporting substances that promote normal thickness of the skin are the most commonly used prescriptions in localized disease. Other topical protocols call for steroid-free inhibitors of inflammation or tar preparations. Wide spread disease is best managed by UVB phototherapy treatments, oral medications that regulate normal skin cell turnover (vitamin A related substances) or inhibit an immune response, systemic treatments that inhibit specific molecules responsible for the immune response in inflammation or some oral antibiotics.

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