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Psoriasis is a common skin disease that affects the life cycle of skin cells. Psoriasis causes cells to build up rapidly on the surface of the skin, forming thick silvery scales and itchy, dry, red patches that are sometimes painful.
Psoriasis is a persistent, long-lasting (chronic) disease. You may have periods when your psoriasis symptoms improve or go into remission alternating with times your psoriasis worsens.
For some people, psoriasis is just a nuisance. For others, it's disabling, especially when associated with arthritis. There's no cure, but psoriasis treatments may offer significant relief. Lifestyle measures, such as using a nonprescription cortisone cream and exposing your skin to small amounts of natural sunlight, can improve your psoriasis symptoms.
Psoriasis signs and symptoms can vary from person to person but may include one or more of the following:
Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. Mild cases of psoriasis may be a nuisance; more-severe cases can be painful, disfiguring and disabling.
Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission. In most cases, however, the disease eventually returns.
Several types of psoriasis exist. These include:
When to see a doctor
If you suspect that you may have psoriasis, see your doctor for an examination. Also, talk to your doctor if your psoriasis:
Seek medical advice if your signs and symptoms worsen or don't improve with treatment. You may need a different medication or a combination of treatments to manage the psoriasis.
The cause of psoriasis isn’t fully known, but it's thought to be related to the immune system and its interaction with the environment in people who have the genetic susceptibility. More specifically, one key cell is a type of white blood cell called a T lymphocyte or T cell. Normally, T cells travel throughout the body to detect and fight off foreign substances, such as viruses or bacteria. If you have psoriasis, however, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.
Overactive T cells trigger other immune responses. The effects include dilation of blood vessels in the skin around the plaques and an increase in other white blood cells that can enter the outer layer of skin. These changes result in an increased production of both healthy skin cells and more T cells and other white blood cells. This causes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly — in days rather than weeks. Dead skin and white blood cells can't slough off quickly enough and build up in thick, scaly patches on the skin's surface. This usually doesn't stop unless treatment interrupts the cycle.
Just what causes T cells to malfunction in people with psoriasis isn't entirely clear, although researchers think genetic and environmental factors both play a role.
Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include:
Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:
Depending on the type and location of the psoriasis and how widespread the disease is, psoriasis can cause complications. These include:
If you have psoriasis, you’re at greater risk of developing certain diseases, such as metabolic syndrome, a cluster of conditions that include high blood pressure and elevated insulin levels; inflammatory bowel disease; cardiovascular disease; and, possibly, cancer.
In addition, psoriatic arthritis can be debilitating and painful, making it difficult to go about your daily routine. Despite medications, psoriatic arthritis can cause joint damage.
You'll likely first see your family doctor or a general practitioner. In some cases, you may be referred directly to a specialist in skin diseases (dermatologist).
Here's some information to help you prepare for your appointment and to know what to expect from your doctor.
What you can do
For psoriasis, some basic questions you might ask your doctor include:
Don't hesitate to ask any other questions you have.
What to expect from your doctor
Your doctor is likely to ask you several questions, such as:
In most cases, diagnosis of psoriasis is fairly straightforward.
Conditions that can look like psoriasis
Other conditions that may look like psoriasis include:
Psoriasis treatments aim to:
Psoriasis treatments can be divided into three main types: topical treatments, light therapy and systemic medications.
Used alone, creams and ointments that you apply to your skin can effectively treat mild to moderate psoriasis. When the disease is more severe, creams are likely to be combined with oral medications or light therapy. Topical psoriasis treatments include:
Light therapy (phototherapy)
As the name suggests, this psoriasis treatment uses natural or artificial ultraviolet light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light either alone or in combination with medications.
Oral or injected medications
If you have severe psoriasis or it's resistant to other types of treatment, your doctor may prescribe oral or injected drugs. Because of severe side effects, some of these medications are used for only brief periods and may be alternated with other forms of treatment.
Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments — topical creams and ultraviolet light therapy (phototherapy) — and then progress to stronger ones only if necessary. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.
In spite of a range of options, effective treatment of psoriasis can be challenging. The disease is unpredictable, going through cycles of improvement and worsening, seemingly at random. Effects of psoriasis treatments also can be unpredictable; what works well for one person might be ineffective for someone else. Your skin also can become resistant to various treatments over time, and the most potent psoriasis treatments can have serious side effects.
Talk to your doctor about your options, especially if you're not improving after using a particular treatment or if you're having uncomfortable side effects. He or she can adjust your treatment plan or modify your approach to ensure the best possible control of your symptoms.
Although self-help measures won't cure psoriasis, they may help improve the appearance and feel of damaged skin. These measures may benefit you:
Many alternative therapies are available to ease the symptoms of psoriasis, including special diets, creams, dietary supplements and herbs. Some alternative therapies are deemed generally safe, and they may be helpful to some people in reducing signs and symptoms, such as itching and scaling.
If you're considering dietary supplements or other alternative therapy to ease the symptoms of psoriasis, consult your doctor. He or she can help you weigh the pros and cons of specific alternative therapies.
Coping with psoriasis can be a challenge, especially if the disease covers large areas of your body or is in places readily seen by other people, such as your face or hands. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden.
Here are some ways to help you cope and to feel more in control:
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