Psoriasis
Psoriasis is a persistent skin disorder that produces red, itchy, dry patches of skin with silvery scales. The disorder often begins in childhood and comes and goes throughout a person’s life. The areas most commonly affected are the scalp, elbows, arms and legs, knees, groin and genitals, fingernails and toenails, and lower back. There are several different types of psoriasis, distinguished by the shape and pattern of the scales. The most common type begins as small, red patches that grow larger and form scales.
The cause of psoriasis is unknown, but it may be linked to an abnormality in the function of white blood cells that somehow triggers inflammation in the skin and causes it to shed too quickly. The condition seems to run in families. Four million to 5 million people in the United States have psoriasis. Factors that can trigger the condition include bacterial or viral infections, certain drugs, dry and cold weather, sunburn, skin injury, drinking alcohol, and stress.
Doctors can diagnose psoriasis by examining the skin or by taking a sample of the skin and examining it under a microscope. The goals of treatment are to lessen inflammation and slow skin cell growth. A variety of different treatments— topical (applied to the skin) creams or lotions, light therapy, and oral medication—have been developed to reach these goals. If you have psoriasis, the treatment your doctor recommends will depend on your age, your overall health, and the severity of your condition. No treatment can cure psoriasis, but symptoms can be improved or controlled.
A common type of cream or ointment prescribed for the treatment of psoriasis is a corticosteroid preparation (such as hydrocortisone), which is used in a weak formula for sensitive areas such as the face or the groin and in a stronger formula for other areas. Side effects of these preparations include thinning of the skin, dilation (widening) of the blood vessels, bruising, and skin-color changes. The doctor may inject a corticosteroid drug into areas that are difficult to treat. Topical retinoids (such as tazarotene) are vitamin A–like medications that may be prescribed to treat mild to moderate psoriasis. Other topical psoriasis preparations include those that contain a drug called anthralin, synthetic vitamin D, or coal tar. Many nonprescription shampoos, oils, and sprays are available to treat psoriasis on the scalp.
Both natural sunlight and artificial ultraviolet light from light boxes alter the growth of skin cells, so doctors can use light therapy to treat psoriasis. Light therapy must be used under the supervision of a doctor because excessive exposure to sunlight or artificial ultraviolet light can cause skin wrinkling, skin cancer, damage to the eyes, or a flare-up of psoriasis. A treatment that combines light therapy with coal tar dressings is helpful for treating severe cases of psoriasis. Another effective treatment, called PUVA (psoralens and ultraviolet A), combines ultraviolet light therapy with the oral medication psoralen.
Other medications that may be prescribed to treat psoriasis include methotrexate and oral retinoids. Methotrexate is a powerful but effective anticancer drug that can cause serious side effects, such as liver disease. Before a doctor prescribes methotrexate, he or she will have the person undergo a liver biopsy (a small sample of liver tissue is obtained and examined under a microscope) to make sure that the person’s liver is healthy. After the person begins taking methotrexate, the doctor carefully monitors blood levels of the drug to prevent potential problems. Retinoids (such as acitretin) may be taken alone or in combination with light therapy. Possible side effects include dryness of the skin, lips, and eyes; increased cholesterol levels; and formation of bone spurs.
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Comments (1)
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