PSORIASIS: Common Community Problem, Uncommon Community Solutions!
by Lewis H. Kaminester, M.D.
F.A.C.P., Board Certified, Dermatologist
If you have noticed patches of raised red skin covered
by white flakes on your skin, along with itching
and burning, you may be one of the more than
4.5 million adults in the United States that have
Psoriasis (sore-I-ah-sis). Most researchers now
conclude that it is related to the immune system (psoriasis is
often called an "immune-mediated" disorder).
Psoriasis is a disease that affects over two percent of our
population. It can be just an annoying rash affecting the elbows,
knees and fingernails, or it can extend to involve more than half
of the body, being a chronic curse to the sufferer.
Researchers believe the immune system sends faulty signals
that speed up the growth cycle in skin cells. Certain people
carry genes that make them more likely to develop psoriasis,
but not everyone with these genes develops psoriasis. Instead,
a "trigger" makes the psoriasis appear in those who have this
susceptibility. Some triggers may work together to cause an
outbreak of psoriasis; this makes it difficult to identify individual
Possible psoriasis triggers include emotional stress, injury to
the skin, some types of infection and reaction to certain drugs.
Once the disease is triggered, the skin cells pile up on the surface
of the body faster than normal. In people without psoriasis,
skin cells mature and are shed about every 28 days. In psoriatic
skin, the skin cells move rapidly up to the surface of the skin
over three to six days. The body can't shed the skin cells fast
enough and this process results in patches also called "lesions"
forming on the skin's surface.
Psoriasis is a genetic disease. A family association exists in
one out of three cases. It often appears between ages 15 and 35,
but it can develop at any age. About 10% to 15% of those with
psoriasis get it before age 10, and occasionally it appears in
infancy. Psoriasis is not contagious ó no one can "catch" it
from another person.
Traditional treatment for psoriasis has included simple sun
exposure, topical steroids rubbed on the skin, and tar or salicylic
acid shampoos. Some new topical creams use vitamin D
derivates. Light box treatments with either ultraviolet B or UVA
require repeated frequent visits to the dermatologistís office. There
is no "cure" for psoriasis!
Now, however, there are new treatments and new hope for
psoriasis sufferers.We have now recognized that psoriasis can be
considered an autoimmune disease, whereby the body is reacting
to its own body cells. New medications and biologicals act on
this theory. Patients with moderate to severe psoriasis, defined
at having 10% or more total body surface involvement, may be
helped with new prescription biologicals or by entering research
studies using the latest findings to control widespread disease with
The Federal Drug Administration (FDA) conducts
such studies to confirm the efficacy of treatments prior to the
medication being released as a prescription to the public.
A number of Palm Beach County residents are currently enrolled
in a new international study using simple oral medication for control
of psoriasis. The oral medication does not cross react with any
other medications, which is a great benefit. Moreover, its side
effects appear to be few. This is in contrast to some biological
medications recently released for prescription use, which can have
serious side effects affecting many organ systems.
Psoriasis sufferers with limited involvement can use a
combination of topical agents, including corticosteroids and
vitamin D analogues. Persons with
more severe involvement should
carefully consider newer methods of
treatment, and reserve therapy with
methotrexate and other cell poisons
as a last resort for treatment of what
can be a most unpleasant and life long
For more information about psoriasis, contact the National Psoriasis Foundation
at 800-723-9166 or visit their website at www.psoriasis.org
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