Psoriasis - The Hidden Disease

A Chronic Skin Disease Reviewed with Treatments Old and New

Sep 27, 2008 Dennis R. King

Psoriasis is a chronic skin disease of unknown cause. The nature of the disease is reviewed along with common treatments and information on the newer "biologics."

According to the National Institutes of Health, approximately 7.5 million Americans have psoriasis. Patients are often reluctant to talk with their health care providers about this disease due to the embarrassment it engenders.

What Is Psoriasis?

Psoriasis is a skin disease that causes thick patches of red skin with silvery scales. They are often sore or itchy and occasionally with pus-filled blisters. The lesions usually occur on the elbows, palms, knees, scalp, back, face and feet. It usually first appears between the ages of 15 and 35 and can run in families. The illness is usually a chronic condition and symptoms can come and go over time. The illness is not contagious so cannot be given to others through contact. A patient cannot spread it to other part of his own body.

Cause of Psoriasis

The actual cause of psoriasis is unknown, but is considered an immune system dysfunction in which T-cells attack skin cells leading to swelling and rapid production of more skin cells. Basal cells of the skin develop too fast and rise to the surface to form typical lesions. Normal skin cells develop and slough off the body within about a month, while psoriatic cells develop in three or four days and do not slough off.

A small number of people with psoriasis will develop psoriatic arthritis and have joint pain, swelling and stiffness.

People with psoriasis have higher rates of heart disease and other systemic health problems. This stems from the systemic inflammation that is present with the disease.

Treatment for Psoriasis

Psoriasis can improve with treatment but may not go away entirely. There are a large number of treatments available for psoriasis and several new forms of treatment have been recently approved.

Over-the-counter Topicals

• Salicylic acid - helps remove scales and is often combined with steroids, anthralin or tar.
• Tar (coal tar) - available in topical, shampoo and bath solution. It can help slow the rapid proliferation of skin cells and reduce inflammation, itching and scaling.

Prescription Topicals

• Anthralin - effective in treating plaque psoriasis.
• Dovonex - a form of synthetic vitamin D3 and slows down the rate of skin cell growth, flattens lesions and removes scale.
• Taclonex - contains calcipotriene ( the active ingredient in Dovonex) and the steroid betamethasone dipropionate. Slows down the rate of skin cell growth, flattens lesions and removes scale. The steroid helps reduce inflammation and itch.
• Tazorac - comes in gel or cream and is a vitamin A derivative also known as a topical retinoid.
• Topical steroid - effective in controlling mild to moderate psoriasis lesions.

Phototherapy

• UVB (ultraviolet light B) phototherapy - exposing the skin to a source of UVB light for a set time.
• PUVA - psoralen ( a light-sensitizing medication) combined with exposure to UVA light.
• Lasers - targeted UVB treatment and pulsed dye lasers to treat chronic localized plaque lesions.

Systemic Medications

Systemic medications affect the entire body and are used for moderate to severe psoriasis in patients who have not responded to conventional topical medications or who are not able to use them.

The following systemic medications have been available for a number of years.

• Cyclosporine - approved by the Food and Drug Administration (FDA) in 1997 for treatment of psoriasis. It is normally used to prevent organ rejection in transplant patients.
• Methotrexate - approved by the FDA in the 1970's for treatment of psoriasis and usually used for cancer treatment.
• Soriatane - an oral retinoid and a synthetic form of vitamin A.

Biologics

Biologics are systemic medications developed from living sources such as cells rather than combinations of chemicals. They work by directly affecting the immune system and lessening its response in psoriasis. Biologics are administered by self-injection usually between twice per week to once every other week. Patients using these type drugs must be closely monitored by their health care providers. Infections and potential cancers can be side effects.

As of January, 2008, the following biologics are approved by the FDA for treating psoriasis:

• Amervive
• Enbrel
• Humira
• Raptive
• Remicade

Overall safety of these medications is still being evaluated along with long-term side effects.

Resources

National Psoriasis Foundation

The copyright of the article Psoriasis - The Hidden Disease in General Medicine is owned by Dennis R. King. Permission to republish Psoriasis - The Hidden Disease in print or online must be granted by the author in writing.