Medical term:

Psoriasis

Definition

Named for the Greek word psōra meaning "itch," psoriasis is a chronic, non-contagious disease characterized by inflamed lesions covered with silvery-white scabs of dead skin.

Description

Psoriasis, which affects at least four million Americans, is slightly more common in women than in men. Although the disease can develop at any time, 10-15% of all cases are diagnosed in children under 10, and the average age at the onset of symptoms is 28. Psoriasis is most common in fair-skinned people and extremely rare in dark-skinned individuals.

Normal skin cells mature and replace dead skin every 28-30 days. Psoriasis causes skin cells to mature in less than a week. Because the body can't shed old skin as rapidly as new cells are rising to the surface, raised patches of dead skin develop on the arms, back, chest, elbows, legs, nails, folds between the buttocks, and scalp.

Psoriasis is considered mild if it affects less than 5% of the surface of the body; moderate, if 5-30% of the skin is involved, and severe, if the disease affects more than 30% of the body surface.

Types of psoriasis

Dermatologists distinguish different forms of psoriasis according to what part of the body is affected, how severe symptoms are, how long they last, and the pattern formed by the scales.

PLAQUE PSORIASIS. Plaque psoriasis (psoriasis vulgaris), the most common form of the disease, is characterized by small, red bumps that enlarge, become inflamed, and form scales. The top scales flake off easily and often, but those beneath the surface of the skin clump together. Removing these scales exposes tender skin, which bleeds and causes the plaques (inflamed patches) to grow.

Plaque psoriasis can develop on any part of the body, but most often occurs on the elbows, knees, scalp, and trunk.

SCALP PSORIASIS. At least 50 of every 100 people who have any form of psoriasis have scalp psoriasis. This form of the disease is characterized by scale-capped plaques on the surface of the skull.

NAIL PSORIASIS. The first sign of nail psoriasis is usually pitting of the fingernails or toenails. Size, shape, and depth of the marks vary, and affected nails may thicken, yellow, or crumble. The skin around an affected nail is sometimes inflamed, and the nail may peel away from the nail bed.

GUTTATE PSORIASIS. Named for the Latin word gutta, which means "a drop," guttate psoriasis is characterized by small, red, drop-like dots that enlarge rapidly and may be somewhat scaly. Often found on the arms, legs, and trunk and sometimes in the scalp, guttate psoriasis can clear up without treatment or disappear and resurface in the form of plaque psoriasis.

PUSTULAR PSORIASIS. Pustular psoriasis usually occurs in adults. It is characterized by blister-like lesions filled with non-infectious pus and surrounded by reddened skin. Pustular psoriasis, which can be limited to one part of the body (localized) or can be widespread, may be the first symptom of psoriasis or develop in a patient with chronic plaque psoriasis.

Generalized pustular psoriasis is also known as Von Zumbusch pustular psoriasis. Widespread, acutely painful patches of inflamed skin develop suddenly. Pustules appear within a few hours, then dry and peel within two days.

Generalized pustular psoriasis can make life-threatening demands on the heart and kidneys.

Palomar-plantar pustulosis (PPP) generally appears between the ages of 20 and 60. PPP causes large pustules to form at the base of the thumb or on the sides of the heel. In time, the pustules turn brown and peel. The disease usually becomes much less active for a while after peeling.

Acrodermatitis continua of Hallopeau is a form of PPP characterized by painful, often disabling, lesions on the fingertips or the tips of the toes. The nails may become deformed, and the disease can damage bone in the affected area.

INVERSE PSORIASIS. Inverse psoriasis occurs in the armpits and groin, under the breasts, and in other areas where skin flexes or folds. This disease is characterized by smooth, inflamed lesions and can be debilitating.

ERYTHRODERMIC PSORIASIS. Characterized by severe scaling, itching, and pain that affects most of the body, erythrodermic psoriasis disrupts the body's chemical balance and can cause severe illness. This particularly inflammatory form of psoriasis can be the first sign of the disease, but often develops in patients with a history of plaque psoriasis.

PSORIATIC ARTHRITIS. About 10% of partients with psoriasis develop a complication called psoriatic arthritis. This type of arthritis can be slow to develop and mild, or it can develop rapidly. Symptoms of psoriatic arthritis include:

joint discomfort, swelling, stiffness, or throbbing
swelling in the toes and ankles
pain in the digits, lower back, wrists, knees, and ankles
eye inflammation or pink eye (conjunctivitis)

Causes and symptoms

The cause of psoriasis is unknown, but research suggests that an immune-system malfunction triggers the disease. Factors that increase the risk of developing psoriasis include:

family history
stress
exposure to cold temperatures
injury, illness, or infection
steroids and other medications
race

Trauma and certain bacteria may trigger psoriatic arthritis in patients with psoriasis.

Diagnosis

A complete medical history and examination of the skin, nails, and scalp are the basis for a diagnosis of psoriasis. In some cases, a microscopic examination of skin cells is also performed.

Blood tests can distinguish psoriatic arthritis from other types of arthritis. Rheumatoid arthritis, in particular, is diagnosed by the presence of a particular antibody present in the blood. That antibody is not present in the blood of patients with psoriatic arthritis.

Treatment

Age, general health, lifestyle, and the severity and location of symptoms influence the type of treatment used to reduce inflammation and decrease the rate at which new skin cells are produced. Because the course of this disease varies with each individual, doctors must experiment with or combine different treatments to find the most effective therapy for a particular patient.

Mild-moderate psoriasis

Steroid creams and ointments are commonly used to treat mild or moderate psoriasis, and steroids are sometimes injected into the skin of patients with a limited number of lesions. In mid-1997, the United States Food and Drug Administration (FDA) approved the use of tazarotene (Tazorac) to treat mild-to-moderate plaque psoriasis. This water-based gel has chemical properties similar to vitamin A.

Brief daily doses of natural sunlight can significantly relieve symptoms. Sunburn has the opposite effect.

Moisturizers and bath oils can loosen scales, soften skin, and may eliminate the itch. So can adding a cup of oatmeal to a tub of bath water. Salicylic acid (an ingredient in aspirin) can be used to remove dead skin or increase the effectiveness of other therapies.

Moderate psoriasis

Administered under medical supervision, ultraviolet light B (UVB) is used to control psoriasis that covers many areas of the body or that has not responded to topical preparations. Doctors combine UVB treatments with topical medications to treat some patients and sometimes prescribe home phototherapy, in which the patient administers his or her own UVB treatments.

Photochemotherapy (PUVA) is a medically supervised procedure that combines medication with exposure to ultraviolet light (UVA) to treat localized or widespread psoriasis. An individual with widespread psoriasis that has not responded to treatment may enroll in one of the day treatment programs conducted at special facilities throughout the United States. Psoriasis patients who participate in these intensive sessions are exposed to UVB and given other treatments for six to eight hours a day for two to four weeks.

Severe psoriasis

Methotrexate (MTX) can be given as a pill or as an injection to alleviate symptoms of severe psoriasis or psoriatic arthritis. Patients who take MTX must be carefully monitored to prevent liver damage.

Psoriatic arthritis can also be treated with non steroidal anti-inflammatory drugs (NSAID), like acetaminophen (Tylenol) or aspirin. Hot compresses and warm water soaks may also provide some relief for painful joints.

Other medications used to treat severe psoriasis include etrentinate (Tegison) and isotretinoin (Accutane), whose chemical properties are similar to those of vitamin A. Most effective in treating pustular or erythrodermic psoriasis, Tegison also relieves some symptoms of plaque psoriasis. Tegison can enhance the effectiveness of UVB or PUVA treatments and reduce the amount of exposure necessary.

Accutane is a less effective psoriasis treatment than Tegison, but can cause many of the same side effects, including nosebleeds, inflammation of the eyes and lips, bone spurs, hair loss, and birth defects. Tegison is stored in the body for an unknown length of time, and should not be taken by a woman who is pregnant or planning to become pregnant. A woman should use reliable birth control while taking Accutane and for at least one month before and after her course of treatment.

Cyclosporin emulsion (Neoral) is used to treat stubborn cases of severe psoriasis. Cyclosporin is also used to prevent rejection of transplanted organs, and Neoral, approved by the FDA in 1997, should be particularly beneficial to psoriasis patients who are young children or African-Americans, or those who have diabetes.

Other conventional treatments for psoriasis include:

Capsaicin (Capsicum frutecens), an ointment that can stop production of the chemical that causes the skin to become inflamed and halts the runaway production of new skin cells. Capsaicin is available without a prescription, but should be used under a doctor's supervision to prevent burns and skin damage.
Hydrocortisone creams, topical ointments containing a form of vitamin D called calcitriol, and coal-tar shampoos and ointments can relieve symptoms. Hydrocortisone creams have been associated with such side effects as folliculitis (inflammation of the hair follicles), while coal-tar preparations have been associated with a heightened risk of skin cancer.

Alternative treatment

Non-traditional psoriasis treatments include:

Soaking in warm water and German chamomile (Matricaria recutita) or bathing in warm salt water.
Drinking as many as three cups a day of hot tea made with one or a combination of the following herbs: burdock (Arctium lappa) root, dandelion (Taraxacum mongolicum) root, Oregon grape (Mahonia aquifolium), sarsaparilla (Smilax officinalis), and balsam pear (Momardica charantia).
Taking two 500-mg capsules of evening primrose oil (Oenothera biennis) a day. Pregnant women should not use evening primrose oil, and patients with liver disease or high cholesterol should use it only under a doctor's supervision.
Eating a diet that includes plenty of fish, turkey, celery (for cleansing the kidneys), parsley, lettuce, lemons (for cleansing the liver), limes, fiber, and fruit and vegetable juices.
Eating a diet that eliminates animal products high in saturated fats, since they promote inflammation.
Drinking plenty of water (at least eight glasses) each day.
Taking nutritional supplements including folic acid, lecithin, vitamin A (specific for the skin), vitamin E, selenium, and zinc.
Regularly imagining clear, healthy skin.

Other helpful alternative approaches include identifying and eliminating food allergens from the diet, enhancing the fuction of the liver, augmenting the hydrochloric acid in the stomach, and completing a detoxification program. Constitutional homeopathic treatment, if properly prescribed, can also help resolve psoriasis.

Prognosis

Most cases of psoriasis can be controlled, and most people who have psoriasis can live normal lives.

Some people who have psoriasis are so self conscious and embarrassed about their appearance that they become depressed and withdrawn. The Social Security Administration grants disability benefits to about 400 psoriasis patients each year, and a comparable number die from complications of the disease.

Key terms

Arthritis — An inflammation of joints.

Prevention

A doctor should be notified if:

psoriasis symptoms appear or reappear after treatment

pustules erupt on the skin and the patient experiences fatigue, muscle aches, and fever
unfamiliar, unexplained symptoms appear.

Resources

Organizations

American Academy of Dermatology. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-0230. Fax: (847) 330-0050. http://www.aad.org.

American Skin Association, Inc. 150 E. 58th St., 3rd floor, New York, NY 10155-0002. (212) 688-6547.

National Psoriasis Foundation. 6600 S.W. 92nd Ave., Suite 300, Portland, OR 97223. (800) 723-9166. http://www.psoriasis.org.

psoriasis

[so-ri´ah-sis]

a chronic, recurrent skin disease marked by discrete bright red macules, papules, or patches covered with lamellated silvery scales. There are also guttate, erythrodermic (exfoliative), and pustular forms. adj., adj psoriat´ic.

Any body surface can be affected, but lesions appear most often on the scalp, knees, and elbows. Sometimes the nails are affected, causing pitting and scaling of the base, or ridging and furrowing with an alteration in transparency. Emotional response to the persistence and cosmetically disfiguring effects can be severe. Psoriasis can occur in either sex at any age, but is most often seen in persons 15 to 35 years of age. It affects about 2 per cent of white adults and is less common in blacks and Asians. About 10 per cent of patients have arthritis associated with their psoriasis (psoriatic arthritis). The cause is not known; psoriasis is not an infectious disease and cannot be transmitted from one person to another. Recent research has established that it is an immune-mediated disorder. It tends to occur in families; about one third of the cases are believed to be related to a hereditary factor. Skin injury (such as from scratching or surgery) or inflammation (as from overexposure to ultraviolet light) can lead to the development of more lesions. Certain drugs are known to exacerbate psoriasis. Early attacks respond well to treatment, only to reappear within weeks or months. Complete and permanent remission is rare.

Treatment. There is at present no curative agent available; some topical treatments currently in use must be prescribed with caution to avoid permanent damage to the skin. Recommended topical agents include moisturizers, keratolytics, coal tar, anthralin, steroids, and vitamin D derivatives. Exposure to the sun or artificial ultraviolet light can be helpful. The oldest form of therapy is the Goeckerman routine, which combines crude coal tar with increasing exposure to ultraviolet B. photochemotherapy (psoralen and ultraviolet light [PUVA]) is a newer form of treatment. With this therapy the combination of a photosensitizing agent (psoralen) with long-wave ultraviolet light (UVA) reduces cellular proliferation by inhibiting DNA synthesis. The folic acid antagonist methotrexate controls psoriasis by inhibiting cell reproduction. Retinoids (acitretin, etretinate, isotretinoin) are used alone or in combination with PUVA and are often effective against pustular forms of the disease. Methotrexate, retinoids, and PUVA have potentially serious side effects and are therefore usually given only to those patients with severe psoriasis that is not controlled by other forms of treatment. Cyclosporine is used in severe cases. Topical, systemic, and ultraviolet therapies are sometimes combined; the patient may be rotated from one therapy to another in succession to reduce cumulative side effects and forestall resistance to therapy.

Extensive information about psoriasis can be obtained from the National Psoriasis Foundation, 6600 S.W. 92nd Ave., Suite 300, Portland, OR 97223 (telephone 800-723-9166).

(See Atlas 2, Part J.)

pso·ri·a·sis

(sō-rī'ă-sis), Do not confuse this word with sauriasis or siriasis.

A common multifactorial inherited condition characterized by the eruption of circumscribed, discrete and confluent, reddish, silvery-scaled maculopapules; the lesions occur predominantly on the elbows, knees, scalp, and trunk, and microscopically show characteristic parakeratosis and elongation of rete ridges with shortening of epidermal keratinocyte transit time due to decreased cyclic guanosine monophosphate.

[G. psōriasis, fr. psōra, the itch]

Farlex Partner Medical Dictionary © Farlex 2012

psoriasis

(sə-rī′ə-sĭs)

A noncontagious inflammatory skin disease characterized by recurring reddish patches covered with silvery scales.

pso′ri·at′ic (sôr′ē-ăt′ĭk) adj.

psoriasis

Plaque psoriasis Dermatology A common–± 3 million, US–chronic hyperproliferative and inflammatory skin disorder, characterized by erythematous papules that coalesce, forming plaques with sharply demarcated borders; removal of a 'virgin' yellow-white lesion results in pinpoint hemorrhage–Auspitz' sign; trauma may evoke lesions on new body sites–Koebner's phenomenon; lesions are prominent on scalp, knees, elbows, umbilicus, genitalia Exacerbation Injury–solar, mechanical, infection– β-hemolytic streptococcus, HIV, drugs–ACE inhibitors, lithium, antimalarials, indomethacin Risk factors Injury or irritation–cuts, burns, rash, insect bites, immunosuppression–eg, AIDS, chemotherapy for cancer, Pts with autoimmune disorders, certain medications, viral or bacterial infections, alcoholism, obesity, lack of sunlight, sunburn, stress, cold climate, friction on skin Management Symptomatic–emollients, keratolytics, topicals– anthralin, corticosteroids, vitamin D analogues, phototherapy–ie, UV light exposure–natural sunlight, artificial UVB light, photochemotherapy– methoxsalen + UVA light, PUVA therapy, oral agents–eg, cyclosporine, etretinate, MTX, calcipotriene

pso·ri·a·sis

(sōr-ī'ă-sis)

A common inherited condition characterized by the eruption of reddish, silvery-scaled maculopapules, predominantly on the elbows, knees, scalp, and trunk.

[G. psōriasis, fr. psōra, an itch]

Medical Dictionary for the Health Professions and Nursing © Farlex 2012

psoriasis

(sŏ-rī′ă-sĭs ) [Gr. psōriasis, itching]

PSORIASIS: silvery plaque on the shin

A chronic skin disorder affecting 1% to 2% of the population, in which red papules and scaly silvery plaques with sharply defined borders appear on the body surface. The rash commonly is found on the knees, shins, elbows, umbilicus, lower back, buttocks, ears, and along the hairline. Pitting of the nails also occurs frequently. Patients complain of itching and sometimes of pain from dry, cracked, or encrusted lesions. Removal of scales usually causes fine bleeding points. Widespread shedding of scales is common, and occasionally the disease becomes pustular. The severity of the disease may range from a minimal cosmetic problem to total body surface involvement. About a third of all affected patients have a family history of the disease. psoriatic (sōr″ē-at′ik), adjective See: illustration

Although psoriasis may begin at any time of life, the most common age of onset is between 10 and 40. Sudden onset may occur related to HIV. The condition has relapses and partial remissions, but established lesions often persist for many months or years. Flare-ups may be related to specific systemic and environmental factors or may be unpredictable. About 5% of patients also develop an inflammatory arthritis (commonly affecting fingers and toes or sacroiliac joints), and patients with psoriasis have an increased rate of inflammatory bowel disease.

Etiology

Although the cause of psoriasis is unknown, some evidence suggests that immune dysregulation contributes to excessive proliferation of skin. Families with psoriasis have been found to have a significantly higher-than-normal incidence of certain human leukocyte antigens. Genetic studies show that about one third of affected patients have a family history of the disease. Emotional stress, skin trauma, cold weather, infections, and some drugs may trigger attacks.

Treatment

The disease has no cure, and all treatments are palliative. Topical corticosteroids, coal tar derivatives, vitamin D₃ analogs (e.g., calcipotriene), retinoids (e.g., etretinate, tacarotene), ultraviolet light exposure, and saltwater immersion are among the many methods that have been used effectively to treat this condition. For severe disease, immune-modulating drugs like methotrexate or cyclosporine sometimes are used, with close monitoring to prevent side effects.

CAUTION!

Many treatments for psoriasis carry some risk for the patient. Etretinate, for example, produces fetal abnormalities and should never be used by women of childbearing age. Phototherapy with ultraviolet light increases the risk of developing many types of skin cancer. Patients receiving PUVA therapy must wear goggles during treatments, stay out of the sun on treatment days, and protect their eyes with UVA-screening sunglasses for 24 hr after the therapy. Use of methotrexate use requires regular monitoring of liver function, renal function, complete blood counts, and lung function.

Patient care

The nurse teaches the patient about the prescribed therapy, to soften and remove scales, to relieve pruritus, to reduce pain and discomfort, to retard rapid cell proliferation, and to help induce remission and monitors for adverse reactions. Assistance is provided to help the patient gain confidence in managing these largely palliative treatments, many of which require special instructions for application and removal. The patient should protect against and minimize trauma. The patient's ability to manage therapies and their results are evaluated. The patient learns to identify stressors that exacerbate the condition, and to avoid and reduce these as much as possible. If the patient smokes cigarettes, participation in a smoking cessation program is recommended. The nurse helps the young patient (aged 20 to 30) to deal with body image changes and effects on self-esteem, encourages the patient to verbalize feelings, and supports the patient through loss of body image and associated grief. Psychological problems often occur. Referral for psychological counseling or cosmetic concealment therapy may be necessary. Patients and their families should be referred to the National Psoriasis Foundation and its local chapters for information and support. (800-723-9166; www.psoriasis.org)

psoriasis annularis

Circular or ringlike lesions of psoriasis.

psoriasis buccalis

Leukoplakia of the oral mucosa.

elephantine psoriasis

A rare but persistent psoriasis that occurs on the back, thighs, and hips in thick scaling plaques.

GUTTATE PSORIASIS: on the back

guttate psoriasis

Psoriasis characterized by small distinct lesions that generally occur over the body. The lesions appear particularly in the young after acute streptococcal infections. See: illustration

nummular psoriasis

The most common form of psoriasis with disks and plaques of varying sizes on the extremities and trunk. There may be a great number of lesions or a solitary lesion.

pustular psoriasis

Psoriasis in which small sterile pustules form, dry up, and then form a scab.

rupioid psoriasis

Psoriasis with hyperkeratotic lesions on the feet.

psoriasis universalis

Severe generalized psoriasis.

psoriasis

A common skin disease featuring obvious, dull red or salmon-pink, oval, thickened patches covered with silvery scales. These may occur anywhere on the body and vary greatly in number. It affects about 2 percent of the UK population. The cause is multifactorial involving genetic predisposition, skin injury, infections, drugs leading to inflammatory infoltrates of the skin and epidermal hyperproliferation. The condition may be complicated by ARTHRITIS. Psoriasis is treated by exposure to sunlight or ultraviolet light, vitamin D3 analogues, COAL TAR, dithranol, corticosteroid ointments or the CYTOTOXIC drug METHOTREXATE.

psoriasis

a noncontagious disease of the skin marked by scaly red patches, due probably to a disorder of the immune system.

pso·ri·a·sis

(sōr-ī'ă-sis)

A common inherited condition characterized by the eruption of reddish, silvery-scaled maculopapules, predominantly on the elbows, knees, scalp, and trunk.

[G. psōriasis, fr. psōra, an itch]

Patient discussion about psoriasis

Q. Is psoriasis infectious? Last week I and my friends from high-school went to the pool. One of my friend has psoriasis on his back, and when the lifeguard noticed it he asked him to leave the pool because he has skin disease that may spread to the other people swimming in the pool. We told him it is psoriasis and not some fungus, but he told us that psoriasis is also infectious. Is that true? Can psoriasis infect people who come in touch with people with psoriasis? Can I go swimming with him or should be more cautious?

A. It is right that psoriasis is not a contagious skin condition. But your friend should take care. However keeping skin humid is better for Psoriasis patients as I recently read these tips at
http://www.vitiligoguide.com/psoriasis/

Q. Is psoriasis contagious? My wife got psoriasis and I don’t want to get infected…

A. Psoriasis itself, as was written above, isn't contagious, i.e. if someone has psoriasis he or she can't transmit it to you. However, there is a form of psoriasis called psoriasis guttate that is associated with infection of the throat by a bacterium called streptococcus (which is contagious), so in some way it is contagious.

You may read more here:http://en.wikipedia.org/wiki/Psoriasis#Types_of_psoriasis

Q. What kind of health complications I should expect if I have Psoriasis? i recently was diagnosed with Plaque Psoriasis- will it affect other organs in my body? Are there any complications I should worry about?

A. Patients suffering from psoriasis may also suffer from arthritis of various type, and also accelerated atherosclerosis (i.e. heart diseases). However, I don't think that the approach should what should you worry about, but rather you may consult your doctor to see what you can do to control the disease and maybe feel better about it.

Take care,

More discussions about psoriasis

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