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Psoriasis is an autoimmune disease in which skin cells grow too quickly, causing them to rapidly accumulate on the surface of the skin. These excess cells can result in patches of red skin or thick, silvery scales that can itch, sting, or burn. Psoriasis can also affect nail growth and appearance, or even cause skin sores. Psoriatic skin patches are most commonly visible on a person’s torso, knees, elbows, and scalp, but they can develop elsewhere, including on the palms, soles, knees, genitals, nails, or even on the face. The abnormal patches of skin are often symmetrical, appearing in the same areas on both the right and left sides of the body. This chronic condition is the most common autoimmune disease in the U.S. The National Psoriasis Foundation estimates that up to 7.5 million Americans (a little more than 1 in 50 people) have it.
There are 8 types of psoriasis:
Scientists still don’t completely know the root cause of psoriasis. Popular theories suggest that psoriasis is tied to an immune system malfunction that makes a type of white blood cell in the body called T lymphocytes (or T cells) become overactive. Usually, T cells attack bacteria, viruses, and other potentially harmful foreign substances that enter the body. In psoriasis sufferers, however, the T cells attack healthy skin cells, triggering a series of other immune reactions. Blood vessels around some areas of skin expand, letting other white blood cells enter the skin’s outermost layer. The presence of white blood cells in the skin speeds up the production of healthy skin cells, white blood cells, and T cells. Because of the rate of cell production, new skin cells move to the skin’s outermost layer much quicker – in a span of days rather than weeks. As new cells move to the surface, dead skin and white blood cells can’t be shed quickly enough from these areas, causing the characteristic abnormal patches of skin to emerge.
Psoriasis can strike anyone, but the following factors increase people’s chances of developing the condition and/or trigger a flare – up:
To determine if you have psoriasis, your physician or a dermatologist will usually do the following:
Occasionally, a doctor may take a small skin sample (biopsy) – this is done after a local anesthetic is applied, so it shouldn’t hurt – and send it to a lab for further testing. This can help determine whether a patient has psoriasis, and if so, what kind of psoriasis it is.
Symptoms of psoriasis can include any of the following:
People who have psoriasis run a higher risk of developing other diseases as well, including:
While living with psoriasis can be challenging, the good news is that doctors are more aware of and sensitive to it than ever, and researchers are intensely focused on finding more answers and remedies. Your physician can help you explore treatment options and lifestyle changes to ease your symptoms and minimize their impact on your quality of life. Stress-reduction techniques are useful, and so is the support of loved ones and fellow psoriasis patients.
These strategies can all help you better manage your psoriasis:
Unfortunately, psoriasis isn’t preventable, but there’s plenty you can do to minimize the occurrence and severity of outbreaks. If you are experiencing a psoriasis flare up or feel you may be at risk of developing psoriasis, talk to your doctor about treatment options and lifestyle changes.
Fortunately, many medications are available to treat psoriasis. These include:
Topical medicines applied to the skin can reduce psoriasis-related inflammation and slow or stop the production of abnormal cells. Topical treatments can come in the form of creams, foams, and solutions, and can include:
Calcipotrienes and Retinoids can be combined with light therapy. See below for more details.
Common side effects of topical medications include:
Systemic medications such as work throughout the entire body. Systemic medication can be taken in pill form, liquid form, or by injection. These include:
Retinoids, which are close relatives of vitamin A. These include:
Common side effects include:
More serious side effects include:
Methotrexate works by suppressing the immune system, thereby decreasing the activity of problematic T cells.
Common side effects of Methotrexate include:
Methotrexate should not be taken by individuals with liver disease, pregnant women, women who are thinking of getting pregnant, or male partners of women who are pregnant or who are thinking of getting pregnant. Alcohol should not be consumed with methotrexate and regular blood tests should be conducted by your doctor to check for liver and blood cell damage.
Cyclosporine (Neoral, Sandimmune) works by suppressing the immune system and slowing skin cell growth. Common side effects include:
Biologics are protein-based drugs that block the inflammatory process of psoriasis. These are given via injection or IV infusion and are usually used to treat moderate to severe psoriasis. Popular biologics include:
More serious side effect include:
Adalimumbab (Humira)
Infliximab (Remicade)
Golimubab (Simponi)
According to the National Center for Complementary and Alternative Medicine and the National Center for Health Statistics, more than 36 percent of all Americans seek complementary treatments for chronic conditions, including psoriasis. Some psoriasis patients report the following strategies are helpful in addressing their condition (be sure to tell your doctor you are considering any of them):
Finding a board-certified dermatologist (and/or a board-certified rheumatologist if you have psoriatic arthritis) is vital. Ask your primary-care physician for a referral, or find a practicing doctor in your area through the American Board of Dermatology and/or the American College of Rheumatology).
Additionally, the National Psoriasis Foundation maintains a Health Care Provider Directory. These physicians support efforts to help people with psoriasis and psoriatic arthritis through advocacy, education, and research.
Interview several doctors, if necessary, to find ones who make you feel comfortable and have experience treating your type of psoriasis.
Some good questions to ask your doctor include:
To read more about all things psoriasis, visit The National Psoriasis Foundation, a non-profit agency dedicated to finding a cure for psoriasis and psoriatic arthritis. Its website includes information, research updates, a healthcare provider directory, and more.
To find a doctor who specializes in psoriasis or to learn more about psoriasis, visit The American Academy of Dermatology.
For links to medical journals on psoriasis and a directory of recent and ongoing clinical studies as well as Psoriasis Q&A, visit The National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health.
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