| Health
Problems Psoriasis
What is
Psoriasis?
It is a common skin condition that at sometime and to a varying extent,
affects well over a million-and-a-half people in the United Kingdom and
Ireland and approximately eighty million people Worldwide.
Psoriasis is in simple terms only a vast acceleration of the usual
replacement processes of the skin. Normally a skin cell matures in twenty
one to forty days during its passage to the surface where a constant
invisible shedding of dead cells, as scales takes place. Psoriatic cells,
however, are believed to turn over in two to three days and in such chaotic
profusion that even live cells reach the surface and accumulate with the
dead ones in visible layers. It appears as raised red patches of skin
covered with silvery scales. It can occur on any part of the body, although
knees, elbows and the scalp are usual sites. There is often accompanying
irritation.
It cannot be caught from other people, nor can it be transferred from one
part of the body to another.
return to top
Known Causes
Basic causes are as yet unknown.
Hereditary factors are thought to play an important part and much Research
is being carried out into this aspect. It does however appear as if a
genetic tendency is triggered off by such things as injury, throat
infection, certain drugs and both physical and emotional stress.
Psoriasis affects both sexes equally. It may appear for the first time at
any age, although it is more likely to appear between 11 and 45. Psoriasis
is known as a waxing and waning condition, and there may therefore be
considerable variations in its intensity. There are also many
clinical forms with skin involvement varying from a few psoriatic patches
to, at its worst and very rarely, a widespread and serious eruption. Most
sufferers, however, have only small patches which either get better
spontaneously or need very little treatment.
The more severe forms that produce general involvement may demand
intensive medical and nursing care. Widespread ignorance as to the nature of
psoriasis and the real or imagined reactions and attitudes of non-sufferers
may also lead to a withdrawal from society and to feelings of isolation,
depression and defensive shyness.
return to top
Symptoms
Psoriasis can cause as little as a single dimple on one of your finger
or toe nails, or affect as much as the majority of your skin surface, your
joints, and your eyes. 2% of people (1 in 50) have psoriasis to some
degree.
The most commonly affected areas are the
back of the elbows and the front of the knees. It often affects the scalp,
too, and can, indeed, affect any part of the body. The standard appearance
is of red areas where the skin is thickened and crusty, often with silvery
flakes, which come off easily. This appears as patches, which are known as
plaques.
Types of psoriasis: -
- Plaque psoriasis. The patches most
commonly seen are called plaques. They especially affect the back of
the elbows and the front of the knees and the back.
- Guttate psoriasis is many small patches
of psoriasis, all over the body, and often happens after a throat
infection.
- Flexural psoriasis causes red, shiny
areas in skin folds e.g. under breasts, between buttocks etc.
- Pustular psoriasis. Smaller, circular
patches, filled with pus, appear on the palms of the hands and soles
of the feet. This can sometimes cause a fever, and may need treatment
with an antibiotic.
- Scalp psoriasis. Scaling and flakes of
the scalp, often particularly affecting the hair margins.
A serious, but rare, complication of
psoriasis is erythroderma, where large areas of the skin become hot, red,
and dry. This is one of the few emergencies involving skin conditions. If
you suffer from this your doctor will admit you to hospital.
Sometimes parts of the body other than the
skin can be affected: - The joints can be affected by a form of arthritis
(Psoriatic arthropathy). This can affect any joint, but often it is only
one joint, that becomes inflamed, at a time. One or more of your finger or
toe nails may develop little pits as on a thimble, or may become generally
more opaque and thickened (nail dystrophy). The
eyes may become inflamed (uveitis). Though
the rash is sometimes quite obvious, it is not infectious and cannot be
caught by contact.
return to top
Conventional
Treatment
At the moment a permanent cure has not been found. Scientists know much
about the cellular changes that occur and have identified many of the
triggers. Many cases are controlled or improved by treatment of the visible
effects rather than the unknown basic causes. These urgently need to be
identified.
A great variety of treatments exist, and work continues to find more
cosmetically acceptable ones. However, at least one-third of psoriatics lose
the condition naturally for long periods of time or even entirely. Education
about the condition has also been shown to be very beneficial.
Side Effects of common Psoriasis Treatments
Below are some of the common conventional treatments for Psoriasis and associated side effects
Corticosteroids
The first thing to realise is that steroids don't cure anything! They merely suppress the symptoms. (That's exactly why they work so fast!) Sometimes, they help people to feel better but this comes at a high price and, over time, your body becomes immune to them, meaning larger more dangerous doses are required.
Steroids can be absorbed through the skin and affect a person's whole body, including internal organs. This happens if a topical steroid is grossly misused, i.e., applied to widespread areas of skin, used over long periods of time, or with improper occlusion of potent steroids. For this reason, a doctor should monitor the use of topical steroids.
Possible side effects associated with chronic and prolonged use of topical corticosteroids include skin atrophy, stretch marks and red spots. Rarely, heavy long-term use can cause a suppression of the adrenal glands. Additionally, resistance can develop if steroids are used over an extended period of time. In an effort to reduce the risk of side effects and resistance, your doctor may recommend that you take periodic breaks from the drug. A safe dose should not exceed more than 50 or 60 grams a week
The following warning on the potential risks of two popular steriod-based eczema drugs Elidel and Protopic can be found on the website of the U.S FDA at:
http://www.fda.gov/bbs/topics/ANSWERS/2005/ANS01343.html
Topical Tazarotene
Tazarotene is a selective retinoid with properties that are similar to vitamin A.
Side effects include redness and burning. It should not be used in women who wish to become pregnant.
Coal Tar
Coal tar is safer than corticosteroids, but it is not used as often because it has limited effectiveness, it irritates the skin, and has an unpleasant odor and can stain skin and clothing
Tars are made from the distillation of coal and wood.
If You are still considering using coal tar products and do not mind the mess, take note of the following News Flash dated January 2002.
"It may be more difficult to find OTC tar medications in California, due to state guidelines regarding tar. As of January 2002, OTC coal tar shampoos, lotions and creams that contain more than 0.5% coal tar are required to be labeled with cancer warnings."
Anthralin
The following is what the National Psoriasis Foundation has to say about Anthralin
at http://www.psoriasis.org/treatment/psoriasis/topicals/anthralin.php
Anthralin has a long history as a safe treatment for psoriasis, but it can also be messy to use, as it tends to stain anything it touches–skin, clothing, bedding and bathroom fixtures, for example. Different regimens and formulations of anthralin may make the medication easier for patients to use at home.
Some practical guidelines for home use of anthralin include:
Apply anthralin only to psoriasis; do not apply to unaffected skin. You may prefer to use plastic disposable gloves to apply
anthralin.
Anthralin cream should be rubbed in well, and any excess should be wiped off.
Expect to see a brown stain on the surrounding skin if the anthralin comes into contact with the unaffected skin. This is a good sign and indicates that the anthralin is working. When the stain occurs in the center of a lesion, the psoriasis is clearing. Stains on skin and hair will eventually fade and disappear.
Use old clothing and sheets when anthralin is on skin. Protective dressings (occlusion) can be used, unless otherwise instructed by your doctor. If staining occurs, rinse with water and do not use soap (see tips for stain removal on page 9).
Wash hands after applying anthralin.
Do not apply anthralin near eyes, on the face or in the groin area. Do not rub eyes with
anthralin-contaminated fingers. Should eye irritation occur, rinse eyes with water and consult your doctor.
Anthralin must be fresh to work effectively. Fresh anthralin paste or cream is bright yellow. The shelf life of paste anthralin is about six months.
Follow your health care provider's instructions when using anthralin. There are many ways in which it can be used. Always check with your doctor about precautions to take while using this medication.
Anthralin is known to be a skin irritant, and the irritation a patient experiences is directly related to the strength of the product being used and the individual's tolerance of the medication. Normally, anthralin is not used on the face or on extremely inflamed psoriasis lesions.
In addition, is not known if anthralin is safe during pregnancy. Women who become pregnant and are using anthralin should consult with their health care provider.
Side effects of anthralin include:
Irritation and discoloration of the skin that is not affected by psoriasis. (Take care to apply the product only to the skin affected by psoriasis, not to normal skin.)
A purple-brown stain on the skin. The discolored skin may go away within 3 weeks after you stop using the drug.
A deep red-brown color of the skin, which develops from the inflammation of psoriasis. It may take weeks or months to go away.
In addition (as an added bonus), anthralin may permanently stain fabrics, showers, countertops, sinks, and other materials.
PUVA treatment (pronounced "poova")
PUVA (Psoralen UVA) combines UVA exposure with a photosensitizing agent, taken internally or as a bath. The photosensitizing agent allows for a lower dose of
UVA. PUVA treatments can be highly effective, but recent studies strongly suggest it poses A THREAT OF SKIN DAMAGE AND CANCER.
The following list of the side effects associated with PUVA can be found on the website of the NPF at
http://www.psoriasis.org/treatment/psoriasis/phototherapy/puva.php
The list goes on and on, down to
Methotrexate
Methotrexate is a treatment taken by pill, liquid or injection - which suppresses the immune system just enough to control the psoriasis........... Patients taking methotrexate must be closely monitored because this drug can cause liver damage or damage the blood producing bone marrow. Alcoholics and patients with long-term medical problems cannot take this drug.
Methotrexate should not be used in pregnancy, as it can be toxic to the embryo and can cause fetal defects and spontaneous abortion (miscarriage). It should be discontinued prior to conception if used in either partner. Male patients should stop taking methotrexate at least 3 months prior to a planned conception and females should discontinue use for at least one ovulatory cycle before conception.
SIDE EFFECTS: The most frequent reactions include mouth sores, stomach upset, and low white blood counts and it can cause severe toxicity of the liver and bone marrow, which require regular monitoring with blood testing. It can also cause headache and drowsiness, itching, skin rash, dizziness, and hair loss.
This information is given
in good faith and for information purposes only. No liability is accepted for
any inaccuracies that may be present. It is recommended that you consult a
health professional about any medicines or treatments that you may be
prescribed.
return to top |
|
