Psoriasis An  estimated 7.5 million Americans suffer with psoriasis, a non-contagious,  chronic skin condition. Often identified by patches of red, scaly skin,  psoriasis occurs when the immune system sends out incorrect signals that cause skin  cells to grow too quickly. With psoriasis, cells build up on the top layer of  skin, creating patches of itchy, dry skin. The most common locations for  psoriasis are on the elbows, knees, or trunk, but it can develop anywhere on  the body.

Psoriasis  is thought to be an autoimmune disease, which arises from an overactive  response by the body towards substances and tissues normally present in the  body. In the case of psoriasis, white blood cells, called T cells, attack  healthy skin as if to fight off infection or heal a wound. Instead of new cells  moving to the outermost layer of skin in a normal manner, they develop more  rapidly. The dead skin can’t slough off fast enough to keep up, so thick, scaly  areas form on the skin’s surface.

Usually,  the first occurrence of psoriasis happens sometime between ages 15 to 35.   However, approximately 20,000 children under age 10 also live with psoriasis. Although  psoriasis seems to have a genetic component, not everyone with that gene  develops the disease.

Signs and Symptoms   Each  case differs based on the individual, but people with psoriasis often  experience at least one of the following symptoms:

  • Burning, itching, or soreness
  • Cracked, dry skin that can bleed
  • Patches of red skin with silvery scales
  • Pitted, ridged, or thickened nails
  • Stiff, swollen joints

If  you think that you could have psoriasis, contact your doctor and schedule a complete exam.

Triggers - Because psoriasis is chronic, anyone with the condition will live with a cycle of  flare-ups and remissions over a lifetime. Typically, patients with psoriasis  may develop initial symptoms or experience flare ups because of various triggers,  including

  • Certain medications
  • Cuts, scrapes, burns, or other damage to the skin
  • Diet
  • Excessive alcohol use
  • Other infections such as strep throat
  • Smoking
  • Stress
  • Weather

Types of Psoriasis   There  are six main types of psoriasis:

Plaque  Psoriasis (Psoriasis Vulgaris)   About  80 percent of people diagnosed with the disease have plaque psoriasis, or  psoriasis vulgaris. Plaque psoriasis often appears as on the elbows, knees, and  lower trunk in the form of raised, red lesions topped with silvery scales.

Guttate  Psoriasis   Usually  found on the limbs or trunk, guttate psoriasis primarily appears in patients  younger than age 30. Guttate psoriasis presents as small, water-drop-shaped  sores and can occur because of an illness or injury to the skin.

Inverse  Psoriasis    With  inverse psoriasis, patients develop smooth, shiny lesions that are bright red  in color. Most often seen in people who are overweight, inverse psoriasis  strikes the armpits, around the genitals, near the groin, and under the  breasts.

Pustular  Psoriasis   When  you have pustular psoriasis, white blisters filled with pus and surrounded by  red skin will appear either in localized areas or all over your body. Because  the pus is made of white blood cells, it is not contagious. Certain things can  trigger pustular psoriasis, such as irritating topical treatments, infections,  overexposure to ultraviolet radiation, and stress.

Erythrodermic  Psoriasis   Characterized  by a fiery red rash coupled with extreme burning or itching, erythrodermic  psoriasis is the least common kind of psoriasis. Triggers for erythrodermic  psoriasis include severe sunburn, corticosteroids, other medications, or  another type of psoriasis that has flared up.

Psoriatic  Arthritis   In  addition to causing pitted, discolored nails, psoriatic arthritis also presents  with the swollen, painful joints that often accompany arthritis. Usually psoriatic  arthritis isn’t as crippling as other forms of arthritis, but it can cause  stiffness and progressive joint damage.

Treatments for  Psoriasis

Currently,  no cure exists for psoriasis. Treatments are designed to minimize discomfort  and encourage healing. When determining the best treatment, your doctor will  take into account the severity of the psoriasis. Mild to moderate psoriasis covers  3 to 10 percent of your body, while psoriasis is considered moderate to severe  when it covers more than 10 percent.

Treating Mild to  Moderate Psoriasis   If  you have mild to moderate psoriasis, your doctor will likely recommend a  combination of over-the-counter medications, prescription topical treatments,  and light therapy/phototherapy.

Over-the-Counter  (OTC) Medications   The  two active ingredients in over-the-counter medications approved by the FDA for  psoriasis are coal tar, which inhibits the quick overgrowth of cells, and salicylic  acid, which makes the outer layer of skin shed. Other OTC treatments may help,  like:

  • Scale lifters to loosen and eliminate scales so that medicine can penetrate the sores
  • Bath solutions, such as Epsom salts, Dead Sea salts, or oilated oatmeal, that reduce itching and remove scaling
  • Occlusion, which covers the areas treated with topical treatments applications, to improve absorption and effectiveness
  • Anti-itch products like calamine lotion or hydrocortisone creams
  • Moisturizers to keep skin hydrated, reduce symptoms, and encourage healing

Prescription Topicals   Designed  to inhibit the overgrowth of cells and lessen inflammation, prescription topicals  include:

  • Anthralin, which reduces the skin cell growth related to plaque
  • Calcipotriene will flattens lesions, removes scales, and slow cell growth. Often used in treatment of psoriasis on the scalp and nails.
  • Calcipotriene and Betamethasone Dipropionate. By combining Calcipotriene with betamethasone dipropionate, this treatment addresses the itch and inflammation common to psoriasis as well as flattening lesions, removing scales, and minimizing cell growth.
  • Calcitriol, an active form of vitamin D3, helps limit extraneous skin cell production
  • Tazarotene, a topical retinoid that slows down cell growth
  • Topical steroids are the most commonly used medications for psoriasis, and they work by reducing inflammation, swelling, and redness

Phototherapy (light  therapy)   Exposure  to ultraviolet light can provide relief from psoriasis. With careful  monitoring, the UVA and UVB rays from the sun can reduce symptoms. Excimer  lasers treat specific areas affected by psoriasis, while pulse dye lasers  provide not only targeted treatment, but also destroy the blood vessels that  promote the development of psoriasis.

In  certain cases, exposure of the skin to ultraviolet light can help control  psoriasis. Both the UVA and UVB rays from sun light can alleviate the symptoms  of psoriasis but the exposure should be in short, controlled sessions.

PUVA  treatment combines a photosensitizing drug (psoralens) with UVA light exposure  and can take two to three weeks of sessions to see a change

Treating Moderate to  Severe Psoriasis   For  patients with moderate to severe psoriasis, treatment involves prescription  medications, biologics and phototherapy (light therapy).

Prescription Medications   Based  on the location, severity, and type of psoriasis, your doctor will prescribe an  oral medication, such as acitretin, cyclosporine and methotrexate.

Biologics Generally  reserved for the most severe cases of psoriasis, biologics are a new class of  injectable drugs that suppress the immune system. Biologics tend to be  expensive and have various side effects.


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Atopic Dermatitis

Atopic Dermatitis Characterized  by irritated, inflamed, itchy patches of skin, the diagnosis of atopic  dermatitis is often used interchangeably with the diagnosis of eczema.  Estimates suggest that between 10 to 20 percent of the world’s population  suffers from atopic dermatitis. Anyone with allergies, asthma, or a family  history of eczema-like conditions may have an increased risk of developing  atopic dermatitis. You cannot catch atopic dermatitis from someone else.

Causes   Thought  of as a skin allergy or sensitivity, atopic dermatitis has no specific cause.  Atopic dermatitis is related to how your immune system responds to contact with  germs and allergens. Genetics and environmental factors seem to play a role in  the development of atopic dermatitis. Certain things can trigger a flare up of  the condition including climate, temperature, irritants, stress and infection.  Most cases of atopic dermatitis develop during the first year of life, and many  resolve themselves by 18 to 24 months. Some people live with constant cycles of  remission and recurrence throughout their lifetime.

Symptoms   With  atopic dermatitis, the skin typically develops itchy patches and inflammation  that leads to swelling, redness, cracking, crusting, weeping and scaling.  Usually atopic dermatitis appears on the face, wrists, hands, folds of the arms  and the back of the knees. The itchiness and inflammation often cause  scratching which worsens the condition of the skin.

Treatments   Although  no cure exists for atopic dermatitis, various therapies can help manage the symptoms.  Often doctors recommend moisturizers to reduce dryness, antihistamines to  reduce itching, corticosteroids to control inflammation and immune modulators  to suppress the skin’s reaction. If a secondary infection develops because of  cracking or scratching, your physician will prescribe a topical or oral  medication to resolve the issue.

Prevention   Following  these tips can help reduce symptoms and manage atopic dermatitis:

  • Avoid known triggers
  • Bath in lukewarm water
  • Choose light-weight cotton clothing
  • Frequently apply moisturizers to skin
  • Keep fingernails short
  • Stay cool
  • Wear hand mitts while you sleep
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