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“Each morning, I vacuum my bed. My torture is skin deep: there is no pain, not even itching; we lepers live a long time, and are ironically healthy in other respects. Lusty, though we are loathsome to love. Keen-sighted, though we hate to look upon ourselves. The name of the disease, spiritually speaking, is Humiliation.” John Updike. From the journal of a leper.
– The New Yorker, July 19, 1986, 28-33.
soriasis is a stubborn, chronic, and as yet incurable disease of the skin. Some eight million people – 150,000 new cases annually – suffer from psoriasis in the United States alone. And they spend more than one billion dollars a year ($2000 every minute!) to treat this poorly understood ailment.
Psoriasis – the word comes from the Greek psora, which means itch – was considered a form of leprosy in biblical times. But this “disease of healthy people,” doesn’t threaten or shorten lives. It is neither an infection nor an allergy. It probably is not due to any vitamin or mineral deficiency. It doesn’t leave scars or make you lose your hair. And, except in severe cases, it doesn’t interfere with physical activities. (In fact, it may not even itch). To the psoriasis sufferer, however, it can be an emotionally disabling and traumatic disorder leading to considerable psychological difficulties, functional declines, disruption of lifestyle, interpersonal problems and, consequently, a diminished quality of life. One study found that almost one quarter of psoriasis patients have contemplated suicide because of their inability to cope with the disease.
Patches of raised, red skin covered by silvery-white scales characterize psoriasis. It can occur at any age, but commonly begins in young adulthood. The natural history of psoriasis is marked by frequent flares and remissions. It usually recurs at unpredictable intervals and may be worse in the winter. It is often precipitated or aggravated by physical or emotional stress, upper respiratory infections, strep throat, viral infections, AIDS, alcoholic beverages, obesity, certain oral medications (lithium, beta-blockers, ACE-inhibitors, and anti-malarial drugs are but a few), and skin injuries such as scratches, cuts, and burns – including sunburn.
Psoriasis is not contagious. It does seem to run in families – about one-third of psoriatic patients have a family history of the condition – although the pattern of heredity is not clear. If, however, both your parents have psoriasis, the chances are 50-50 that you, too, will inherit it. Psoriasis is also associated with a form of arthritis that affects the joints of the fingers. Up to thirty percent of people with psoriasis have symptoms of arthritis of various joints.
No one knows the cause of psoriasis, but we do know how it comes about. Normal skin cells have a life span of about twenty-eight days. This is the time it takes for a cell to be born, move to the outer surface of the skin, and flake off.
In psoriasis, due to some abnormality in the mechanism, which makes the skin grow and replace itself, this orderly process goes awry. The skin cells develop, reproduce, and die at a rate ten times faster than the normal cells, causing a build-up of scales in thick and sharply-bordered patches. These layers of dead skin form silvery-looking plaques that are shed in clumps, leaving the skin beneath red and sore looking. These patches may be small – the size of a matchhead or smaller – or extremely large, covering the entire body; if they appear in the body’s creases and folds, they may cause itching and pain. Although psoriasis can affect any part of the skin, the patches usually occur on the elbows, knees, and scalp.
Psoriasis comes in many shapes and forms. It can, for example, limit itself to the fingernails and toenails as small pits or stippling or loosening of the nails from their beds. In some unfortunate people, it affects the genital area and can limit sexual activity. In extreme cases, it is widespread, with painful cracks and total body redness and scaling, causing severe embarrassment. This, in turn, can lead to psychological problems: the true “heartbreak” of psoriasis.
Psoriasis is one of the most difficult of all chronic skin disorders to manage. Therapies that seem to be successful can suddenly stop being effective. Psoriasis can go into spontaneous remission and disappear only to reappear just as abruptly.
If you have psoriasis, there are some remedies you can try yourself. But for serious or stubborn cases, I recommend you see your dermatologist. There are many treatments, both old and new, that require a doctor’s know-how.
The method of treatment depends on the extent and severity of the symptoms. An old standby is one of the various types of tar preparations that have been used with good results by thousands of psoriasis sufferers. Other methods are sunlight and ultraviolet radiation. There are also cortisone-like medications that are applied or injected into the patches. These cortisone-like preparations are the most widely used topical modality for psoriasis and generally work to reduce any associated itching.
In addition, there are various oral remedies that, while often effective, may have potentially serious side effects. One of these is methotrexate, a drug that has been used for many years to treat difficult and extensive cases of psoriasis. Nausea, mouth ulcers, headaches, and harmful effects on the liver or kidneys often complicate treatment with methotrexate.
Another powerful oral medication for severe and stubborn psoriasis is a pill called acitretin (Soriataine). It is extremely effective for the severe, generalized forms of psoriasis, but there are many serious, adverse side effects. If you plan to enter into this therapy, make sure your dermatologist explains it to you. One of the latest treatments aims at regulating the immune system with cyclosporine (Neoral), a drug that’s used as an immunosuppressant in organ transplant patients.
Every new treatment for psoriasis becomes headline news. Most of these “miracle treatments” quickly fall into disfavor or are discarded when another “breakthrough” is heralded. One of the earlier popular treatments – PUVA therapy – is aimed at slowing down excess cell reproduction. The patient swallows a relatively harmless drug called methoxsalen and then is exposed to longwave ultraviolet light. The proponents of this therapy swear by it, and today it has become a fairly common treatment for people with extensive psoriasis. There is some indication, however, that the PUVA treatment can lead to severe skin damage appearing many years later. Another reported treatment, called climatotherapy, consists of bathing in the Dead Sea!
One of the recent developments in the topical treatment of psoriasis is a relative of vitamin D, which acts by slowing the growth of excessive skin cells and cell division. Called calcipotriene, this entirely new class of medication has gained fairly widespread acceptance for the management of patches of psoriasis, and in many published clinical trials, calcipotriene – the trade names for which are Dovonex Cream and Ointment – has compared favorably with many cortisone-like surface medications. Dozens of clinical studies have vouched for the safety and efficacy of calcipotriene in psoriasis. Another relatively new topical medication is tazoratene (Tazorac Gel) that also acts like the above-mentioned calcipotriene. Both Dovonex and Tazorac are prescription medications.
Another innovation is treating the psoriatic patches with the “excimer laser” which purports “to produce a much more rapid response, making it much more convenient for the patient.” But the jury is still out on this method.
And for those of you who are discouraged by the progress of your treatments, just be aware that more than forty experimental drugs are currently being tested to control this cosmetic scourge.
A stubborn form of psoriasis – on the scalp – occurs in about fifty percent of those suffering from the disorder. Difficulties in the treatment of scalp psoriasis arise because the presence of hair makes treating the lesions more challenging. Various shampoos, lotions and gels containing tar, salicylic acid, and cortisone-like products are usually recommended by dermatologists, but it’s most important to shampoo on a daily basis. (This, needless to say, is often very difficult for women with scalp psoriasis.) A new topical mousse – Olux Foam – is another shampoo treatment with a novel delivery system that seems to cure the itching in a large percent of the people using it.
But let’s face it: while many of these treatments can help relieve the itching and scaling, there is no known “cure” for psoriasis. The cure will come about only when we know the exact nature and mechanism of the disease.
And while you must face the possibility that psoriasis will be a permanent guest in your life, let me offer some general guidelines to help you overcome the difficulties that accompany your condition:
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For further information about psoriasis, write to: National Psoriasis Foundation 6600 SW. 92nd Avenue – Suite 300 Portland, OR 97223-7915 800-723-9166; (503) 244-7404 E-mail: getinfo@npfusa.org www.psoriasis.org www.aad.org/pamphlets/ 1-888-462-DERM x22 |
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| TREATING PSORIASIS |
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For generalized or widespread psoriatic patches, tar baths are very helpful, provided you are not allergic to tar. Try one of the following tar preparation in your bath:
Cutar
Balnetar
Directions for use are on the labels.
Various tar medications can be very helpful in controlling localized patches of psoriasis. They are safer and less expensive than the strong cortisone-type preparations. However, they all stink, sting, and stain. The following are two of the more popular and effective tar preparations:
Tegrin Skin Cream
Cortizone 10 Creme
Directions on the label.
For psoriasis of the scalp, a stubborn area to treat, it is important to shampoo often (daily or twice daily!) and thoroughly. Effective shampoos include those with tar. Try any of the following and find out which is best for you:
Tarsum Shampoo
T-Gel Shampoo
DHS Tar Shampoo
Directions for each are on the labels.
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