PSORIASIS

PSORIASIS – is characterised by distinctive salmon-pink or red
scaly patches. These usually have well-defined edges. The scaly parts tend
to be silvery-white in colour, unless they appear in skin folds, when they look smooth
and shiny. Patches of psoriasis are often symmetrical, affecting both sides of the body.
Itching is mild in most cases.

Psoriasis usually starts in young adults. About half the people who have psoriasis will
know of another affected family member. Affected skin is replaced much more rapidly
than normal and has a more vigorous blood supply than normal, which can lead to redness,
scaling, thickening and itching.

Psoriasis can be brought on or made worse by stress, scratching, rubbing, injury, some
medications (lithium, beta-blockers for high blood pressure, anti-malarials, or when you
stop taking oral corticosteroids or using strong corticosteroid creams) and some infections.
It is not contagious and it is not due to an allergy.

Any part of the skin can be affected, including nails, which can thicken, become pitted,
ridged and discoloured. Many cases are very mild, but can be unsightly. Once it starts,
it tend to continue, but it can get better or worse, or even disappear for long periods.
When it clears up, it can leave pigmentation marks on the skin.

Sunlight can help clear psoriasis up unless yours is the sun-sensitive kind. High alcohol
consumption and smoking are linked to severe, treatment-resistant psoriasis.

TREATMENT
Psoriasis can be difficult to treat, but symptoms can usually be controlled. There are
many different forms of psoriasis, and no one treatment helps all sufferers. Thus
treatments tend to be used in rotation or in combination. Many new treatments being
developed target the abnormal immune response associated with the disease.

Tar and oil baths, medicated shampoos and regular use of a moisturiser all help.

Steroid (cortisone) ointments help reduce inflammation and irritation. (Problems with
prolonged use of these ointments can include thinning of the skin. The skin may also
build up resistance. Steroid ointments are best used for short courses, or as ‘pulse’
treatment for a few days at a time.)

Coal tar and pine tar have been used for psoriasis for more than a century. They smell
 strongly, stain clothing and can cause sensitivity to sunlight, so should not be used
immediately before spending time in the sun. Refined tars come in cream, ointment, gel,
and stick bases.

Calcipotriol is a medication related to vitamin D and care has to be taken that this
treatment does not increase calcium levels in the blood.

Dithranol (anthralin) is made from tree bark and applied as a thick ointment. It is left
on overnight under dressings, or in more concentrated form for about 10 minutes, and
then removed. It can irritate skin and discolour it in the short term, so is not used on
very sensitive-skinned people, in body folds or on the face.

Ultraviolet light treatment can be effective when creams have failed. Such phototherapy
should be carried out in a specialist medical facility to minimise burning and cancer risks.
Its disadvantages are that you will need several treatments a week over several weeks
or months, and it can cause long-term damage to the skin. This treatment is available
at some hospitals, the Skin and Cancer Foundation and at some dermatology practices.

Oral treatments in tablet form are available when psoriasis is widespread or interferes
with normal functioning, but all have side effects. Treatments, including methotrexate,
acitretin and cyclosporin, are generally effective at controlling even severe psoriasis, but
skilled monitoring is required.

Complementary Treatments
Non-medical treatments have been tried, but most have benefited only a small number
of patients.

One success story is a lubricating ointment used on the udders of milking cows. Any
cream with moisturising properties can help.

Homeopathic solutions are tailored to each case, but may include sulphur for dry, red,
and itchy patches, graphites if the skin has a sticky discharge, and petroleum if the
skin is sensitive, cracked and bleeding.

Diet has not been found to be a significant factor in controlling psoriasis, but obesity
that causes large skin folds can make the condition more difficult to manage.

Self help treatments include soaking in warm baths with a bath oil or tar solution,
which can soften the psoriasis and lift the scaling. Bland soaps or substitutes are
useful. Antiseptics are unnecessasry and may irritate the skin.

Even if you are not using medicated preparations, you should use moisturisers to keep
the psoriasis soft and to prevent cracking and soreness. Vaseline, emulsifying ointment
and sorbolene are suitable. Waterproof dressings can sometimes help small patches of
psoriasis.

Rest, particularly bed rest, can help in difficult cases. In up to 8% of cases, psoriasis
can lead to arthritis.

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