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How can I deal with these scales?

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Friday, December 31, 2010

How can I deal with these scales?

Psoriasis is an autoimmune disease that affects the life cycle of skin cells so they build up quickly, layering on top of each other, and it causes thick scaly skin, and or areas of dry, red, itchy patches.  It is a chronic disease and it has periods of latency (no problems at all )and then flare ups, which can have all sorts of different triggers. And, it can also be associated with arthritis, which can be super painful. There is no cure for psoriasis, unfortunately. The key is learning what are your triggers, what treatments work best with your lifestyle/beliefs, and how to live with this disease.

What are the symptoms?
- Red cracked skin that may have silvery patches
-dry, cracked skin that may bleed
-itching, burning, and soreness along these dry skin
-swollen joints
* they can range from small spots of these areas to large patches and can be on your scalp under your hair, and affect your hands and nails.

What IS actually happening?
It is an immune system response.  In your blood, you have White Blood Cells (WBCs) that are the fighters; when they sense any sort of pathogen (attack on your system from a virus, bacteria, etc) they go to the site, and attack. One of the types of WBCs is a T cell, the true surveyors of the body that go around and attack and kill any foreign substance as the first line.  When you have overactive T cells, the cells attack your skin cells as if they were any other virus or bacteria despite the fact that they are normal healthy cells that are NOT a risk to your system.  So, the t cells attack, then more WBC's come to the area and also attack (can cause swelling) then the body produces new skin cells, and this is a constant cycle; this forms the scaly plaques because as soon as your body is creating healthy cells, your T cells are attacking.  The dead skin cells and WBCs cannot slough off quickly enough and young new skin cells move to the outer most layer of the epidermis too fast....the cycle of skin cells dying and renewing goes from weeks to days, like a fast forward for your skin.  

What  causes psoriasis?
True causes of psoriasis are unknown BUT there are certain "causative factors" that are thought to possibly start a reaction.
-Infections (strep)
-Injuries (cuts, scrapes, bug bites, sunburns, burns)
-weather (cold)
-Alcohol use
-medications (lithium, certain beta blockers for high blood pressure, and anti-malarial pills)

Does anything put me at risk?
-Family history of psoriasis
-Medical history (HIV, chronic infections, etc)

Are there any complications?
Due to the nature of the disease, it can cause depression (from altered body image), constant pain/discomfort, bacterial infections (from scratching at the skin and allowing bacteria in), stress, anxiety, and possible isolation (because especially if on the face people don't feel comfortable with others).

You are diagnosed by your HCP usually by physical exam as well as from what you tell your HCP about your symptoms and how they show up, if they come and go, etc.  There are a few other skin disorders that can mimic psoriasis: sebhorric dermatitis, pityriasis rosea, and ringworm of the body (tinea corporis).  

Medical Treatment options:
Topical treatments: corticosteroids (anti-inflammatory drugs), Vitamin D analogues (slow the growth of skin cells), Anthralin (normalizes DNA in cells and can remove scales form the skin), retinoids (Vitamin A which can decrease inflammation and normalize DNA in cells), calcineurin inhibitors (alter and slow T cell activity- but not yet FDA approved for psoriasis treatment),  salicylic acid (promotes sloughing of skin and helps to remove plaques), coal tar (the oldest treatment, decreases inflammation, scaling, and flaking...but it is smelly and a pretty gross treatment), & regular moisturizers (they can help with the dryness, itchiness, and cracking of the skin).

Light therapy (phototherapy): UV rays (kill the T cells therefore they are unable to activate and slows the cycle), UVB treatment (needs to be done supervised and will start with 2-3 times weekly then decrease to maintenance exposure to prevent the cycles from re-starting), & photochemotherapy (apply a UV sensitive medication and then expose to sunlight- a very aggressive treatment and significantly increased the risk of melanoma).

Oral/Injected Medications: Retinoids (vitamin A medications- can cause birth defects for up to three years after taking the medication, and help to normalize the DNA function), Methotrexate (decreases inflammation and decreases production of skin cells), cyclosporine (decreases the immune system, therefore the immune response), Immunomodulator drugs (like Enbrel or Remicade- are used for people who have failed other treatments and/or have psoriatic arthritis and they block certain interactions within the immune system).

What can I do to make living with psoriasis easier?
- Daily baths help to soften and remove scales, and adding bath oils or other emulsions softens and soothes the skin.
-Use heavy, thick moisturizers frequently throughout the day (especially in the cold) can use OTC like Cetaphil or Goldbond
-Use a moisturizer before bed and wrap the affected areas in saran wrap and/or use specialty gloves/socks for hands and feet.
-Expose your skin (with SPF 15 or above) to sunlight for small amounts of time (if possible) ** this is NOT an excuse to go to tanning beds for everyone, but talk to your HCP about how best to expose your skin to treat your psoriasis
-Avoid alcohol and smoking
-Try to make time for yourself to relax and de-stress

Alternative therapies:
-Taking Omega-3 supplements is thought to decrease inflammation, although the research is not all that great, but it is worth a try, and I see no harm.
-Capsaicin cream (an extract from chili peppers) can help to decrease itchiness and reduce the severity
-Aloe vera (topically) can decrease redness, itchiness, scaliness, and soothe the skin.

Despite this being a chronic disease, there are very clearly different levels of the disease and tons of different treatment options, you just need to work with your HCP and find what works best for you, your lifestyle, and your level of disease.  And, with all the therapies out there, you may even be told to go out and sunbathe....I wouldn't mind that!!

Yours in Good Health



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