EDUCATION

WHAT IS PSORIASIS Psoriasis is a common and recurring condition in which the skin develops red patches of various sizes, covered with dry, silvery scales. Most often , it affects the scalp, the trunk of the body and the outer side of the arms and legs, especially the elbows and knees. The palms and soles may also be involved. Fortunately, the face is usually spared.

WHAT CAUSES PSORIASIS Though psoriasis is one of the oldest skin conditions known to man and was even around in Biblical times, its cause is still unknown. But we do know something about its development. The "epidermis", or outer layer of our skin, is constantly manufacturing new cells and shedding old ones. In psoriasis, it is thought that some defect on the enzymes of the skin surface, takes about 28 days. In psoriasis, this process is speeded up to 4 or 5 days. Instead of shedding inconspicuously, the outer cells form scales which remain heaped up on the skin.

CAN ANYBODY DEVELOP PSORIASIS There are some factors that seem to determine who is most likely to get psoriasis, and possibly the most important of these is heredity. Often, the person with psoriasis has a parent or grandparent who also has the condition. In terms of probability it has been estimated that a person with one affected parent has about a 10% chance of also being affected. Having two parents with psoriasis increases the chances to about 30%.

HOW IS PSORIASIS DIAGNOSED The white, silvery scales of psoriasis are so distinctive that it is relatively easy to diagnose.Where the scales are not evident, as often occurs in people who bathe and scrub frequently, scratching the lesions will show the typical scales. Further scratching will show bleeding pinpoints, which are also characteristic of the disease. In about a quarter of all cases, the nails may also show peculiar changes. There may be pitting. Or the nails may be thickened, yellowish or opaque, with ridges and scales heaped up at the free edge. These characteristics, plus the distribution of the scaly patches on the body and the family history, will lead to the diagnosis. In cases of doubt, a biopsy - that is, the microscopic examination of tiny piece of skin removed under local anesthesia - will provide confirmation.

WHAT DIFFERENTIATES PSORIASIS OF THE SCALP FROM PLAIN DANDRUFF Dandruff covers most of the scalp, while psoriasis occurs in patches, with normal scalp in between. Passing your finger over your scalp, you cannot feel dandruff; you only see the flakes on your shoulders. But you can feel the psoriatic lump caused by heaped up scales held together by the hairs.

WILL PSORIASIS ON THE SCALP CAUSE LOSS OF HAIR No, it will not. Some hairs may break when squeezed by the scales. But the roots, which are deep down in the skin, are not affected. So, once your scalp is clear, the hair will grow as healthy as before.

WHAT IS THE IMPORTANCE OF "NERVES" IN PSORIASIS "Nerves" do not cause psoriasis and seldom trigger the first attack. But they can aggravate and perpetuate the disease. For instance, the patches or "plaques" of psoriasis may clear up during a restful vacation on a sunny beach... only to relapse when you return to the pressures and stress of a responsible job.

DO INFECTIONS AFFECT PSORIASIS Streptococcal sore throat in children often triggers an attack of psoriasis. This is usually of a peculiar type called "guttate", meaning "drop-like" in Latin. The red, flaky lesions - instead of being solid patches - are round and small and resemble drops of water sprinkled over the body. In addition, an adult with chronic psoriasis may develop a flare-up after a strep throat infection. This reaction develops about two weeks after the infection, which may indicate that it is of an allergic nature. However, this is the only evidence that allergy may play a role in psoriasis.

DO HORMONES AFFECT PSORIASIS We know that there is some relationship between psoriasis and hormonal changes in different stages of life, but we don't know exactly what it is. In both men and women, psoriasis develops more frequently or gets worse at puberty, and there is another smaller peak at menopause. Often the lesions improve or disappear during pregnancy, only to reappear after childbirth.

HOW ABOUT DIET At present, diet is thought to play only a small role in psoriasis. Some dermatologists like their patients to reduce their intake of greasy food. In general, obese individuals respond better to therapy if they lose weight. And some people have flare-ups following an excess of alcoholic drinks. In general, a well balanced diet is advisable in people with psoriasis, just as it is in everyone.

WHAT IS THE ROLE OF CLIMATE AND SUNLIGHT Hot, humid environments tend to make bad cases of psoriasis worse. In contrast, sunlight and dry, sunny climates, as a rule as helpful - particulary in mild cases. In temperate climates, where sunlight is not available all year, artificial ultraviolet light is frequently used in the treatment. One time-tested, effective therapy combines the application of a preparation containing coal tar, followed by exposure to an ultraviolet lamp. Recently, investigations with a substance taken by mouth, followed by exposure to a special source of ultraviolet light have given encouraging results.

THEN A DAY AT THE BEACH WOULD BE THERAPEUTIC Only if you are careful. Exposure to sunlight or artificial ultraviolet light should always be done cautiously and in moderation. The exposure shold be just enough to cause a mild redness the first time, then gradually and carefully increased on subsequent occasions. Prolonged exposure to sunlight, such as being at the beach all day, may do considerable harm, especially if you are fair-skinned. A severe sunburn may actually cause the psoriasis to spread all over the sunburned areas.

WHY DOES THAT HAPPEN In some people with psoriasis, an unusual phenomenon may take place: superficial injury to normal skin may cause it to develop a patch of psoriasis at the injury site. Bad sunburn is one such injury. Others can be scrapes and scratches.

WHAT CAN I EXPECT FROM TREATMENT In general, the course of psoriasis is unpredictable and irregular. Nevertheless, under treatment, the plaques will frequently disappear entirely, or the disease will retreat to a few spots on elbows or knees. These minimal spots, or some slight pitting on the nails may remain minimal for years. Then, under severe stress, or for some other, unknown reason, the rash may again blossom over the body... again requiring aggressive treatment to hasten its retreat. This erratic course may go on for years, often with long periods of freedom from skin trouble.

IS IT TRUE THAT PSORIASIS IS INCURABLE That depends on what you mean by the word "cure". If we mean that a "cure" is to make a disease disappear and never return, than many diseases are incurable, including the common cold. If by "cure" we mean to make the symptoms disappear, then psoriasis is often curable. It may take time. And certainly it takes patience and preserverance. Of course, individuals with a tendancy to psoriasis may develop new lesions months or years later, just as those with a tendency to cold may develop another one any time in the future.

WHAT KIND OF TREATMENT WILL THE DOCTOR PRESCRIBE Naturally, your doctor knows best what is likely to help your particular case. He or she will study your psoriasis and choose the measure or measures that seem most suitable. Routine measures may include local preparations made from coal tar or cortisone derivatives that you massage into your skin. You may even be told to cover some areas of your body or leave them uncovered. Your doctor may also inject medication into a psoriasis plaque in order to speed recovery. And the "lamp" treatments mentioned before may also be used.

WHAT CAN I DO TO HELP Cooperate fully with your doctor. Set aside a certain amount of time daily for treatment. Massage the prescribed preparations into the affected skin without fail and in accordance with your physican's directions. Try not to scratch. Any itching will probably be minimal, and your doctor can prescribe a locally applied cream or ointment to relieve it. Avoid quick "cures", often widely advertised. Expensive quack therapies which are said to have worked wonders for somebody else are likely to fail when you use them. Your doctor may tell you to avoid situations of stress that may aggravate the condition. Above all, be patient. Do not get discouraged if progress is slow, if you are more stubborn than the disease, you can control it, make it disappear, or at least, keep it to a minimum. Do not allow it to run your life!

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