Psoriasis

[patoco]

Psoriasis

Lymphedema People

http://www.lymphedemapeople.com

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Psoriasis rounds out the "big three" that those of us with lymphedema seem to deal with the most, with the others being dry skin and eczema.

I thought it would be helpful to have some information on it and here is an article from PsoriasisNet.

http://www.skincarephysicians.com/psori ... hatis.html

What is Psoriasis?

Psoriasis is an inflammatory skin condition. There are five types, each with unique signs and symptoms. Between 10% and 30% of people who develop psoriasis get a related form of arthritis called “psoriatic arthritis,” which causes inflammation of the joints.

Plaque psoriasis is the most common type of psoriasis. About 80% of people who develop psoriasis have plaque psoriasis, which appears as patches of raised, reddish skin covered by silvery-white scale. These patches, or plaques, frequently form on the elbows, knees, lower back,
and scalp. However, the plaques can occur anywhere on the body.

The other types are guttate psoriasis (small, red spots on the skin),
pustular psoriasis (white pustules surrounded by red skin), inverse psoriasis (smooth, red lesions form in skin folds), and erythrodermic psoriasis (widespread redness, severe itching, and pain).

Regardless of type, psoriasis usually causes discomfort. The skin often itches, and it may crack and bleed. In severe cases, the itching and discomfort may keep a person awake at night, and the pain can make everyday tasks difficult.

Psoriasis is a chronic, meaning lifelong, condition because there is currently no cure. People often experience flares and remissions throughout their life. Controlling the signs and symptoms typically requires lifelong therapy.

Treatment depends on the severity and type of psoriasis. Some psoriasis is so mild that the person is unaware of the condition. A few develop such severe psoriasis that lesions cover most of the body and hospitalization is required. These represent the extremes. Most cases of psoriasis fall somewhere in between.

Who Gets Psoriasis

More than 4.5 million adults in the United States have been diagnosed with psoriasis, and approximately 150,000 new cases are diagnosed each year. An estimated 20% have moderate to severe psoriasis.

Psoriasis occurs about equally in males and females. Recent studies show that there may be an ethnic link. It seems that psoriasis is most common in Caucasians and slightly less common in African Americans. Worldwide, psoriasis is most common in Scandinavia and other parts of northern Europe. It appears to be far less common among Asians and is rare in Native Americans.

There also is a genetic component associated with psoriasis. Approximately one-third of people who develop psoriasis have at least one family member with the condition.

Research shows that the signs and symptoms of psoriasis usually appear between 15 and 35 years of age. About 75% develop psoriasis before age 40. However, it is possible to develop psoriasis at any age. After age 40, a peak onset period occurs between 50 and 60 years of age.

About 1 in 10 people develop psoriasis during childhood, and psoriasis can begin in infancy. The earlier the psoriasis appears, the more likely it is to be widespread and recurrent.

Psoriatic arthritis develops in roughly one million people across the United States, and 5% to 10% experience some disability. Psoriatic arthritis usually first appears between 30 and 50 years of age — often months to years after skin lesions first occur. However, not everyone who develops psoriatic arthritis has psoriasis. About 30% of people who get psoriatic arthritis never develop the skin condition.

Causes

Psoriasis may be one of the oldest recorded skin conditions. It was probably first described around 35 AD. Some evidence indicates an even earlier date. Yet, until recently, little was known about psoriasis.

While scientists still do not fully know what causes psoriasis, research has significantly advanced our understanding. One important breakthrough began with the discovery that kidney-transplant recipients who had psoriasis experienced clearing when taking cyclosporine. Since cyclosporine is a potent immunosuppressive medication, this indicates that the immune system is involved.

Immune Mediated. Researchers now believe that psoriasis is an immune-mediated condition. This means the condition is caused by faulty signals in the body’s immune system. It is believed that psoriasis develops when the immune system tells the body to over-react and accelerate the growth of skin cells. Normally, skin cells mature and are shed from the skin’s surface every 28 to 30 days. When psoriasis develops, the skin cells mature in 3 to 6 days and move to the skin surface. Instead of being shed, the skin cells pile up, causing the visible lesions.

Genes. Researchers have identified genes that cause psoriasis. These genes determine how a person’s immune system reacts. These genes can cause psoriasis or another immune-mediated condition, such as rheumatoid arthritis or type 1 diabetes. The risk of developing psoriasis or another immune-mediated condition, especially diabetes or Crohn’s disease, increases when a close blood relative has psoriasis.

Family History. Some people who have a family history of psoriasis never develop this condition. Research indicates that a “trigger” is needed. Stress, skin injuries, a strep infection, certain medications, and sunburn are some of the known potential triggers. Medications that can trigger psoriasis are anti-malarial drugs, beta-blockers (medication used to treat high blood pressure and heart conditions), and lithium. Dermatologists have seen psoriasis suddenly appear after a person takes one of these medications, gets a strep infection, or experiences another trigger.

Psoriasis research continues to accelerate at a rapid pace and will continue to advance our knowledge of what causes psoriasis.

Quality of Life

All types of psoriasis, ranging from mild to severe, can affect a person’s quality of life. Living with this lifelong condition can be physically and emotionally challenging.

Itching, soreness, and cracked and bleeding skin are common. Nail psoriasis can be painful. Even the simple act of squeezing a tube of toothpaste can hurt. One woman described her psoriasis as feeling like “a bad sunburn that won’t go away.”

Several studies have shown that people often feel frustrated. In some cases, psoriasis limits activities and makes it difficult to perform job responsibilities. The National Psoriasis Foundation reports that 56 million work hours are lost each year by those who have psoriasis. Additionally, a survey conducted by the National Psoriasis Foundation in 2002 indicates that 26% of people living with moderate to severe psoriasis have been forced to change or discontinue their normal daily activities.

Studies also have shown that stress, anxiety, loneliness, and low self-esteem are part of daily life for people living with psoriasis. One study found that thoughts of suicide are three times higher for psoriatics than the general population.

Embarrassment is another common feeling. Imagine getting your hair cut and noticing that the stylist or barber is visibly uncomfortable. What if you extended your hand to someone and the person recoiled? How would you feel if you spent most of your life trying to hide your skin?

Treatment Advances Improve Outlook
With the emergence of several new therapies, including the biologic agents, more people are experiencing substantial improvements and reporting a greatly improved quality of life.

References:
American Academy of Dermatology. “American Academy of Dermatology’s Psoriasis Public Awareness Campaign Provides Latest Information About this Skin Condition.” Available at: http://www.newswire1.net/NW2004/C_AAD_C ... index.html. Accessed April 26, 2005.

American Academy of Dermatology. Psoriasis. Available at: http://www.aad.org/public/Publications/ ... riasis.htm. Accessed April 26, 2005.

Bowcock, A et al. “Genetics of psoriasis: The potential impact on new therapies.” Journal of the American Academy of Dermatology. 2003 August;49(2):S51-6.

Gupta MA et al. “Suicidal ideation in psoriasis.” International Journal of Dermatology. 1993 March;32(3):188-90

Holsinger, L. “A battle with my skin.” Journal of the American Academy of Dermatology. 2004 July;51(1)S41-42.

Hurley, HJ. “Papulosquamous Eruptions and Exfoliative Dermatitis” in Dermatology. Philadelphia, PA: W.B. Saunders Company; 1975.

Lebwohl, M. “Innovations in the treatment of psoriasis.” Journal of the American Academy of Dermatology. 2004 July;51(1)S40-41.

The Lewin Group, Inc. The Burden of Skin Diseases. Prepared for the Society for Investigative Dermatology and the American Academy of Dermatology Association. 2005. Available at: http://www.newswire1.net/NW2005/C_AAD_C ... 05/assets/
downloads/printfriendlyskin.pdf. Accessed June 21, 2005.

National Psoriasis Foundation. Psoriasis and Psoriatic Arthritis: Treatment Guide for the Health Insurance Industry. 2004.

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Psoriasis

Mayo Clinic

Introduction

Millions of people, among them novelist John Updike and the actor Jerry Mathers — best known for his long-running television role as Beaver Cleaver — suffer from psoriasis, an inflammatory disorder that affects the skin and nails. Psoriasis is marked by patches of thick, red skin covered with silvery scales that occur primarily on your elbows, knees, legs, lower back and scalp. Although not life-threatening, the disease can be painful, affect your ability to function, and cause psychological and emotional distress.

Psoriasis develops when the ordinary life cycle of skin cells accelerates. Skin cells regularly die and flake off in scales — but in people with psoriasis this process happens within days rather than weeks.

The disease is chronic, but you may have periods when it becomes worse alternating with times when it improves or goes into remission. And although no cure exists, treatments may offer significant relief.

Signs and symptoms

Author John Updike described psoriasis as a "flaming scabbiness from head to toe." Not everyone with psoriasis has problems this severe or pervasive — in fact, the majority of affected people have relatively mild symptoms. Still, psoriasis at its worst can be painful, disfiguring and disabling.

Several types of psoriasis exist, but the most common form, plaque psoriasis, causes dry, red skin lesions (plaques) covered with silvery scales. These usually itch or feel sore and may occur anywhere on your body, including your genitals, the soft tissue inside your mouth, and your fingernails and toenails. But plaques are most common on your knees, elbows, trunk, palms, soles and scalp. You may have just a few plaques or many, and in severe cases, the skin around your joints may crack and bleed.

Other types of psoriasis have different characteristics. They include:

Guttate psoriasis. This primarily affects people younger than 30 and is usually triggered by a bacterial infection such as strep throat. It's marked by small, waterdrop-shaped sores on your trunk, arms, legs and scalp. The sores are covered by a fine scale and aren't as thick as plaque sores are. You may have a single outbreak that goes away on its own, or you may have repeated episodes, especially if you have ongoing respiratory infections.

Pustular psoriasis. This rare form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips. It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters dry within a day or two but may reappear every few days or weeks. Generalized pustular psoriasis can also cause fever, chills, severe itching, weight loss and fatigue.

Inverse psoriasis. Mainly affecting the skin in the armpits, groin, under the breasts and around the genitals, inverse psoriasis causes smooth patches of red, inflamed skin. It's more common in overweight people and is exacerbated by friction and sweating.

Erythrodermic psoriasis. The least common type of psoriasis, this can cover your entire body with a red, peeling rash that may itch or burn intensely. Eythrodermic psoriasis may be triggered by severe sunburn, by corticosteroids and other medications, or by another type of psoriasis that's poorly controlled.

Psoriatic arthritis. In addition to inflamed, scaly skin, psoriatic arthritis causes pitted, discolored nails and the swollen, painful joints that are typical of arthritis. It can also lead to inflammatory eye conditions such as conjunctivitis. Symptoms range from mild to severe. Although the disease usually isn't as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity. Adults in their 30s, 40s and 50s are most often affected, but children also can develop a form of the disease.
Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission, although in most cases, the disease eventually returns.

Causes

No thicker than a sheet of paper, the outermost layer of your skin — the epidermis — serves as a strong barrier between you and the environment. In addition to offering protection from trauma, harmful substances and infection, this thin layer of flesh is also an endlessly renewable resource.

Basal cells at the base of the epidermis divide to form squamous cells, which produce keratin, a hard, protective protein. As the basal cells divide, they push new squamous cells toward the surface of your skin, where they eventually shrink, flatten and die. These dead cells make up the stratum corneum, the outermost portion of the epidermis. Stratum corneum cells flake off every day and are continuously replaced by more cells.

It normally takes about a month for new cells to make their way to the stratum corneum. But for people with psoriasis, cells reach the surface in a matter of days rather than weeks. And because the old cells can't slough off quickly enough, they build up in thick red patches.

Psoriasis and T cells

Over the years, researchers have developed various theories to explain what causes psoriasis. Current thinking is that accelerated cell turnover occurs when the immune system begins focusing on healthy skin cells instead of on invading microorganisms. Ordinarily, T cells, white blood cells that circulate throughout your body, spring into defensive action when they detect foreign substances (antigens) such as viruses and bacteria attempting to enter your skin. In psoriasis, the T cells respond to your own skin cells as if they were antigens.

This initiates an immune response that includes the release of cytokines — proteins that tell skin cells to reproduce at a quickened rate. Cytokines also stimulate the activation of more T cells, recruit those cells into the skin and then cause the skin cells to release more cytokines. Blood vessels close to the skin dilate as other white cells are recruited into the skin. What results is an ongoing cycle in which new skin cells move to the stratum corneum too quickly and dead skin and white blood cells pile up on the skin's surface.

Why T cells misbehave

Just what causes T cells to misfire in people with psoriasis isn't entirely clear, although researchers think genetic and environmental factors both play a role. In people with a hereditary predisposition to the disease, certain factors can trigger the condition or make an existing problem worse. These factors include:

Systemic infections such as strep throat

An injury to your skin

Certain medications, including lithium, which is prescribed for bipolar disorder, high blood pressure medications such as beta blockers, antimalarial drugs and iodides

Stress

Alcohol — the poor nutrition that often accompanies heavy drinking can make psoriasis worse

Excessive sun exposure or prolonged contact with chemicals such as disinfectants and paint thinners

Risk Factors

Perhaps the most significant risk factor for psoriasis is having a family history of the disease. About one in three people with psoriasis have a close relative who also has the condition. On the other hand, roughly the same proportion of people carries genes that have been linked to psoriasis yet never develop skin problems, indicating just how complex and perplexing psoriasis is.

Other risk factors include:

Medications. Taking certain drugs — especially beta blockers, antimalarial medications and lithium — makes you more prone to psoriasis.

Other medical conditions. People with HIV are more likely to develop psoriasis than people with healthy immune systems are. Children and young adults with recurring infections, particularly strep throat, may also be at increased risk.

Stress. Because stress can have a strong impact on your immune system, high stress levels may increase your risk of psoriasis.

Exposure to sun and toxins. Although moderate amounts of sunlight can actually help psoriasis, excessive exposure, and sunburn in particular, can trigger the disease. So can prolonged exposure to toxic chemicals.

When to seek medical advice

For most people, psoriasis is a mild nuisance, but for others it can be disabling. If your skin condition is painful or makes performing routine tasks difficult, or if you're concerned about the appearance of your skin, talk to your doctor or dermatologist. Most often, psoriasis can be diagnosed with a visual exam. Sometimes, however, your doctor may take a small sample of skin (biopsy) that's then examined under a microscope to determine the exact type of psoriasis and to rule out other, similar.

Treatment

Psoriasis can be challenging to treat in spite of a wide range of therapeutic options. The disease is unpredictable, going through cycles of improvement and exacerbation seemingly at whim. And treatments themselves can be unpredictable; what works well for one person might be ineffective for someone else. Your skin can also become resistant to various therapies over time and the most potent treatments can have serious side effects.

Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments — topical creams and light therapy (phototherapy) — and then progress to stronger ones if necessary. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.

Topical Treatments

Used alone, creams and ointments can effectively treat mild to moderate psoriasis. When skin disease is more severe, creams are likely to be combined with systemic drugs or phototherapy. Topical treatments include:

Topical corticosteroids. These powerful anti-inflammatory drugs help slow cell turnover by suppressing the immune system. Low-potency corticosteroid ointments are usually recommended for sensitive areas such as your face and for treating widespread patches of damaged skin. Your doctor may prescribe a high-potency corticosteroid ointment for small areas of your skin, for recalcitrant plaques on your hands or feet, or when other treatments fail. Although topical corticosteroids can relieve signs and symptoms of psoriasis in the short run, resistance to treatment can develop fairly quickly and withdrawal of the medication can sometimes cause the disease to flare. Long-term or excessive use can lead to thinning skin and easy bruising as well as to more serious internal side effects.

Vitamin D analogues. These synthetic forms of vitamin D reduce skin inflammation and help prevent skin cells from proliferating. Calcipotriene (Dovonex) is a prescription cream or solution containing a vitamin D analogue that may be used alone to treat mild to moderate psoriasis or in combination with other topical medications or phototherapy.

Anthralin. This substance is believed to normalize DNA activity in skin cells and to reduce inflammation. Originally derived from the dried stems and branches of a Brazilian tree, anthralin (Drithocreme) is now synthesized in laboratories. Its primary drawback is that it can irritate healthy skin as well as stain virtually anything it touches, including skin, clothing and bedding. For that reason doctors often recommend short-contact treatment — allowing the cream to stay on your skin for a brief time before washing it off. Anthralin is sometimes used in combination with ultaviolet (UV) light.

Coal tar. A thick, black byproduct of the manufacture of gas and coke, coal tar is probably the oldest treatment for psoriasis. It's effective for all forms of the disease except the severe generalized pustular types. Exactly how it works isn't known. Coal tar is available with or without a prescription and has few known side effects. It's often used in combination with light therapy (Goeckerman treatment).

Topical retinoids. These are commonly used to treat acne and sun-damaged skin, but tazarotene (Tazorac) was developed specifically for the treatment of psoriasis. Like other vitamin A derivatives, it normalizes DNA activity in skin cells. The most common side effect is skin irritation. Although the risk of birth defects is far lower for topical retinoids than for oral retinoids, your doctor needs to know if you're pregnant or intend to become pregnant while using tazarotene.

Clobetasol propionate. This is a potent corticosteroid foam that can be used on your skin or scalp. It penetrates easily and isn't as messy as some other topical products.
Moisturizers. By themselves, moisturizing creams won't heal psoriasis, but they can reduce itching and scaling and can help combat the dryness that results from other therapies. Moisturizers that are heavy and oily are usually more effective than lighter lotions.

Light therapy (phototherapy)

As the name suggests, this treatment uses natural or artificial light. The simplest and easiest form of phototherapy involves exposing your skin to moderate amounts of natural sunlight. Other traditional forms of therapy include the use of broadband ultraviolet B (UVB) light either alone or in combination with coal tar.

Other types of phototherapy include:

Psoralen UVA (PUVA) therapy. A more aggressive treatment, psoralen UVA (PUVA) therapy involves taking a light-sensitizing medication (psoralen) before exposure to ultraviolet A (UVA) light. You usually have two or three treatments a week for a prescribed number of weeks. PUVA is effective in suppressing the growth of skin cells in severe psoriasis, but long-term treatment may increase your risk of skin cancer, including melanoma, the most serious form of skin cancer. The risk of skin cancer depends on a number of factors, among them skin pigmentation, family history, total dosage of UVA over time, the concurrent use of therapies that suppress the immune system, and the amount of protection given to your face and genital areas while undergoing PUVA therapy. There may be a delay of up to 15 years after the first treatment before any cancer is detected.

Narrow-band UVB (NBUVB) therapy. This form of phototherapy doesn't require oral medications before each treatment and so may be less likely to cause cancer. Yet much about NBUVB remains unknown because it has been in widespread use for only a few years. It's usually administered two or three times a week. Many people who would have been treated with PUVA are now being treated with NBUVB. Sometimes your doctor may also use phototherapy and oral medications such as retinoids, methotrexate or the newer immune-modulating drugs in rotation to minimize the side effects of both.

Combination light therapy. Combining ultraviolet light with other treatments such as retinoids improves phototherapy's effectiveness. Some doctors give UVB treatment in conjunction with coal tar, an approach called the Goeckerman treatment. The two therapies together are more effective than either alone because coal tar makes skin more receptive to UVB light. Another method, the Ingram regimen, combines UVB therapy with a coal tar bath and an anthralin-salicylic acid paste that's left on your skin for several hours or overnight.

Oral medications

If you have severe psoriasis or disease that's resistant to other forms of treatment, your doctor may prescribe oral or injected drugs. Many of these have serious side effects and are generally used for brief periods of time.

Retinoids. Related to vitamin A, this group of drugs may reduce the proliferation of skin cells in people with severe psoriasis who don't respond to other therapies. Signs and symptoms usually return once therapy is discontinued, however. And because retinoids such as acitretin (Soriatane) can cause severe birth defects, women must protect themselves from pregnancy for at least three years after taking the medication.

Methotrexate. Taken orally or given by injection, this drug can slow the progression of arthritis in some people with psoriatic arthritis. Taken orally, it also helps symptoms of psoriasis by decreasing the production of skin cells, suppressing inflammation and inhibiting the release of histamine — a substance involved in allergic reactions. Methotrexate is generally well tolerated in low doses, but when used for long periods it can cause a number of serious side effects, including severe liver damage and decreased production of red and white blood cells and platelets. Taking 1 milligram daily of the B vitamin folic acid can reduce the risk of methotrexate-induced mouth sores or enlarged red blood cells (macrocytosis), but folic acid won't help other potential side effects such as nausea, dizziness, diarrhea and fatigue.

Azathioprine. A potent anti-inflammatory drug used to prevent organ rejection after transplants, azathioprine also may be used to treat severe psoriatic arthritis. Taken long-term, azathioprine increases the risk of developing cancerous or noncancerous growths (neoplasias) and certain blood disorders. Other potential side effects include nausea and vomiting, bruising more easily than normal, and fatigue.

Cyclosporine. Used primarily to prevent rejection of transplanted organs, cyclosporine can improve joint and skin inflammation in people with psoriatic arthritis. It works by suppressing the immune system, but the improvement stops once treatment is discontinued. Like other immunosuppressant drugs, cyclosporine increases your risk of infection and other health problems, including cancer. Cyclosporine also makes you more susceptible to kidney problems and high blood pressure — the risk increases with higher dosages and long-term therapy.

Hydroxyurea. This medication isn't as effective as cyclosporine or methotrexate, but unlike the stronger drugs it can be used with phototherapy treatments. Possible side effects include anemia and a decrease in white blood cells and platelets. It should not be taken by women who are pregnant or planning to become pregnant.

Immune-modulating drugs (biologics). The Food and Drug Administration has approved several immune-modulating drugs for the treatment of moderate to severe cases of psoriasis. They include alefacept (Amevive), efalizumab (Raptiva) and etanercept (Enbrel). These drugs are given by intravenous infusion or intramuscular injection, and are usually used for people who have failed to respond to traditional therapy or for people with associated arthritis. Biologics work by blocking interactions between certain immune system cells. Although they're derived from natural sources rather than chemical ones, they have strong effects on the immune system and pose the same risks as other immunosuppressant drugs. These include an increased risk of cancer and serious, even fatal, infections. Etanercept has also been linked to tuberculosis and leukocytoclastic vasculitis, an inflammatory blood vessel disorder.

Self-care

Although self-help measures won't cure psoriasis, they may help improve the appearance and feel of damaged skin. These measures may benefit you:

Follow a nutritious diet. Although researchers haven't found a clear link between diet and psoriasis, certain foods may trigger flares in some people. If you think a particular food or food group affects your skin, try eliminating it for a time. Other than that, the best dietary approach is the same one that's recommended for most people: well-balanced meals that emphasize fresh fruits and vegetables, whole grains and lean meats. Especially helpful are the right kinds of lipids, especially omega-3 fatty acids, which are essential for healthy skin.

Your body doesn't produce omega-3s — instead you obtain them from food or supplements. The best dietary sources are fish or fish oil capsules — particularly salmon and salmon oil — flaxseeds and flaxseed oil, walnuts, and soybean and canola oils. Some dark green leafy vegetables such as spinach, kale and broccoli contain modest amounts of omega-3s. Incorporating these foods into your diet can help dry skin, but it does even more for your overall health. Omega-3s lower triglyceride levels and reduce your risk of heart attack and stroke. They also lower blood pressure and may reduce the pain and inflammation of rheumatoid arthritis.

Maintain a healthy weight. Being overweight increases your risk of inverse psoriasis. In addition, plaques associated with all types of psoriasis often develop in skin creases and folds.

Take daily baths. Bathing daily can help remove scales and calm inflamed skin. Avoid hot water and harsh soaps, which can make your symptoms worse. Instead, use lukewarm water and mild, superfatted soaps that have added oils and fats. Better still, try a soap substitute. These products vary, but may include a mild synthetic detergent or an oil mixed with a wetting agent (surfactant). They typically come in a bar, gel or liquid form, and are less drying than are deodorant and antibacterial detergents. Even more important, add bath oil, oilated oatmeal, apple cider vinegar, Epsom salts or Dead Sea salts to the water and soak for at least 15 minutes.

Use moisturizer. Blot your skin after bathing, then immediately apply a heavy, water-in-oil moisturizing cream while your skin is still moist. For very dry skin, oils may be preferable — they have more staying power than creams do and are more effective at preventing water from evaporating from your skin. Shampoos and ointments containing coal tar or salicylic acid may offer added relief but aren't as cosmetically elegant as nonmedicinal creams are.

Avoid sun exposure. For people with psoriasis, UV rays are a blessing and a curse. A moderate amount of sunlight can significantly improve lesions but too much sun can trigger or exacerbate outbreaks and increase the risk of skin cancer. If you sunbathe, it's best to try short sessions three or more times a week. Keep a record of when and how long you're in the sun to help avoid overexposure. And be sure to protect healthy skin with a sunscreen of at least 15 SPF, paying careful attention to your ears, hands and face. Before beginning any sunbathing program, it's best to ask your doctor about the best way to use natural sunlight to treat your skin.

Apply cortisone. Apply an over-the-counter cortisone cream 0.5 percent or 1 percent, for a few weeks when your symptoms are especially bad.

http://www.mayoclinic.com/health/psoria ... DSECTION=1

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Additional Information

National Psoriasis Foundation

http://www.psoriasis.org/home/

Psoriasis - eMedicine Consumer Health

http://www.emedicinehealth.com/psoriasis/article_em.htm

Psoriasis - eMedicine/Webb MD

http://www.emedicine.com/EMERG/topic489.htm

Psoriasis Hall of PShame

http://www.pinch.com/skin/pshame.html

[patoco]

Etanercept safe and effective for long-term psoriasis treatment

Reuters Health
Last Modified: June 18, 2007

Last Updated: 2007-06-18 16:00:27 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Etanercept improves the symptoms of moderate-to-severe plaque psoriasis, with efficacy maintained for up to 96 weeks of treatment, according to a study published in the June issue of the Archives of Dermatology.

The Canadian and US research team also found that extended exposure to etanercept did not increase the drug's toxicity.

Led by Dr. Stephen Tyring, from the University of Texas Health Science Center at Houston, the investigators extended a phase III, prospective study that initially compared etanercept and placebo in a 12-week double-blind period. As previously reported, etanercept, but not placebo, was associated with significant improvement.

This initial study was followed by an open-label period for up to 84 weeks. Two hundred thirty-one patients in the placebo group and 233 in the treatment group completed the trial.

Dr. Tyring and his associates report that the Psoriasis Area and Severity Index (PASI) scores peaked at week 48, with over 60% of patients in each group experiencing at least 75% improvement. At the end of this phase of the study, these PASI scores declined to slightly more than 50%.

The two groups did not differ significantly in the number of infections or noninfectious adverse events, the report indicates. Furthermore, the number of malignancies that were diagnosed did not differ significantly from that of the general population.

Most adverse events were not ascribed to the use of the etanercept. The only exceptions, which the investigators considered possibly related to treatment, were one death following an MI after 10 months of etanercept, one case of Hodgkin's disease after 11 months, and one case of worsening congestive heart failure after 20 months treatment.

Antibodies to etanercept were detected in 18.3%. However, "The anti-etanercept antibodies detected were determined to be non-neutralizing," the authors note. Moreover, the presence of the antibodies did not affect the safety profile or efficacy results.

The outcomes were so promising that Dr. Tyring's group has extended the open-label study to 132 weeks.

Arch Dermatol 2007;143:719-726.

http://www.oncolink.upenn.edu/resources ... &year=2007

[patoco]

What's new in psoriasis? Analysis of the clinical significance of systematic reviews on psoriasis published in 2007 and 2008.

Clin Exp Dermatol. 2009 Jun

Brown BC, Warren RB, Grindlay DJ, Griffiths CE.
Dermatological Sciences, Salford Royal Hospital, University of Manchester, Manchester, UK; and NHS Evidence - skin disorders, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.

Summary This review summarizes the clinical importance of six systematic reviews on psoriasis published between January 2007 and October 2008. A meta-analysis demonstrated that several traditional nonbiological systemic therapies have equal or superior efficacy to some biological therapies used in the treatment of psoriasis. Two further meta-analyses comparing biological therapies for psoriasis (excluding adalimumab) have established a hierarchy of efficacy for short-term treatment (10-16 weeks): infliximab > etanercept 50 mg twice weekly > etanercept 25 mg twice weekly > efalizumab > alefacept. Excluding adalimumab, rates of adverse events are significantly higher for biological therapies than for placebo, except for etanercept at both 25 and 50 mg twice weekly. Further, head to head trials of biological therapies for psoriasis and longer-term safety data on their use are required. Psoriasis can be induced by and/or exacerbated during antitumour necrosis factor (TNF) therapy. It is recommended to initially switch anti-TNF agent in this situation and only discontinue therapy if psoriasis is extensive and/or intolerable, allowing the primary disease to remain under control. Most screening and monitoring tests carried out during treatment of psoriasis with biological therapies are neither supported nor refuted by current evidence and the clinician must assess each case individually. Studies designed specifically to assess appropriate use of these tests are required. Further research is needed to evaluate the effectiveness of existing psychological interventions in psoriasis. The effectiveness of support groups has not been adequately proven, although there are limited data supporting the use of cognitive behavioural therapy.

Wiley InterScience

http://www3.interscience.wiley.com/jour ... 1&SRETRY=0

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Development and pilot-testing of a psoriasis screening tool.

Br J Dermatol. 2009 Apr 22

Dominguez PL, Assarpour A, Kuo H, Holt EW, Tyler S, Qureshi AA.
Center for Skin and Related Musculoskeletal Diseases, Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital (BWH), 45 Francis St, 221L, Boston, MA 02115, U.S.A.

KEYWORDSdata collection • epidemiology • mass screening • psoriasis • questionnaires

Background There is a need to validate psoriasis self-reports in epidemiological studies, where individuals may not be seeing dermatologists or other health care providers. Objectives To develop and pilot test the Psoriasis Screening Tool (PST) in an ambulatory setting. Patients and methods The PST was designed with eight closed-ended questions requiring a 'yes' or 'no' response. Typical images of skin, nail and scalp changes in psoriasis were included with respective questions. We administered the PST to 222 consecutive individuals being seen at a dermatology clinic. All English-speaking subjects completed the PST without assistance. A board-certified dermatologist established the diagnosis of psoriasis or excluded psoriasis in all participants. Results A total of 222 completed PST questionnaires were included for analysis. There were 111 individuals in the psoriasis group and 111 individuals in the nonpsoriasis group. A combination of three questions resulted in a sensitivity of 96.4% [95% confidence interval (CI) 93.2-98.0] and specificity of 97.3% (95% CI 94.1-98.9) for psoriasis. Adding a pictorial question increased the sensitivity of the screening tool to 98.2% (95% CI 95.0-99.5). Of the 111 individuals with psoriasis, 69% answered yes to having plaque-type psoriasis, 50% answered yes to having nail involvement, 66% answered yes to having scalp involvement, and 59% answered yes to having inverse-type psoriasis. Conclusions This pilot study suggests that the PST can distinguish individuals with psoriasis from individuals without psoriasis in an English-speaking population being seen at an outpatient dermatology clinic. Furthermore, the PST may be used to identify psoriasis phenotypes. Although the PST may be limited by spectrum bias in this pilot study, we believe it remains a reliable tool to collect information on psoriasis in remote populations.

Wiley InterScience

http://www3.interscience.wiley.com/jour ... 5/abstract

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Patented small molecules against psoriasis.

Expert Opin Ther Pat. 2009 Jun 30

Abdelnoor AM.
Professor, Chairperson and Faculty of Medicine, American University of Beirut, Department of Microbiology & Immunology, P. O. Box 11-0236, Riad el-Solh, Beirut 1107 2020, Lebanon, USA +1 961 1 340460 ext. 5120 ; +1 961 1 744487 ; aanoor@aub.edu.lb.

Background: It is hypothesized that psoriasis is an autoimmune disease. The most recent therapeutic approach that proved to be more effective than earlier methods of treatment is the use of mAb/fusion proteins. Efforts nowadays are focused on investigating the antipsoriatic affect of small molecules that can be administered orally, some of which are capable of entering cells, and being selective in targeting intracellular pathways. Objective: Preclinical patented small molecules that are recommended for the treatment of psoriasis are reviewed. Emphasis is placed on their mechanism of action. Methods: http://ep.espacenet.com/ , Pubmed, Scopus and Google websites were the main sources used for the patented small molecule search. A number of patents were poorly described and difficulties were faced in trying to figure out the patentee(s) explanation. Moreover, most patents were recommended for the treatment of a number of autoimmune diseases and cancer, and not only for psoriasis. Results/conclusions: Small molecules that inhibit the activation of T lymphocytes, leukocyte trafficking, leukotriene activity/production and angiogenesis, and promote apoptosis have been patented. Small molecules that have been patented for the treatment of other autoimmune diseases and could be used for treating psoriasis are described. Moreover, other possible mechanistic approaches using small molecules are discussed.

Expert Opinion

http://www.informapharmascience.com/doi ... 0903029201

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Psoriasis--new insights into pathogenesis and treatment.

Dtsch Arztebl Int. 2009 Jan

Mrowietz U, Reich K.
Psoriasis-Zentrum, Abteilung Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105 Kiel, Germany. umrowietz@dermatology.uni-kiel.de

BACKGROUND: Psoriasis is one of the most prevalent chronic inflammatory diseases, affecting approximately 2 million people in Germany.

METHODS: Selective literature review taking into account the German S1 and S3 guidelines for the treatment of this condition.

RESULTS AND CONCLUSIONS: Psoriasis is a very troublesome disease with a high economic impact. The disease often persists for life, and the patient has an increased risk of cardiovascular diseases and their complications. One out of five patients develops psoriatic arthritis. The clinical picture of psoriasis is highly variable with regard to lesional characteristics and the severity of disease. To improve the management of psoriasis the guidelines must be followed and all appropriate topical and systemic treatment options must be tried, with clearly defined treatment goals. The spectrum of established systemic treatments for psoriasis has been extended by the biologics. These can be used to achieve a good skin status and a clear-cut improvement in quality of life even in patients who do not--or no longer--respond adequately to conventional therapies.

PubMed Central

http://www.pubmedcentral.nih.gov/articl ... d=19564982

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Angiogenesis drives psoriasis pathogenesis.

Int J Exp Pathol. 2009 Jun

Heidenreich R, Röcken M, Ghoreschi K.
Department of Dermatology, University Medical Center, University of Tübingen, Tübingen, Germany. regina.heidenreich@med.uni-tuebingen.de

KEYWORDS
psoriasis • angiogenesis • Th17

Psoriasis pathogenesis is closely associated with disease-inducing Th1 and Th17 cells. Yet, several studies suggest that aberrant keratinocyte or endothelial cell signalling significantly contributes to disease manifestation. Histological hallmarks of psoriatic skin include the infiltration of multiple immune cells, keratinocyte proliferation and increased dermal vascularity. Formation of new blood vessels starts with early psoriatic changes and disappears with disease clearance. Several angiogenic mediators like vascular endothelial growth factor, hypoxia-inducible factors, angiopoietins and pro-angiogenic cytokines, such as tumour necrosis factor (TNF), interleukin (IL)-8 and IL-17, are up-regulated in psoriasis development. Contact- and mediator-dependent factors derived from keratinocytes, mast cells and immune cells may contribute to the strong blood vessel formation of psoriasis. New technologies and experimental models provide new insights into the role of angiogenesis in psoriasis pathogenesis. Interestingly, many therapies target not only immune cells, but also protein structures of endothelial cells. Here we summarize the role of pro-angiogenic factors in psoriasis development and discuss angiogenesis as a potential target of novel therapies

Wiley InterScience

http://www3.interscience.wiley.com/jour ... 6/abstract

[patoco]

Unilateral psoriasis in a woman with ipsilateral post-mastectomy lymphedema.

Dec 2011

Kim M, Jung JY, Na SY, Na SJ, Lee JH, Cho S.

Source

Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.

Abstract

Psoriasis is a multi-factorial disease with various clinical manifestations. We present a case of unilateral psoriasis associated with ipsilateral lymphedema that developed after mastectomy for breast cancer. A 42-year-old Korean woman was referred to our clinic with a 1-month history of multiple erythematous scaly patches on the right arm, back, and breast and was diagnosed with psoriasis by a skin biopsy. Three years previously, she had been diagnosed with breast cancer (T1N2), underwent a right quadrantectomy and axillary lymph node dissection, and completed adjuvant chemotherapy followed by high-dose adjuvant radiotherapy. She had started rehabilitation therapy on the right arm for secondary lymphedema 30 months previously. Because of the long interval between radiation and psoriasis, we speculated that changes in the local milieu caused by the lymphedema might be a causative factor. We hereby report a rare case of unilateral psoriasis following post-mastectomy lymphedema.

PubMed

http://www.ncbi.nlm.nih.gov/pubmed/22346263