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Psoriasis More Than Skin Deep

Susan C. Taylor, MD

Professor of Dermatology, Columbia University

Q. How does psoriasis develop, and what are the symptoms?

A. Psoriasis is a chronic skin condition that develops from faulty signals in the immune system that cause new skin cells to form in days rather than weeks. Psoriasis occurs when skin cells grow too quickly. The body does not shed these excess skin cells, so they pile up on the surface of the skin and lesions form. About 80 percent of people living with psoriasis have plaque psoriasis, which causes patches of thick, scaly skin that may be white, silvery, or red. Called plaques, these patches can develop anywhere on the skin. The most common areas to find plaques are on the elbows, knees, lower back, and scalp.

The symptoms of psoriasis are itching and sometimes bleeding. This causes considerable discomfort and emotional stress for patients. It is important to note that psoriasis is not contagious. You cannot get psoriasis from touching someone who has it, from swimming in the same pool, or even from intimate contact.

Q. Are their common risk factors, or are certain people more prone to the condition?

A. Psoriasis affects nearly 7 million Americans and can start at any age, although it generally begins in early adulthood (twenties and thirties). Psoriasis has a genetic component, as approximately 40 percent of patients with psoriasis have a family history of the disease. While the exact cause of psoriasis is unknown, it is believed to occur due to an interaction of multiple genes, the immune system, and the environment.

Studies indicate that psoriasis develops about equally in males and females. Research also shows that Whites develop psoriasis more frequently than other races. A study conducted in the United States found the prevalence was 2.5 percent in Whites and 1.3 percent in Blacks.

Q. How is psoriasis generally treated?

A. Currently, there is no cure for psoriasis, although there are many treatment options that can clear psoriasis for a period of time. Each treatment has advantages and disadvantages, and what works for one patient may not be effective for another. Board-certified dermatologists have the medical training and experience needed to determine the most appropriate treatments for each patient.

To choose the most appropriate treatment method, dermatologists consider several factors:

  • Type of psoriasis
  • Severity of psoriasis (the amount of skin affected)
  • Location of psoriasis
  • Patient’s age and medical history
  • Effect of psoriasis on patient’s overall physical and emotionalwell-being

Psoriasis treatments fall into three categories:

  • Mild to moderate psoriasis: topical (applied to the skin)
  • Moderate to severe psoriasis: phototherapy (light, usually ultraviolet, applied to the skin)
  • Moderate, severe, or disabling psoriasis: systemic (taken orally or by injection or infusion)

Each of these therapies is effective, but there are also drawbacks. Some topical treatments are messy and may stain clothing and skin. Phototherapy can require two to five weekly visits to a dermatologist’s office or psoriasis clinic for several weeks. Many of the systemic medications have potentially serious side effects and must be combined or rotated with other therapies to maximize their effectiveness and minimize the side effects. Research is being conducted to find therapies that are safe, effective, and easy to use and that provide long-term relief.

Q. What is the psychological impact of the condition?

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A. For some people psoriasis is merely a nuisance; others find that it affects every aspect of their daily life. The unpredictable nature of psoriasis may be the reason. Some people have frequent flare-ups that occur weekly or monthly; others have only occasional flare-ups.

When psoriasis flares, it can cause severe itching and pain. Sometimes the skin cracks and bleeds, which can wake a sleeping person frequently and cause sleep deprivation, making it difficult to focus at school or work. Sometimes a flare-up requires a visit to a dermatologist for additional treatment. Time must be taken from school or work to visit the doctor and get treatment.

These cycles of flare-ups and remissions often lead to feelings of sadness, despair, guilt, and anger as well as low self-esteem. Depression is higher in people who have psoriasis than in the general population. Feelings of embarrassment also are common.

Q. Why should women be aware of or interested in psoriasis?

A. First, it is critically important that every patient with psoriasis see a dermatologist and find the right treatment. There are safe and effective treatments available, and no one with psoriasis should suffer.

Also, new research is finding that psoriasis, especially severe psoriasis, is linked with a number of serious medical conditions, including cardiovascular disease and cancer, so evaluation for these disorders is important.

A number of studies have found an increased risk of certain types of cancer in psoriasis patients, such as a form of skin cancer known as squamous cell carcinoma and also lymphoma. In some instances these cancers have been associated with specific psoriasis treatments that suppress the immune system. Following the recommended routine health screenings for cancers and avoiding high-risk behaviors that increase the risk of developing some cancers (such as smoking, alcohol abuse, and intentional sun exposure) must be a high priority for psoriasis patients who may be at an increased risk of these potentially life-threatening diseases.

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Cyndi’s Story

Cyndi McGowen was in her midtwenties when she first developed psoriasis. The League City, Texas, woman didn’t know what to think of the small spot of scaly, itchy skin on her elbow. But, she says, she is so grateful that she took the issue seriously and saw a doctor right away. “I saw a dermatologist to find out exactly what I had. The doctor explained to me that I had psoriasis and started working with me on a management plan.” This proactive approach, Cyndi says, has allowed her to cope with the condition.

Though she felt she was tackling the problem from a medical angle, however, Cyndi found the emotional impact of psoriasis a tough challenge. “When it started spreading and covering more of my body, people started looking at me differently. You could see in their eyes that they were trying to figure out what was wrong with me and if it was contagious.” The result, Cyndi says, was that she became very self-conscious about her appearance, covering her body with long-sleeved shirts and pants to avoid strangers’ stares and becoming increasingly less confident in many aspects of her life.

It wasn’t until she started volunteering for the National Psoriasis Foundation by hosting local support group meetings and getting to know other psoriasis patients that Cyndi realized that the cover-up campaign she’d been carrying on had to stop. “I got out the clothes that I used to wear—the clothes that I loved to wear—and I started wearing sleeveless shirts and skirts again.” It wasn’t long before Cyndi realized that a funny thing was happening: she was showing more of her psoriasis, but people were noticing it less. Her new confidence was overpowering her physical appearance.

Now, Cyndi has become an advocate for other psoriasis patients and hopes to help educate newly diagnosed patients so that they can take control of the condition. “The best thing you can do when you don’t understand what is going on is educate yourself.” In addition, Cyndi urges all patients not to allow psoriasis to interfere with their lives or to diminish their spirit: “Remember to stay true to yourself.”

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