Psoriasis, Scaly Skin, Patchy Inflammation, Discoid Psoriasis, Plaque Psoriasis or Pustular Psoriasis.
Psoriasis is a skin disorder characterized by sudden or gradual development of reddened, thick, itchy patches of silvery scales (raised layers of dead skin flakes) usually in the elbows, knees, scalp, hands, trunk and nails. The skin may blister (raised and bubblelike) or have pustules (small, raised, and pus-filled). The nails may show pitting (pin-sized punched-out areas) and the joints may be painful (arthritis).
Skin patches -- red, dry, and covered with silvery scales
Pustules
Blisters
Nail changes
Itching
Patches and itching may involve the scalp
Joint pain (arthritis)
Inherited or genetic factors (passed down from parents) may play a role.
In a normal person, the new skin cells gradually move from lower layers to the surface (takes about a month), but in Psoriasis the process speeds up to a few days -- which results in piling up of dead skin cells (scales) in patches.
Evidence of genetic factors -- increased HLA (white blood cell or leukocyte surface protein) and a strong family history in Psoriasis sufferers.
The immune system (body's defenses) of disease-fighting cells (i.e., white blood cells and protein antibodies) may also play a role by misunderstanding internal communications and attacking skin and joints -- causing inflammation (irritation, swelling, pain) and damage.
Your doctor may consult with a dermatologist (skin doctor).
History
Medical exam will reveal the patches and the other signs.
Koebner's phenomenon describes a psoriatic response (patches, scales, etc.) that occurs in an area where an injury to the skin took place 1-2 weeks earlier.
Blood tests may be done for ESR (if elevated, it indicates inflammation), complete blood cell count (often shows increase in white blood cells), Uric acid levels, Rheumatoid factor (to rule out Rheumatoid Arthritis, must be negative for Psoriasis), HLA antigen (often increased in Psoriasis), and, if anemia (low red blood cell count) is present, iron, B12, and folate levels are also tested.
Small areas on the patches can be scraped and when looked at under a microscope may show fungal infection.
Biopsy (taking a small piece) of the patch is rarely needed for diagnosis and is often done to rule out other possible causes.
Risk Factors
Can occur at any age (even infants) but more common between 15-60.
Male = female
Family history -- especially in the younger patient
Caucasians
Factors that can initiate a flare up of Psoriasis include:
Local injury to the skin (sunburn, insect bites, Burns, and rashes)
Hormonal changes
Medications -- e.g., sudden discontinuation of steroids
Stress -- emotional or physical
Alcohol abuse
Obesity
Infections -- e.g., streptococcal throat infections (guttate Psoriasis)
Viral infections such as HIV
Weakened (e.g., in AIDS, cancer) or overactive immune system (as in autoimmune diseases like Rheumatoid Arthritis)
Cold climates
Lack of sunlight
Drugs such as anti-malarial medications
Increased blood Uric acid levels in some patients
Treatments
Avoid excess sun exposure
Ultra Violet Light (UVL) -- sunlight, UV-B, and UV-A are effective therapies. Safer in pregnant women and children than medications.
Topical corticosteroid creams and ointments of varying strengths (depending on the severity) can be prescribed to reduce the redness and the inflammation.
Tar shampoos, gels, and baths (for wide-spread disease) are often prescribed.
Agents to soften the dry skin (keratolytic agents) such as salicylic acid gel can be used in conjunction with other therapies.
Oatmeal baths can help with itching.
Soft brushing or scrubbing after baths may help in removing the dead skin.
In severe cases or with severe and wide spread disease -- agents such as oral corticosteroids, vitamin A derivatives (Etretinate), and chemotherapy drugs such as Methotrexate or Cyclosporin are only for severe and life-threatening cases.
PUVA is Psoralen (medication) plus UVA but may cause dryness, Cataracts, and increase risk for skin cancer.
Vitamin D ointment is helpful, but high Calcium levels are potential side effects.
Avoid harsh brushing, stress, skin trauma, sunburn and Skin Infections (good hygiene).
Infections of the skin are treated with antibiotic or antifungal medications.
Desert climates are very good for Psoriasis.
Drink plenty of fluids.
Avoid alcohol
If on therapy, be aware that periodic medical follow-ups and routine blood levels of certain chemicals and parameters are required (especially if on potent medications and treatments).
Inflammation - psoriasis, scaly skin, patchy inflammation
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