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HERNANDO AND CITRUS COUNTY
Psoriasis and psoriatic arthritis
Dr. Utpal Patel, MD, PhD
It is said that the skin can be a window into the body. Rashes on the skin often give a dermatologist clues about underlying conditions. Rashes can be transient (as occurs with poison ivy) or lifelong (as with psoriasis). They can have a variety of causes, including an inappropriate immune response, medications, allergens, infections, even cancer. In this and upcoming issues, we will discuss some of the most common types of skin conditions that cause rashes, beginning with psoriasis.
Psoriasis is a chronic skin condition affecting 1-3 percent of the population and can be seen in all age groups, but is typically seen in adults. Current research shows that psoriasis is caused by an immune response resulting in overproduction of new skin cells, causing them to build up in thickened plaques at the surface of the skin. Psoriasis is not contagious but rather genetic. For a person to develop psoriasis, he or she must have inherited the right mix of genes and be exposed to an appropriate environmental trigger. There are multiple triggers that can cause or worsen psoriasis-- including stress, strep throat infection, trauma or injury, and certain medications (such as beta blockers, lithium, and others). The most common form of psoriasis is called plaque psoriasis, which presents as raised red skin covered with white scales, typically on the scalp, knees, elbows, hands, and feet, without additional symptoms. Most forms of psoriasis are considered mild to moderate, affecting less than 5 percent of the body surface, but about 20 percent of patients have more severe psoriasis that affects a greater area of the body. On occasion, psoriasis can be so severe that it covers the entire body surface, termed erythrodermic psoriasis. Erythrodermic psoriasis can be life threatening by limiting the skin’s ability to regulate vital body function, such as temperature and hydration. Another severe form of psoriasis includes a blistering variant, known as pustular psoriasis that can be limited to the hands and feet or be generalized and cover the entire body. Occasionally psoriasis can involve the scalp and this form tends to be quite itchy. A rare and often painful form of psoriasis, termed inverse psoriasis, involves body folds such as the armpit, under the breasts, and genitalia. Beyond the skin, psoriasis can involve the nails, leading to brittle, loose, thick nails with pits (small depressions). These nail findings are frequently misdiagnosed as fungal infections, leading to unnecessary and ineffective treatments.
As mentioned earlier, skin conditions often can be a sign of internal conditions. Psoriasis is one such example representing inflammation of the skin. As such, it is associated with multiple inflammatory comorbidities that need attention and screening to prevent long-term complications. For example, about 15 percent of people with psoriasis will develop inflammation of joints, leading to a type of arthritis called psoriatic arthritis that causes swollen, stiff, and sometimes painful joints that impair performance of everyday activities. If psoriatic arthritis is left untreated, the joints can deteriorate, leading to permanent disability; thus, early treatment is the standard of care.
Patients with psoriasis also have an increased risk of inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, lymphoma (a type of cancer), heart disease, obesity, type II diabetes, and metabolic syndrome. Psoriasis can also have a substantial psychological and emotional impact on patients’ lives due to a lack of understanding of the condition by the general population. This is supported by studies showing increased risk of depression, suicide, smoking, and alcohol consumption in patients with psoriasis.
To summarize, psoriasis is a chronic inflammatory skin condition that can be associated with systemic co-morbidities. It can lead to medical, psychological, and emotional complications for patients. Fortunately, today we have a variety of topical and systemic medications that can be used to control and manage psoriasis and psoriatic arthritis. If you think you may have psoriasis or psoriatic arthritis, a board certified dermatologist can evaluate, diagnose, and discuss treatment options that are best for you.
Dr. Utpal Patel, MD, PhD