Ask Your Doctor - PSORIASIS by Dr. Brett Hodge

Psoriasis (pronounced sore-i-ah-sis) is a common and chronic condition that affects millions of people worldwide. This disorder can cause severe emotion and physical impact on individuals with it. Although there is no cure, many of the symptoms can be controlled with treatment.

What is psoriasis?
In this condition patches also called plaques are frequently found on the knees, elbows, scalp, hands, feet or lower back. In about 50% of cases, the fingernails and toenails are also affected. 10 to 30% of people with psoriasis also develop a related arthritis called psoriatic arthritis.
There are several different types of psoriasis. About 90% of all cases of psoriasis are plaque psoriasis, but other varieties are described.
Psoriasis is not contagious and cannot be passed from one person to another.

What causes psoriasis?
At present the cause is unknown. Many researchers now believe that the cause is related to a problem in the immune system. It is believed that one type of cells destroy normal skin cells, while another type of cells begin overproduction of a substance called cytokines which turns off a signal that regulates skin cell growth.
It is believed that some people carry genes that make them more likely to develop psoriasis, but not everyone with these genes develops psoriasis. Instead a ‘trigger’ makes the psoriasis appear. Triggers for psoriasis include:
· emotional stress
· injury to the skin
· alcohol
· cold and dry weather
· some types of infection and reaction to certain drugs

What are the symptoms of psoriasis?
The symptoms of psoriasis vary depending on the type you have. The most common symptoms are:
Patches of red, inflamed skin often covered with loose, silver-coloured scales; these patches may be itchy and painful and sometimes crack and bleed.
Disorders of the fingernails and toenails, including discolouration and pitting of nails.
Patches of scales or crust on the scalp.

How is psoriasis diagnosed?
Clinical history and examination are important. There is no blood test to make the diagnosis. A biopsy (taking a small piece of skin) is often taken to confirm the diagnosis.

How is psoriasis treated?
There are a number of treatment options for psoriasis. Some can be used alone or in combination. These include topical treatments, phototherapy (light treatment) and oral and injected medications. There are alternative medicines but none of these alternative approaches have been proven helpful in treating psoriasis. Treatment can be very complicated and requires a lot of commitment.

Progression of psoriasis
Progression varies from one individual to another. In most people, symptoms come and go. Untreated, extremely severe, psoriasis can be dangerous. Coping with psoriasis can be very difficult. Many people are embarrassed with their condition and are often shunned by friends and fellow workers. People’s ignorance of this condition is hard to overcome, but by public education much of the stigma associated with this chronic disorder can be eliminated.

Conclusion
Psoriasis is a chronic disorder that affects millions of people. It is related to a defect in the immune system and results in skin lesions that can have severe physical and emotional effects. There is no cure for this disorder, but symptoms can be improved with treatment. People should be aware that psoriasis is not a contagious or infectious disorder. The emotional toll caused by peoples’ attitudes to individuals with psoriasis can be enormous.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.