Psoriasis - Answering Your Questions

Dr. Patricia Wong, an established Palo Alto dermatologist, has been kind enough to share her expertise on psoriasis with us. She has treated many patients with this condition, and hopes that this information will be helpful to anyone with psoriasis or anyone who knows of someone with psoriasis.

What is psoriasis?
This chronic inflammatory skin condition affects approximately 2% of the population. The process involves rapidly replicating skin cells. New skin cells are produced about eight times faster than normal--over several days instead of a month--but the rate at which old cells slough off is unchanged. This causes red, scaly patches which can be itchy. It can have widespread involvement of the scalp, nails, skin, and joints. Patients can feel very self-conscious about their appearance especially if the involvement is extensive or in exposed areas. The scaling and redness can be a source of embarrasment.

What causes psoriasis?
Psoriasis is caused by genetic, immunologic and environmental factors. Individuals may have several disease genes which require environmental trigger factors to activate the psoriasis. These triggers may include stress, Strep throat infection, and certain medications. No clear inheritance pattern is seen. Patients who have early onset psoriasis demonstrate a significantly higher frequency of HLA -Cw6 major histocompatability complex located on the short arm of chromosome 6 (for those of you who really like the details) . Sixty percent of the patients develop psoriasis before the age of 30. Age of onset has 2 peaks, between 20- 30's and mid 50's to 60's. Early onset psoriasis has a stronger family linkage and a tendency to become more extensive. Late onset psoriasis tends to be sporadic and usually milder.

Is it contagious?
No. You cannot develop psoriasis from touching someone that has it nor spread it to other parts of your body by touching. It is not a sexually transmissible disease.

Do I have it because I am doing something wrong?Can I be cured?
Psoriasis is not curable but it is treatable; with proper treatment often the psoriasis will clear or even go into remission for long periods of time. Psoriasis can spontaneously go into remission. This means it may disappear for a while and then recur. The length of remission varies considerably but long term remissions are rare.

What can I do to treat it?
It is advised to see a dermatologist rather than a general practitioner as the treatment of psoriasis may be complex. Treatment varies depending on the specific body areas involved and the extent of involvement. Individuals vary in their response and tolerance to the different medications.

Localized psoriasis generally requires localized treatment - topical medication or localized phototherapy. Multiple agents are available including tar, anthralin, topical corticosteroids, topical vitamin D and Vitamin A analogues, topical immunomodulators and keratolytics such as salicylic acid. One of the main reasons psoriasis is difficult to treat is that patients find the treatments time consuming, messy, greasy and become frustrated. Compliance decreases over time as individuals become weary of continuing their treatment.

Extensive psoriasis requires phototherapy or systemic treatment. There are many oral medications available and each has its advantages and potential side-effects. Acitretin, methotrexate, cyclosporine, mycophenolate mofetil are some of the medications commonly used. There are also new biologic medications available that can be administered by the patient as an injection. These are expensive but can help clear stubborn psoriasis that has not responded to the above mentioned medications. These include alefacept, etanercept, and adalimumab.

Where is a reliable source of information?
The National Psoriasis Foundation is an excellent resource and offers a variety of brochures and newsletters. Anyone can join, even without paying, though there is a recommended donation of $27 to cover mailing costs. Their address is 6600 SW 92nd Avenue, Suite 300 Portland, OR 97223-7195 USA . Telephone number 1-800-723-9166.

What can I expect from the disease?
While the quality of life can be greatly impacted, very few people actually die from psoriasis. There appears to be an increased rate of obesity, higher levels of depression, and alcohol misuse in psoriasis patients which may be related to the emotional burden of having a stigmatizing disease. Alcohol and smoking cigarettes can destabilize the disease and make it very difficult to treat. It is strongly advised to consult with a dermatologist as psoriasis is a treatable condition and can be improved or potentially cleared with treatment. You do not need to feel victimized by psoriasis.

What suggestions do you have for coping with this problem emotionally?
There are several points to consider: the feeling of having no control over the psoriasis, the bothersome aspects of complying with the treatment program, and the social stigmatism. You need to find a dermatologist who understands how the psoriasis is affecting you and let them know to what extent you are willing to commit in terms of time, energy, and risks to deal with it. Your dermatologist can help you decide the most effective route of treatment. You should be active in dealing with it and not let the sense of isolation and stigmatization overwhelm you and interfere with treating the psoriasis.