Is
Skin-Cap?
everyone with psoriasis will have a family history of the disease.
What is parakeratosis, and what does
it have to do with psoriasis?
Parakeratosis is a word you may have
come across when you read about psoriasis, especially plaque-type psoriasis. It
is a term that describes the process by which psoriatic skin continuously forms
and scales off.
In
normal skin, the outer layer, made up mostly of cells called keratinocytes, is
replaced every 27 to 28 days with newly formed keratinocytes. The replacement
usually occurs without a person noticing it; if it takes place unusually quickly
or in unusual amounts, we may notice flakes and scales on our skin, clothing,
bedding, etc.
In
psoriasis, the process of keratinocyte production is sped up. New keratinocytes
are formed and moved upward to the skin surface faster than they can be incorporated
into skin. Some are moved upward so fast that they are not yet mature cells. The
keratinocytes accumulate and are scaled off. Parakeratosis is the word used to
describe the entire process.
Psoriatic plaque has other features also, including
inflammatory cells and dilated small blood vessels that contribute to both the
appearance and the symptoms of a psoriatic lesion.
In general, the cycle of psoriasis can best be described
as the body's immune system triggering excessive
skin-cell reproduction. In healthy skin, cells mature and are shed in about 28
days. In people with psoriasis, this process is accelerated to only 3 or 4 days.
This excessive reproduction causes skin cells to build up and form abnormal scaling
seen on lesions in psoriasis.
Can psoriasis occur on the sole of
the foot and be mistaken for a plantar wart?
Psoriasis can and does
occur on the sole of the foot. The psoriatic lesion can be painful to walk on,
as can a plantar wart. It can be mistaken for a plantar wart by both the patient
and the physician or podiatrist.
Psoriasis on the sole of the foot is usually of the plaque type. A person who has had psoriasis
for some time may recognize the lesion as psoriatic plaque. Psoriasis may not
be the first thing that comes to mind in a person who has no previous experience
with the disease. Failure to recognize the lesion as psoriasis may lead to a long
period of incorrect treatment, and failure to institute treatment for a developing
case of psoriasis.
There
are some diagnostic tips for differentiating psoriasis on the sole of the foot
from plantar wart:
If
psoriasis is developing on the sole of the foot, there is a good probability it
is also developing on other parts of the body. Likely places to look for developing
psoriatic lesions are the knees, elbows, hands and scalp.
Is it possible to have psoriasis and
eczema at the same time?
The biology of skin limits the number of
ways in which it can manifest a disease processy redness, flaking, swelling,
etc. Thus, many skin conditions can superficially resemble one another and a dermatologic
examination is necessary to establish a diagnosis. Self-diagnosis of a troublesome
skin condition can delay proper treatment.
Psoriasis and eczema are two skin problems that seem
to be mutually exclusive to a degree, although this is not a hard and fast rule.
In persons with psoriasis the incidence of allergic contact dermatitis and atopic
dermatitiswo major forms of eczemappears to be substantially lower than in the
general population. A suggested reason is that the immune system dysregulation
believed to be a factor in psoriasis is not the same as dysregulation of immune
pathways in these forms of eczema.
Other skin diseases that superficially resemble psoriasis
can coexist with psoriasis. These include fungal and yeast infections, scabies,
cutaneous (skin) lymphoma, and cutaneous manifestations of syphilis. Many skin
lesions that superficially resemble psoriasis lack the unique appearance of psoriasis:
-
Psoriatic
lesions have well-defined borders.
-
The
surface of a psoriatic lesion has silvery scales that easily flake off.
-
The
skin under the scales has a shiny red appearance.
Can psoriasis be cured?
No. The tendency to develop psoriasis is inherited through a person genes. We
hope to be able to safely modify these genes in the future, but the technology
is not yet developed. We do foresee a time, when we will have more specific and
more effective therapies for the various forms of psoriasis. Also, while psoriasis
cannot be cured, it can often be completely cleared for periods of months or even
years. Occasionally, it never returns at all. In most patients, however, it is
a chronic, life-long condition with alternating periods of flaring and clearing.
Is risk for skin infections higher
in people with psoriasis than in people with normal skin?
Studies
have shown that psoriatic plaques and adjacent normal skin usually have the same
type of bacteria, but the number of bacteria per square millimeter is higher in
the psoriatic plaques. This, in itself, is usually not an increased risk for secondary
infections.
Risk
is increased when skin and/or plaques or guttate pustules are colonized by the highly invasive Staphylococcus aureus, a species
of bacteria capable of causing serious skin and systemic infections.
Risk for secondary infections may also be increased
by hard scratching that abrades the skin and opens it to bacterial invasion. Hard
scratching should be avoided for this reason, and also because abrasion of the
skin can be a trigger for formation of new
psoriatic lesions.
A
skin hygiene program recommended by a dermatologist is usually adequate to keep
bacterial populations in check. Specific anti-bacterial measures may be prescribed
by a dermatologist when such measures are warranted.
Symptoms of secondary infection are redness of skin
around a psoriatic lesion or increased redness of the lesion, increased warmth
in the skin and/or pus in the skin in the area of a lesion. Fever, malaise and
light-headedness can be symptoms of more serious, systemic infection.
Will psoriasis shorten my life?
Psoriasis itself does not appear to shorten a person life. Patients with psoriasis
should be able to live full lives into their senior years.
Will psoriasis cause my hair to fall
out?
Psoriasis itself will not cause the hair to fall out. However,
very thick scales in the scalp can entrap hair and as you attempt to remove the
scales, you can loose hair in the process. In addition, some medications such
as salicylic acid can temporarily damage the hair.
Should I change my psoriasis skin
care regimen during the winter?
It important to increase your use
of moisturizing creams and ointments during the winter, applying heavy layers,
especially over the skin affected by psoriasis. It is helpful to apply the moisturizing
cream while your skin is damp. Also, be sure to pat yourself dry after bathingon
rub yourself with the towel.
During the winter months, the humidity is generally
lower, especially in homes with forced air heating. This tends to cause dry, itchy
skin. Scratching affected skin will worsen your psoriasis and can even cause new
lesions to form. Thus, it is important not to scratch, pick, or scrub psoriasis
lesions.
Is
it true that getting a skin scrape can lead to a psoriatic lesion?
Yes. Psoriasis patients can develop lesions at the site of significant skin trauma,
especially during a period of active disease. Psoriasis worsens in areas of skin
scrapes, scratches, and cuts (such as surgical wounds). That why it is so important
not to pick, scratch, or scrub the lesions and scales. The development of a psoriatic
lesion at the site of skin trauma is called Koebner phenomenon.
Can you control psoriasis with diet?
Unfortunately no. However, the healthier the diet the better. Especially a diet
that includes regular exercise. For more information about exercise and psoriasis,
visit the web site of the National
Psoriasis Foundation.
For African-Americans and other darker-skinned
people, is the treatment for psoriasis different than for people with light-colored
skin?
The immunologic dysfunctions that are a major predisposing factor
in psoriasis are believed to be the same in all persons regardless of skin color.
The patterns of genetic inheritability for the predisposing factors may vary in
different groups.
The
pigmentation of skin is controlled by hormonal processes that are unrelated to
the immune and inflammatory processes that underlie psoriasis. It is interesting
to note that all humans, regardless of skin color, have about the same number
of melanocytes (pigment-containing cells) at any given site on the skin. Variations
in skin color are due to differences in hormonal regulation of pigment formation
within the melanocytes, and transfer of the pigment from melanocytes to keratinocytes
(the cells that make up the majority of the outer layer of skin). A principal
hormone in the regulation of human skin color is melanocyte-stimulating hormone
(MSH).
The
incidence of psoriasis is much lower in dark-skinned West Africans and African-Americans
than in light-skinned people of European ancestry. Incidence is also low in Japanese
and Eskimos, and is extremely low to non-existent in Native Americans in both
North and South America. The reasons for this epidemiologic disparity are not
known, but are believed to involve genetic, geographic and environmental factors.
The treatment of psoriasis in African-Americans is
largely the same as treatment in light-skinned patients. An adjustment is therapy
is made in the use of photochemotherapy (PUVA) and phototherapy. In PUVA, both the chemical
photosensitizer and the ultraviolet dose are adjusted for skin type and pigmentation.
Are homeopathic treatments effective
for psoriasis?
There is no scientific evidence that homeopathic treatments
are effective for treating psoriasis. However, it抯 not impossible that some of
these treatments might be helpful. Scientific studies need to be done in order
to resolve this issue.
Is there a way to curb scratching?
I have had psoriasis for 20 years and my husband has been very supportive, but
recently he has started to complain about my constant scratching. He knows I need
to scratch to relieve itching, but it seems to bother him more now. I afraid
wee heading for marital problems unless I can stop scratching or he can stop
letting it bother him. Any suggestions?
Psoriasis in a spouse can
be difficult for both marriage partners. The spouse with psoriasis not only suffers
from the disease and perhaps from problems with self-image, but also may be acutely
aware of the partner struggles to be supportive. Over time, it is the ittle
things?that can come between partnersor example, flaked-off skin that must be
shaken from bed sheets every morning, or in this case the spouse constant scratching
that becomes a ast straw?for an otherwise supportive husband.
The husband growing irritation may actually be a
message worth heeding, however. While scratching is effective in temporarily relieving
pruritus, hard scratching can also be a trigger for formation of new psoriatic
lesions or worsening of existing lesions. Especially during active phases of psoriasis,
abrasion of the skin is one of the causes of Koebner phenomenonhe induction
of psoriatic lesions by injury to the skin. Hard, constant scratching can cause
the type of skin injury that leads to development of Koebner phenomenon.
Since pruritus has become a major issue for both
husband and wife, the issue should be discussed with the patient dermatologist.
Pruritus control should perhaps be made a focus of psoriasis treatment, along
with educational counseling of both marriage partners. As discussed in May Update,
general measures for control of pruritus include keeping the skin cool and moisturized
and avoiding irritating fabrics. Ice packs may help stop the itching. A heavy
moisturizing cream applied twice daily will help control scaling and pruritus.
Specific pharmacologic measures should be prescribed by the dermatologist on the
basis of the patient history of psoriasis and overall medical condition.
What should I look for in an OTC
psoriasis shampoo?
There are numerous shampoos available at most drug
stores. Look for a shampoo that contains tar or salicylic acid. Be sure to treat
your scalp gently, as harsh shampoos, scalp massages or scratching can aggravate
psoriasis.
Is
Skin-Cape product label. Numerous potentially harmful side effects of clobetasol
propionate include stretch marks, thinning skin and dilation of tiny blood vessels.
The U.S. Food and Drug Administration (FDA) cautioned that users should not stop
treatment with this product without a dermatologist help because an abrupt halt
could cause serious, even life-threatening, flare-ups.
What effect does the sun have on psoriasis?
Natural sunlight can have a positive effect on psoriasis. The long-known benefits
of sunlight provided the basis for the development of ultraviolet light therapy
for treating psoriasis and other skin diseases. However, you should never get
enough sun exposure to turn your skin red or cause a sunburn, which can actually
cause psoriasis to flare and worsen.
An educational program brought to you by
the American Academy of Dermatology.
This
information sponsored by an unrestricted educational grant from
Amgen / Wyeth
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