WHAT IS PSORIASIS?
Psoriasis (sore-EYE-ah-sis) is a medical condition that occurs when skin cells reproduce too quickly. Instead of the usual 28 days or so, the cells replicate within days due to faulty signals in the immune system. The body does not shed these excess skin cells, so the cells pile up on the surface of the skin and lesions form.
Lesions vary in appearance according to the type of psoriasis. There are various types of psoriasis such as plaque, guttate, pustular, inverse and erythrodermic.
The vast majority (80% or so) of people living with psoriasis have plaque psoriasis, also called “psoriasis vulgaris.” Plaque psoriasis causes patches of thick, scaly skin that may be white, silvery, or red. Called plaques, these patches can develop anywhere on the skin but commonly on the elbows, knees, lower back, and scalp.
Psoriasis can also affect the nails and about half of those who have psoriasis see a change in their finger and or toe nails. If the nails begin to pull away from the nail bed or develop pitting, ridges, or a yellowish-orange color, this may be a sign of psoriatic arthritis. Left untreated, this condition can progress and become debilitating. It is important to see a dermatologist if nail changes begin or joint pain develops. Early treatment can prevent joint deterioration.
It is important to note that psoriasis is NOT contagious, so you cannot get it from touching or being in the company of someone.
Psoriasis is a complex disease and scientists are still unravelling its mysteries.
Below is a extract of an insightful rendition of psoriasis, in the main, based on an article “Psoriasis – Another Disorder of the Skin Barrier “
It affects 2-3% of the population, the spots (lesions) are red and scaly and the epidermis’s top layer, the stratum corneum, thickened due to an increase in the production of cells. The red colour is due to inflammation.
These two features; too many epidermal cells and inflammation have resulted in long standing discussions. Is the psoriatic skin inflamed because of a defect in the epidermis or is it due to a disorder of the immune system?
Research in the 1960’s showed that the epidermal cells divide too quickly, they do not get a chance to mature. Normally it would take about a month but in psoriasisit can happen within a week. Drug treatment, therefore, focused on reducing the abnormal cell division.
In the 1970’s research into the immune system revealed a link with the skin and psoriasis was described as an autoimmune disorder with the resultant increased use of immuno suppressants and the birth of biologics to tame the aberrant immune system.
More recently advances in molecular biology allowed scientists to map genes and to understand how they work. Thus it became possible to predict how the environment would react with inherited tendencies that exacerbated the expression of psoriasis.
Molecular genetic evidence showed that psoriasis is strongly linked to genes that affect the epidermis and result in a compromised epidermal barrier. Thus, adefective barrier in psoriasis could be the underlying trigger that causes excess cell division.
When the skin barrier is disturbed and the skin leaks water, a host of responses follow in an attempt to repair the skin, one of which is to make more epidermal cells. Another is the release of cytokines that cause inflammation and in cases it cannot turn itself of and continues to produce more cytokines.
This results in a vicious circle aka Psoriasis. By repairing the epidermal barrier it is plausible that it would also calm the immune system, or so eloquently put:
“Whenever you see an inflamed skin, regardless of cause, the stratum corneum is leaky and permeable. But if you repair the stratumcorneum that tells the underlying tissues that they do not have to react like there is danger in the environment’”
Albert Kligman MD, PhD 1919-2010
3. How does psoriasis affect quality of life?
For some people, psoriasis is simply a nuisance while others find that psoriasis affects every aspect of their daily life. Psoriasis is a chronic (life-long) medical condition. Some people have frequent flare-ups that occur weekly or monthly. Others have occasional flare-ups.
When psoriasis flares, it can cause severe itching and pain. Sometimes the skin cracks and bleeds. When trying to sleep, cracking and bleeding skin can wake a person frequently and cause sleep deprivation. A lack of sleep can make it difficult to focus at school or work. Sometimes a flare-up requires a visit to a dermatologist/doctor for additional treatment. It is important to take the time to visit a doctor and to get treatment.
These cycles of flare-ups and remissions often lead to feelings of sadness, despair, guilt and anger as well as low self-esteem. Depression is higher in people who have psoriasis than in the general population. Feelings of embarrassment also are common.
4. Knowledge is Power
Because psoriasis is a life-long condition, it is important to take an active role in managing it. Psoriasis will manage the patient if the patient does not manage the condition.
Learn more about psoriasis, see a medical practitioner or dermatologist to discuss treatment options, speak to other psoriasis patients and develop a healthy lifestyle to enjoy life to the fullest. Finally, consider joining a psoriasis support group. It may well be worth your while.
Associations you may wish to contact:
- South African Psoriasis Association
- National Psoriasis Foundation USA
- Talk Psoriasis by Inspire
- British SkinFoundation