DermWeb Psoriasis
Psoriasis: What is it and How is it Treated?


The purpose of this handout is to give you some useful information about psoriasis and its treatment. At this time psoriasis cannot be cured but can be helped and improved with treatment. You may have had psoriasis for a long time and know a great deal about it, or you may have just found out that you have this condition. Some treatments you may have used before. It is important that you know all you can about psoriasis so that you can better understand the treatments and how to get the best possible results.

What is Psoriasis?

PSORIASIS IS A CHRONIC SCALING DISEASE of the skin. It may range from just a few spots anywhere on the body to large areas of involvement. It is not contagious or spreadable from one part of the body to another or from one person to another.
There is no blood test for psoriasis. The diagnosis is made by observation and examination of the skin. Sometimes microscopic examination of the skin (biopsy) is helpful where the changes are not typical or characteristic.
The exact cause of psoriasis is unknown, but hereditary and genetic factors are important. Psoriasis runs in families. This does not mean, however, that every child of a parent with psoriasis will develop psoriasis, but it is common that somewhere down the line psoriasis will appear in families. Psoriasis is not caused by allergies, infections, dietary deficiencies or excesses, or nervous tension.

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How Serious is Psoriasis?

PSORIASIS DOES NOT AFFECT the overall general health. If it is widespread it can certainly cause a great deal of skin discomfort and emotional embarrassment, and can affect job and leisure time activities. Fortunately most people who have psoriasis only have a small amount and while it certainly can be a nuisance, it does not alter the lifestyle.
In about 10 percent of people with psoriasis there can develop a form of arthritis called psoriatic arthritis. It will take proper medical examination to confirm this diagnosis. Although not always, psoriatic arthritis is more often seen in people with widespread psoriasis than those who have a small amount. The psoriatic arthritis can affect people of all ages.

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Is there a Cure for Psoriasis?

THERE IS NO PRESENT CURE FOR PSORIASIS, but there are a number of drugs and treatments that can relieve and control psoriasis, often for long periods of time. Psoriasis on its own can come and go often with long periods of remission. In most cases, however, psoriasis is persistent. It can come and go without any obvious reason. Psoriasis does not necessarily become worse with age. Psoriasis can occur at any age from infancy to the elderly. Psoriasis will often remain in small localized areas and never spread.

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What Makes Psoriasis Worse?

THERE ARE SOME THINGS that can make psoriasis worse at times. It helps to be aware of these aggravating factors. But remember, psoriasis can flare without any seeming cause. The following are some of the things which seem to make psoriasis worse in some people:

1. Skin injury and irritation

RUBBING, SCRATCHING, AND SUNBURN could all make psoriasis worse. You should try to stop mechanically irritating your psoriasis if possible. Psoriasis can develop for the first time in sites of skin injury from cuts, burns or infections.

2. Sun exposure

FOR MOST PEOPLE WITH PSORIASIS, moderate sun exposure is very helpful, but sunburn can cause psoriasis to flare. A small number (perhaps 10 percent) of people may find their psoriasis worsens with sun exposure. If you are a fair-skinned person you may need sunscreens to protect against sunburn.

3. Diet

NO CONSISTENT LINKAGE WITH PSORIASIS has yet been found; however there are certain important guidelines one should follow.

  • A healthy balanced diet is important for personal good health.
  • Some people find their psoriasis is worse if they are overweight--weight loss is helpful in controlling their psoriasis.
  • Some people note that alcohol of any type will flare their psoriasis.

4. Stress and anxiety

SOME PEOPLE FIND that stress and tension seems to make their psoriasis worse. If this does occur, it is important to try to find ways to lessen the stress situations.

5. Medications

SOME DRUGS GIVEN for other reasons can make psoriasis worse, but certainly not in everyone. These drugs include: gold, lithium, beta-blockers such as Inderal used for hypertension. Your dermatologist should know if you are taking any medications. If you have questions by all means ask.

6. Infections

SOME THROAT AND UPPER RESPIRATORY TRACT INFECTIONS -- especially strepto-coccal infections can make your psoriasis worse. This is most commonly seen in children and adolescents.

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How is Psoriasis Treated?

TREATMENT IS DETERMINED by the location, severity and history of psoriasis in each individual. There is no one way of treatment, for each person with psoriasis may respond differently.
One main objective of treatment is to slow down the more rapid than usual growth rate of the skin cells. The rapid growth rate of skin cells causes the red, scaly psoriasis patches. The underlying cause of this increased skin growth is not yet known.
For patients with minimal psoriasis, therapy is limited to topical medications, that is drugs applied to the skin. For patients with moderate to widespread psoriasis, topical treatments are often combined with ultraviolet light therapy. Either sunlight or artificial ultraviolet light therapy can be used.
If topical and ultraviolet light therapy are not effective, or are not practical, systemic or oral medications can be used. These may be combined with ultraviolet light therapy, the so-called photochemotherapy or PUVA therapy. In severe cases and unresponsive cases of psoriasis, there are oral medications that slow down the growth rate of skin which are helpful. These drugs can have significant side effects and have to be used with the proper safeguard and caution. Even these strong drugs do not cure psoriasis but only help to control the disease.

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Topical Drugs

1. Corticosteroids

MANY DERMATOLOGISTS PREFER cortisone creams or ointments for starting treatment. They are easy to use and are probably the best form of therapy for such areas as the scalp, face, ears and skin folds. Misuse of topical cortisone creams, putting on strong creams on the skin for too often and too long, can lead to changes in skin colour, thinning and easy bruising. The face and skin folds are special danger areas. Often if only cortisone creams are used for treatment, the psoriasis will become resistant and will flare quickly if the creams are stopped.

2. Tars

IT IS KNOWN that the application of tars to the skin can improve psoriasis. The problem is that many tars are messy and smelly to use. The purified tars in creams and ointments or gels are much easier and more pleasant to use. Tar seems to increase the effectiveness of ultraviolet light. The tars can also be used in solutions for bathing.

3. Anthralin

THIS IS AN OLD REMEDY for psoriasis but is probably the most effective of all topical treatments. The disadvantage of anthralin is that it is messy, stains clothing and the skin. However if directions for its use are followed, these side effects can be minimized.
The application of certain strengths of anthralin in creams and ointments to the skin for only short periods of time, ten to twenty minutes, can be very effective and can reduce the problems of staining of clothing and the skin.
Often a combination of a variety of topical drugs are used if the psoriasis is not responsive to one treatment or the other. We frequently find that we need to change from one treatment to the other to keep the psoriasis improving.

4. Ultraviolet Light

AS MENTIONED, sunlight is helpful in a majority of patients. Because of our weather pattern, we cannot rely on sunlight for much of the year.
Artificial ultraviolet light is very helpful. The most useful ultraviolet light is UVB, or short-wave ultraviolet light. It is not the light used in "sun tan parlors." By receiving properly controlled exposures to UVB. along with topical drugs, good clearing and maintenance of psoriasis can occur.
A long-wave ultraviolet light, UVA, is used in combination with certain oral medications for resistant psoriasis. This treatment is described in the next section.

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Systemic Drugs

PATIENTS WITH MORE EXTENSIVE DISEASE that does not respond to topical preparations may need more intensive treatment. None of these treatments however, produce a permanent cure of psoriasis.
One agent, psoralen, is a drug extracted from plants. This drug when used in combination with long-wave ultraviolet light (PUVA therapy) can be very effective in providing control of psoriasis. This is the least toxic of the oral drugs, but it needs to be used with precaution and under the supervision of your dermatologist. This treatment requires special ultraviolet light equipment and so is not easily available in many areas.
Another drug, Tegison, is a relatively new one. This drug can slow down the rapid growth rate of skin cells and therefore help to reduce the psoriasis activity. It is an analog derivative of Vitamin A; however Vitamin A itself is not helpful in the treatment of psoriasis. Tegison has a number of side effects that require proper monitoring and blood tests. It is often more helpful to use Tegison in combination with ultraviolet light than by itself. Not all people with psoriasis will find improvement with this medication.
Anti-cancer drugs, such as methotrexate have serious toxic side effects and must be used cautiously. With proper safeguards they can be used safely in many patients. Blood tests and sometimes liver biopsies are necessary before and during treatment.
All of these oral drugs may cause genetic damage to the fetus and therefore these agents should not be used in pregnant women and should be used with great care and caution in women of child-bearing age.

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What Does this all Mean?

PSORIASIS CAN VARY from a nuisance problem to a life-altering condition. You should know as much as you can about psoriasis, the aggravating circumstances and the treatments. The object of treatment is to improve your psoriasis to the best degree possible so that it is physically and socially acceptable to you.
There are organizations which can supply valuable information about psoriasis. These include:

    824 Meath Street
    K1Z 6E8
    SUITE 300 - 6600 SW 92ND AVE

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