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Frequently Asked Questions About Psoriasis
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General Information
Related Risks: Fact or Fiction
Skin Care
Treatment
Who gets psoriasis?
Psoriasis occurs in both children and adults and may appear at any
age, although it is most commonly diagnosed between the ages of 15
and 35. Both men and women of any race may be affected.
How common is psoriasis?
It is estimated that over seven million Americans (2.6%) have
psoriasis, with more than 150,000 new cases reported each year.
According to the National Psoriasis Foundation, 20,000 children
under 10 years of age are diagnosed with psoriasis annually.
What causes psoriasis?
The exact cause of psoriasis is unknown; however, researchers
suspect that whether a person develops psoriasis or not may depend
on a "trigger." Possible psoriasis triggers include emotional
stress, skin injury, systemic
infections, and certain medications. Studies have also indicated
that a person is born genetically
predisposed to psoriasis, and multiple genes have been
discovered over the past 5 years confirming this fact. Even so, not
everyone with psoriasis will have a family history of the disease.
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 process—by 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 dermatitis—two
major forms of eczema—appears 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:
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Psoriatic lesions have well-defined
borders.
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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’s 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 for secondary infections may increase with hard scratching as
this abrades the skin and opens it to bacterial invasion. Hard
scratching should be avoided for this reason, and because abrasion
of the skin can
trigger 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 a serious
systemic infection.
Will psoriasis shorten
my life?
Psoriasis itself does not appear to shorten a person’s 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’s 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 bathing—don’t 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’s 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’s
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’s 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’m afraid we’re
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’s struggles to be supportive. Over time, it is the
”little things” that can come between partners—for example,
flaked-off skin that must be shaken from bed sheets every morning,
or in this case the spouse’s constant scratching that becomes a
“last straw” for an otherwise supportive husband.
The husband’s 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’s
phenomenon—the 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’s phenomenon.
Since pruritus has become a major issue
for both husband and wife, the issue should be discussed with the
patient’s dermatologist. Pruritus control should perhaps be made a
focus of psoriasis treatment, along with educational counseling of
both marriage partners. As discussed in May’s 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’s 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.
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.
All content solely
developed by the American Academy of Dermatology
For an overview, visit
the AAD pamphlet
Psoriasis and Psoriatic Arthritis.
Supported by an educational donation
provided by Abbott.
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