"Heartbreak of Psoriasis"

The Treatment for the "Heartbreak of Psoriasis"

Psoriasis, which affects 1.5 percent to 2 percent of the population in the U.S., is a hereditary disorder of the skin with several clinical types. The most frequent type is Psoriasis Vulgaris, which occurs as chronic, recurring, scaling papules and plaques usually affecting the scalp, elbows, knees, palms, soles, nails and genital areas. The clinical presentation varies in individuals from only a few localized plaques to generalized skin involvement. Age of onset varies from early, peak incidence about 22 years of age, to late presentation at about age 55. There is equal incidence in males and females.

Psoriasis is a genetic, immune-mediated disease. When one parent has psoriasis, about 8 percent of offspring develop psoriasis and when both parents have psoriasis about 41 percent develop psoriasis. In the U.S., there are three to five million persons with psoriasis, most have localized psoriasis, but approximately 300,000 persons have generalized psoriasis which can cause embarrassment and a compromised lifestyle.

There are a number of trigger factors which can be a major factor in eliciting new lesions or aggravating existing lesions: physical trauma-rubbing and scratching which can produce new lesions (Koebner's phenomenon). Stress is a factor in as high as 40 percent of flare ups in adults as well as certain drugs and alcohol.

Factors influencing the selection of various treatment modalities include: 1) Age, 2) Type of Psoriasis, 3) Site and extent of involvement, 4) Previous treatment, 5) Associated medical disorders such as Diabetes, HIV, etc.

It is probably best that all patients with suspected psoriasis be seen at least once by a dermatologist to establish the diagnosis and select a treatment regimen. Generalized psoriasis, should be managed by a dermatologist who has access to all therapies as "rotational" therapy, shifting from Ultraviolet light to PUVA to Methotrexate is necessary in most patients. Newer biologic agents (Alefacept, infliximab, etanercept and efalizumab) are emerging as Psoriasis treatments that have the potential to induce longer periods of remission. In addition, for localized psoriasis, topical treatments include: 1) Low, mid potency and ultra potent steroids, 2) Intralesional steroids, 3) Occlusion therapy with saran wrap, 4) Calcipotriene (Vitamin D analog) ointment or cream, 5) Coal tar, 6) Anthralin, 7) Tazarotene (a new topical retinoid).

Topical treatments are also used in various combinations for generalized psoriasis as well. In addition, systemic antibiotics are often helpful. Soriatane (Acitretin) at times can be used alone or in combination with PUVA (Re-PUVA). Grenz Ray (superficial, soft X-ray) can be used in stubborn areas of psoriasis of the scalp, palms of the hands or soles of the feet.

At the Arkansas Dermatology Clinic, they manage a large number of patients with generalized severe psoriasis. Mary E. Kirkland administers the Ultraviolet Light and Phototherapy and has recently completed a course of instruction sponsored by the National Psoriasis Foundation in the use of phototherapy and received a certificate. In conclusion, psoriasis can be a severe emotional burden and requires an excellent patient-physician relationship. Although there is no cure available, often complete remissions for months at a time can be achieved.

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