Psoriasis is a complex multi-system disease that can affect the skin, but can also impact the joints and other organs. It is genetically-based, in other words, patients are born with a tendency to psoriasis. It is assumed that many genes are involved, and the more affected genes one inherits, the more likely and earlier in life psoriasis starts. Though it is not usually life-threatening, severe psoriasis can have a great impact on someone’s health.
The rash of psoriasis can vary greatly between people, but most will have thick red plaques on the skin that have coarse silvery scales. They occur most frequently on the elbows and knees, but can actually manifest on any part of the body, including the face, scalp, nails, folds and genital areas. Patients with mild disease may only have thin plaques or a bit of dandruff-like scale, and may only need some creams to keep things under control.
Those with more extensive disease, involving large areas of the skin, or have socially or functionally disabling disease will need more involved treatments, including phototherapy or oral or injectable medications. These often require regular monitoring and follow-up, and should be used in conjunction with a dermatologist.
Psoriasis is now recognized as multi-system disease, and can be associated with arthritis, heart disease, diabetes, obesity and liver damage. Managing the patient with psoriasis should always involve care of the other accompanying problems. The role of the family doctor is vital in sorting out these issues. At times, it may be important to involve other specialists apart from the dermatologist.
In addition to carefully following the treatment plan your doctor or dermatologist provides, patients can improve their condition by a few simple measures.
It is always important to keep the skin moisturized. A dry skin can be itchy, scratching leads to micro-trauma to the skin and psoriasis can occur where the skin is damaged. Furthermore, scratching psoriatic plaques can make them bleed, worsening the condition. Patients should use any simple moisturizer several times a day in conjunction with their prescriptive medication.
If there is a lot of scaling in the scalp, then washing the hair daily will help remove retained scales, limiting the amount that falls onto clothing. Medicated shampoos may be recommended by the doctor, but these are harsh and should always be used in conjunction with a conditioner. On the days that treatment shampoos are not use, then a gentle baby shampoo can be substituted.
Patients often find their psoriasis improves over the spring and summer, and they ascribe it to getting more ‘sun and surf’. They are happy that their medication requirements are less during the warmer months. However, it is not recommended that patients deliberately expose themselves to excessive sunlight, as this can increase their risk of developing skin cancer. When patients are outdoors, then adequate sun protection is vital to reduce exposure to dangerous ultraviolet rays.
