Psoriasis: Newly Diagnosed

Psoriasis is measured in terms of its physical and emotional impact. Physically, if less then 2 percent of the body is involved, the case is considered mild. Most people have a mild case of psoriasis. Between 3 and 10 percent is considered moderate, and more than 10 percent is severe. One percent of the skin is equal to the size of a palm.

Psoriasis is not contagious. No one can “catch” it from you. For some, it is a minor skin irritation, but for others, psoriasis can be painful and potentially disabling. Some people who have psoriasis experience periods where the psoriasis completely clears (remissions). Others often say that their psoriasis occurs in a cyclical pattern.

For example, their psoriasis may be better in the summer and worse in the winter.

Why am I feeling this way?

You may feel relieved that you now have a diagnosis and can begin to understand what is happening to your body. People often have trouble getting the correct diagnosis because psoriasis-and especially psoriatic arthritis-mimics many other diseases.

You may also feel angry that psoriasis isn’t well understood by others. People may think it is only a cosmetic condition, when in fact it can have not only serious physical symptoms but also lead to low self-esteem and depression. This misunderstanding can make social interactions difficult.

In order to cope with the emotional and physical aspects of psoriasis and psoriatic arthritis, it is important to learn about your condition, to seek support from others and to treat it. Early treatment for psoriatic arthritis, for example, can prevent your joints from becoming more painful. The diagnosis of psoriatic arthritis or psoriasis may be troubling and shocking, but it can help you to take control of your disease.

What causes psoriasis?
Psoriasis occurs when faulty signals in the immune system cause skin cells to grow too quickly- every three to four days instead of the usual 30-day cycle. Extra skin cells build up on the skin’s surface. They then form “plaques,” which are red, flaky and scaly patches that are often itchy and uncomfortable. Psoriasis generally appears on the joints, limbs and scalp, but it can appear anywhere on the body.

What causes psoriatic arthritis?
Psoriatic arthritis is a chronic inflammatory disease of the joints and connective tissue. Like psoriasis, it appears to be related to the immune system, where for reasons that remain unknown, your immune system attacks your own healthy cells. In psoriatic arthritis, the joints become stiff and painful, and the nails may become pitted with small indentations.

What treatments are available?
While there is no cure, many different treatments can clear psoriasis for periods of time. Your physician will determine which treatment is best for you based on your type of psoriasis, its location on the body, its severity, and your age and medical history.

If your psoriasis is mild or moderate, your physician probably will give you topical treatments first. Topical treatments are ointments, gels or lotions that may contain steroids or coal tar. Steroids are man-made drugs that are created to resemble hormones (cortisone, for example) that occur naturally in the body. Coal tar has been used for centuries to treat the scaling, inflammation and itching of psoriasis. You may need to experiment with numerous therapies before you find the treatment that works well for you.

If your psoriasis is moderate to severe, your physician may administer ultraviolet (UVB) light therapy. UVB light therapy involves exposing the skin to a particular wavelength of light. It is a common, safe and very effective treatment for moderate to severe psoriasis.

If your psoriasis doesn’t clear after using topical or ultraviolet light medications, the physician may prescribe systemic medications. They are called “systemic” because they work throughout the body to treat psoriasis, instead of only on top of the skin. They include the prescription drugs methotrexate, cyclosporine and oral retinoids.

If you’ve been diagnosed with psoriatic arthritis, your physician may give you aspirin, ibuprofen or prescription drugs. These drugs are all called nonsteroidal anti-inflammatory drugs (NSAIDs). Their main purpose is to decrease inflammation, joint pain and stiffness. If you already have some joint or tissue damage, your doctor may give you disease-modifying antirheumatic drugs (DMARDs). These drugs can help to slow or stop joint and tissue damage.

A new category of drugs is called “biologics.” These turn off or block certain processes within the immune system that lead to psoriasis and psoriatic arthritis. Amevive was recently approved for treating psoriasis. Efalizumab (brand name Raptiva) is in development for psoriasis. Enbrel has been approved for psoriatic arthritis, and is in development for psoriasis. Infliximab (brand name Remicade) is also in development for psoriatic arthritis and psoriasis. Your physician may prescribe a biologic if other treatments do not work on your psoriasis or psoriatic arthritis.

Is there hope that a cure will be found?
Yes. More is known today about psoriasis than ever before. Researchers are learning more about how the immune system works in psoriasis and psoriatic arthritis, and how genes make certain people more likely to have psoriasis. The National Psoriasis Foundation and the federal government are promoting and funding research to find the cause and cure for psoriasis.

What should I do next?
A great first step is to join the National Psoriasis Foundation. Join as a Friend for free registration. Or, become a Member to access unique content not available to non-members as well as special membership benefits.

Provided by ArmMed Media
Revision date: June 18, 2011
Last revised: by David A. Scott, M.D.