About Your Diagnosis

Psoriasis is a chronic skin disorder with frequent recurrences and remissions characterized by silvery white, scaly plaques. Your psoriasis can vary from mild to severe, depending upon the type of psoriasis and the extent of involvement. The exact cause is unknown. Psoriasis is likely autoimmune (i.e., a condition in which your immune system mistakenly attacks normal parts of the body, resulting in tissue injury or disease). This condition is common, affecting about 2% of individuals in the United States. It is less common in individuals of African, Asian, and Native American descent. It affects men and women equally. It typically begins in adolescence or early adulthood and persists throughout life. This condition is hereditary but is not infectious or cancerous. Other members of your family may have psoriasis. Minor injury, including scratching or rubbing, can provoke an outbreak of the lesions. Other factors that can increase your risk for an episode of psoriasis include stress, infections, cold and dry climates, obesity, and other autoimmune conditions. Diagnosis is usually based upon the appearance of the skin lesions. Your doctor may perform a skin biopsy (i.e., removal of a small piece of skin or other tissue) for laboratory evaluation to assist in diagnosis. Psoriasis is not curable. Psoriasis is a chronic condition in which episodes may persist for days to months. Periods of remission occur between episodes. The severity may decrease during pregnancy. Treatment aims to control symptoms and lessen the severity and duration of skin lesions, but does not cure psoriasis.

Living With Your Diagnosis
Skin lesions are slightly raised, silvery white scales with red or pink margins. The lesions can develop painful fissures (cracks). Lesions may be single, localized to certain areas of the body, or generalized. They are typically bilateral (i.e., involve both sides of the body). Psoriasis can affect any part of the body. It most commonly involves the skin of the scalp, face, elbows, hands, knees, feet, chest, lower back, and the folds between the buttocks. Fingernails and toenails are frequently involved. Nails often show discoloration and pitting. Itching is common, particularly in the scalp. Joint pain occasionally occurs, especially if psoriasis involves the fingernails and toenails. Rarely, you may have fever, chills, arthritis, and a generalized pustular psoriasis. Secondary bacterial infections can occur, especially if you scratch the lesions. These infections often require antibiotic therapy. You may also experience social embarrassment because of your skin’s appearance: “the heartbreak of psoriasis.” Other complications include arthritis and pustular psoriasis.

Treatment
Specific treatment depends upon the type, location, and severity of your psoriasis, its impact on the quality of your life, and your response to therapy. Treatment does not cure psoriasis, but it lessens the severity of your condition and prevents complications. Treatment includes the avoidance of precipitating factors, general measures, and medications. Treatment of mild-to-moderate psoriasis includes topical creams, lotions, and ointments to reduce inflammation, scaling, and itching. Shampoos and lotions are frequently used to treat psoriasis of the scalp. Be cautious when using topical medications because they may be absorbed through your skin into your bloodstream, thereby causing toxic effects. Do not exceed prescribed doses of your medicine.

General measures include:
1. Maintaining good skin hygiene.
2. Avoiding skin injury.
3. Avoiding excessive skin dryness.
4. Exposing your skin to moderate amounts of sunlight.
5. Considering moving to areas with a warmer climate.
6. Oatmeal baths to loosen scales, which can improve the appearance of your skin and enhance the effects of topical medications. Your doctor may prescribe a variety of medications to reduce inflammation, scaling, and itching and to lessen the severity and duration of outbreaks of psoriasis.

These medications include:
1. Ointments and shampoos containing coal tar. These medications are effective for psoriasis of the scalp and for mild-to-moderate cases.
2. Topical steroids and other topical anti-inflammatory agents. These agents are effective in mild-to-moderate cases and as combination therapy for more severe cases. Before using these agents, soak the affected areas in water to loosen and to remove scales, which increases the effectiveness of the topical medications. Your doctor may recommend placing occlusive dressings over the topical medications to increase their effects. Side effects include skin atrophy, formation of abnormal, small blood vessels, and absorption of medication through the skin into the bloodstream, which can cause toxic effects. To decrease the risk of side effects, do not exceed the recommended dose prescribed by your doctor.
3. Salicylic acid in mineral oil. This helps to remove plaques, thereby maximizing the effects of topical medications.
4. PUVA (combination of the medicine psoralen and exposure to ultraviolet light wavelength A [UVA]).
5. Combination of emollients or tar baths with ultraviolet light wavelength B (UVB).
6. In severe cases, immunosuppressive agents (i.e., medications that lessen the effects of your immune system) such as methotrexate, isotretinoin, and etretinate. These medications are effective but do carry the risk of toxic effects to the liver and kidney. Therefore, your doctor will closely follow laboratory tests to monitor your response to these medications and to check for side effects. Isotretinoin can be toxic to a developing fetus and should not be used in women who are pregnant or who may become pregnant.
7. Antihistamines to relieve itching. They may cause drowsiness, so use these agents cautiously when driving or performing other activities in which you must be awake and alert.
8. Antibiotics to treat secondary bacterial infections. A rare form of psoriasis, known as guttate psoriasis, is caused by a strep infection. Prompt antibiotic therapy is indicated for individuals with this type of psoriasis.

The DOs
• Take medications as prescribed by your doctor.
• Inform your doctor of all other medications, including over-the-counter medicines, that you are taking. Continue these medications unless your doctor instructs you to stop them.
• Read the labels of medicines and follow all instructions. Consult your doctor if you have any concerns or if you have possible side effects caused by the medication.
• Frequently expose your skin to moderate amounts of sunlight.
• Maintain good skin hygiene to reduce outbreaks of psoriasis and to decrease the risk of secondary bacterial infection.
• Oatmeal baths (one cup of oatmeal in a bathtub of warm water) loosens scales, which can improve the appearance of your skin and enhance the effects of topical medications.
• Consider moving to a warmer climate.
• Keep scheduled follow-up appointments with your doctor; they are essential to monitor your condition, your response to therapy, and to screen for possible side effects of treatment.
• Monitor your skin for healing and for evidence of secondary bacterial infection. Signs and symptoms of infection include redness around the skin lesions, purulent discharge (pus), increased pain or swelling of lesions or lymph nodes, and fever.
• Individuals with psoriasis frequently become depressed or experience other psychological conditions. If you feel depressed or are having difficulty adjusting to your psoriasis, talk to your doctor about the best treatment options, including psychological counseling.

The DON’Ts
• Do not stop your medicine or change the prescribed dose without consulting your doctor.
• Do not exceed recommended doses of medicines, because higher doses can increase the risk of toxic effects.
• Do not use potent topical steroids on the skin of the face or genitals, because these areas are most prone to skin atrophy.
• Do not abruptly stop steroids or immunosuppressive therapy because you may have a rebound worsening of your condition. In particular, do not suddenly stop steroids because this action can have serious effects to your health. Consult your doctor before stopping these medications.
• Do not drive or perform other potentially hazardous activities when taking medications that cause drowsiness or sedation (e.g., antihistamines and pain medications).
• Avoid skin injuries, including scratching, rubbing, or scrubbing, which can trigger outbreaks.
• Avoid skin dryness to reduce the frequency of outbreaks.
• Avoid activities that can cause infection of skin lesions.

When To Call Your Doctor
• If you have any signs or symptoms of infection.
• If you notice that lesions are becoming worse or if new lesions appear despite appropriate therapy.
• If you notice pustules on the skin, especially if accompanied by fever, fatigue, muscle aches, or joint pain/swelling.
• If you have new or unexplained symptoms.