HELL on Earth

PSORIASIS FACTS

Psoriasis (sore-I-ah-sis) is a common immune-mediated chronic skin disease that comes in different forms and varying levels of severity. Most researchers now conclude that it is related to the immune system (psoriasis is often called an "immune-mediated" disorder). In general, it is a condition that is frequently found on the knees, elbows, scalp, hands, feet or lower back. Many treatments are available to help manage its symptoms. More than 4.5 million adults in the United States have it. Between 10 percent and 30 percent of people with psoriasis also develop a related form of arthritis, called psoriatic (sore-ee-AA-tic) arthritis. Psoriasis is an immune-mediated, genetic disease manifesting in the skin and/or the joints. It affects more than 4.5 million people in the United States. In plaque psoriasis, the most common type, patches of skin called "lesions" become inflamed and are covered by silvery white scale. Psoriasis can be limited to a few lesions or can involve moderate to large areas of skin. The severity of psoriasis can vary from person to person; however, for most people, psoriasis tends to be mild. Q: Is psoriasis contagious? No, psoriasis is not contagious. It is not something you can "catch" or "pass on." The psoriatic lesions may not look good, but they are not infections or open wounds. People with psoriasis pose no threat to the health or safety of others. Q: What causes psoriasis? No one knows exactly what causes psoriasis, but it is believed to have a genetic component. Most researchers agree that the immune system is somehow mistakenly triggered, which speeds up the growth cycle of skin cells. A normal skin cell matures and falls off the body's surface in 28 to 30 days. But a psoriatic skin cell takes only 3 to 4 days to mature and move to the surface. Instead of falling off (shedding), the cells pile up and form the lesions. Q: Who gets psoriasis? The average age of diagnosis is 28, and psoriasis most often appears between the ages of 15 and 35; however, it can develop at any time—a first-time diagnosis of psoriasis has been seen in elderly people, small children and even newborn babies. Psoriasis in infants is rare, but between 10 percent and 15 percent of people with psoriasis get it before age 10. Between 150,000 and 260,000 new cases of psoriasis are diagnosed each year. Psoriasis is a fairly common disease in many parts of the world. It affects about 2 percent of the population in Europe and America, which translates into around 14.5 million people in Europe and between 5 and 6 million people in the U.S. " Map of Worldwide Psoriasis Statistics"
There is great variation in the ethnic groups and regions where psoriasis is found. For example, in Africa, psoriasis is more common in the dry countries of the eastern region than in the more humid and hot countries of western Africa. In Kenya (eastern Africa), psoriasis affects 3.5 percent of the population, while in Nigeria (western Africa), a lower prevalence of less than 1 percent has been reported. A similar prevalence rate to that of Nigeria has been reported among African Americans, who are most closely linked with western Africans. Psoriasis affects men and women equally, and across all socioeconomic groups. Psoriasis may strike at any age. Although the disease has some genetic roots that are present at birth, its signs and symptoms may not show up for many years. The most common age for the onset of the disease is 15-20 years, with a second smaller peak at 55-60 years. People with early onset are more likely to experience widespread and recurrent psoriasis than those in whom psoriasis occurs later in life. Demographics and Psoriasis Severity
Psoriasis is often classified as mild, moderate or severe. In the US and Europe, between one-quater and one-third of patients are considered moderate to severe. The proportion of psoriasis sufferers who fit into the different severity categories is difficult to estimate accurately. This is because the measures are based on the number of patients who seek treatment. In most cases, the patients who consult doctors for treatment are those with moderate to severe psoriasis. Patients with mild psoriasis may not go regularly to a doctor, preferring to use over-the-counter medicines and advice from pharmacists. Psoriasis and Genetics
Scientists believe that psoriasis has several genetic components that make certain people more likely to develop it, but that it requires one or more external triggers to actually make the disease appear. The exact triggers are unknown but may include trauma, stress, or infection. It is important to note, an individual with psoriasis will not necessarily pass it on to his or her offspring. Because each parent contributes only half of the child's genetic material, the child may not inherit those genes linked to psoriasis. Research has shown that a child with one affected parent has roughly a 25 % chance of inheriting psoriasis. Even if the child does inherit these genes, he or she may not experience the external triggers that may lead to developing psoriasis. Q: How is psoriasis diagnosed? No special blood tests or diagnostic tools exist to diagnose psoriasis. The physician or other health care provider usually examines the affected skin and decides if it is from psoriasis. Less often, the physician examines a piece of skin (biopsy) under the microscope. Q: Is all psoriasis alike? There are various forms of psoriasis. Plaque psoriasis is the most common. Other forms are:
Guttate, characterized by small dot-like lesions
Pustular, characterized by weeping lesions and intense scaling
Inverse, characterized by intense inflammation
Erythrodermic, characterized by intense shedding and redness of the skin
Psoriasis can range from mild to moderate to very severe and disabling. Q: What parts of the body are affected? Psoriasis most commonly appears on the scalp, knees, elbows and torso. But psoriasis can develop anywhere, including the nails, palms, soles, genitals and face (which is rare). Often the lesions appear symmetrically, which means in the same place on the right and left sides of the body. Q: Do people know they are going to get psoriasis? It is not possible to predict who will get psoriasis. About one out of three people with psoriasis have with a family history of the disease. Physical trauma to the skin, infections, stress and reactions to certain drugs can trigger psoriasis, even in people without a family history of psoriasis. The National Psoriasis Foundation created and supports the National Psoriasis Tissue Bank to help investigate the genetic causes of psoriasis and psoriatic arthritis. Q: Do people get health complications from psoriasis? Yes. The skin, the largest organ in the body, plays an important role. It controls body temperature and serves as a barrier to infection. Large areas of psoriasis can lead to infection, fluid loss and poor blood flow (circulation). Q: Is psoriasis associated with other diseases? Psoriatic arthritis is a specific type of arthritis that has been diagnosed in approximately 23 percent of people who have psoriasis, according to the Psoriasis Foundation’s 2001 Benchmark Survey. Psoriatic arthritis is similar to rheumatoid arthritis but generally milder. In psoriatic arthritis, the joints and the soft tissue around them become inflamed and stiff. Psoriatic arthritis can affect the fingers and toes and may involve the, neck, lower back, knees and ankles. In severe cases, Psoriatic Arthritis can be disabeling and cause Irreversible damage to the joints . Q: Does psoriasis affect a person's quality of life? For the most part, people with psoriasis function normally. Sometimes people experience low self-esteem because of the psoriasis. Psoriasis is often misunderstood by the public, which can make social interactions difficult. This may lead to emotional reactions such as anxiety, anger, embarrassment and depression. Psoriasis can affect the type of work people do if it is visible. Q: What is the economic impact of psoriasis? Psoriasis is a chronic (life-long) illness. Most people need ongoing treatments and visits to the doctor. In severe cases, people may need to be hospitalized. About 56 million hours of work are lost each year by people who suffer from psoriasis, and between $1.6 Billion and $3.2 Billion is spent per year to treat psoriasis. Q: Is there a cure for psoriasis? There is NoCure, but many different treatments, both topical (on the skin) and systemic (throughout the body), can clear psoriasis for periods of time. People often need to try out different treatments before they find one that works for them. Q: Is there hope that a cure will be found? Researchers are studying psoriasis more than ever before. They understand much more about its genetic causes and how it involves the immune system. The National Psoriasis Foundation and the federal government are promoting and funding research to find the cause and cure for psoriasis. The National Psoriasis Foundation has gathered the information in this section to help educate people about this complex disease, including its appearance, symptoms and medical and social effects. What does it look like? It generally appears as patches of raised red skin covered by a flaky white buildup. In certain kinds of psoriasis, it also has a pimple-ish (pustular psoriasis) or burned (erythrodermic) appearance. Psoriasis can also cause intense itching and burning. What causes it? Researchers believe the immune system sends faulty signals that speed up the growth cycle in skin cells. Certain people carry genes that make them more likely to develop psoriasis, but not everyone with these genes develops psoriasis. Instead, a "trigger" makes the psoriasis appear in those who have these genes. Also, some triggers may work together to cause an outbreak of psoriasis; this makes it difficult to identify individual factors. PSORIASIS TRIGGERS :
Possible psoriasis triggers:
Psoriasis is not contagious—no one can "catch" it from another person. Because of their genes, certain people are more likely to develop it, but a "trigger" is usually necessary to make psoriasis appear. These triggers may include emotional stress, injury to the skin, some types of infection and reaction to certain drugs. Stress
Stress is a proven trigger in some people. It can cause psoriasis to flare for the first time or aggravate existing psoriasis. Relaxation and stress reduction may help people with psoriasis. For example, not only does relaxation help lower stress levels, but also it gives people a feeling of control. These techniques, however, seem to work best with traditional medical treatments, instead of using the techniques alone. How can people cope with stress? Cope with the stigma: A stigma—a characteristic that other people think of as negative—can erode a person's self-esteem. Low self-esteem can lead to stress, and possibly a worsening of psoriasis. One way to overcome the stigma, however, is to understand how and why it occurs. Hypnosis: This relaxation technique may help people who are using other treatments. For example, one study found that people who listen to meditation-based relaxation tapes while they are using light therapy may clear faster than those who don't listen to the tapes. Injury to skin
Sometimes psoriasis appears in areas of the skin that have been injured or traumatized. This is called the "Koebner phenomenon." Vaccinations, sunburns and scratches can all trigger a Koebner (KEB-ner) response. The Koebner response can be treated if it is caught early enough. For example, people receiving a vaccination may be at risk for the Koebner response, but the physician can bring it under control if the psoriasis occurs at the injection site. Medicine
Certain medications are associated with triggering psoriasis. Lithium: Used to treat manic depression and other psychiatric disorders. Lithium aggravates psoriasis in about half of those with psoriasis who take it. However, people can ask their physicians about alternatives to lithium. Antimalarials: Quinacrine, chloroquine and hydroxychloroquine may cause a flare of psoriasis, usually two to three weeks after the drug is taken. Hydroxychloroquine has the lowest incidence of side effects. Inderal: This high blood pressure medication worsens psoriasis in about 25 percent to 30 percent of patients with psoriasis who take it. It is not known if all high blood pressure (beta blocker) medications worsen psoriasis, but they may have that potential. Sometimes other medications can be substituted. Quinidine: This heart medication has been reported to worsen some cases of psoriasis. Indomethacin: This drug is used to treat arthritis. It is a nonsteroidal anti-inflammatory drug. It has worsened some cases of psoriasis. Other anti-inflammatories usually can be substituted. Indomethacin's negative effects are usually minimal when it is taken properly. Its side effects are usually outweighed by its benefits in psoriatic arthritis. What are other triggers? Weather: May make skin drier and more susceptible to a psoriasis outbreak. Strep infection: May trigger guttate psoriasis. Diet: Although unproven, changing the diet has helped some people improve their psoriasis or avoid flares. Allergies: Although unproven, some people suspect that allergies trigger their psoriasis. Emotional stress
Injury to the skin
Some types of infection
Reaction to certain drugs
Once the disease is triggered, the skin cells pile up on the surface of the body faster than normal. In people without psoriasis, skin cells mature and are shed about every 28 days. In psoriatic skin, the skin cells move rapidly up to the surface of the skin over three to six days. The body can't shed the skin cells fast enough and this process results in patches also called "lesions" forming on the skin's surface. How is psoriasis diagnosed? There is no blood test for psoriasis. Physicians usually diagnose it by examining the affected skin. Less often, a small piece of skin affected by the psoriasis is cut out and examined under a microscope. Who gets psoriasis? Psoriasis is a genetic disease. A family association exists in one out of three cases. It often appears between ages 15 and 35, but it can develop at any age. About 10 percent to 15 percent of those with psoriasis get it before age 10, and occasionally it appears in infancy. Psoriasis is not contagious—no one can "catch" it from another person. How serious is psoriasis? 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. Between 3 and 10 percent is considered moderate, and more than 10 percent is severe. (The palm of one hand equals 1 percent.) Psoriasis also is measured by its impact on quality of life. When psoriasis involves the hands and feet, it may also be considered severe because of how it affects a person's ability to function. Or, if a person's psychological or emotional well-being is considerably affected, the psoriasis may also be considered severe. Are there different types of psoriasis? There are five different types of psoriasis. The most common form of psoriasis is called "plaque psoriasis," which is characterized by well-defined patches of red, raised skin. About 80 percent of people with psoriasis have this type. Plaque psoriasis can appear on any skin surface, although the knees, elbows, scalp, trunk and nails are the most common locations. PLAQUE PSORIASIS :
Plaque psoriasis is the most typical form of the disease—four out of five people with psoriasis have this type. The technical name for plaque psoriasis is "psoriasis vulgaris" (vulgaris means common). Typically, it is characterized by patches on the elbows, knees, scalp and lower back, but it can be found on any area of the skin. It may first appear as small red spots. They may enlarge gradually into well-defined patches of red, raised skin called either "plaques" or "lesions." They are covered by a flaky, silvery white buildup called "scale," which is composed of dead skin cells. This scale comes loose and sheds constantly from the plaques. Skin affected with psoriasis is generally very dry, and other possible symptoms include skin pain, itching and cracking. The less common forms of psoriasis are guttate, pustular, inverse and erythrodermic. It is easier to discuss your psoriasis and evaluate your treatment choices if you refer to it by its specific name. Treatments vary with the type and severity of psoriasis. Learn more about treatments for plaque psoriasis. PLAQUE PSORIASIS TREATMENTS :
Psoriasis has NO CURE, but a wide range of treatments can give people control over their disease. Many different treatments can reduce or nearly eliminate the symptoms of psoriasis. No single treatment works for everyone, but something is likely to work in most cases. A number of factors determine which treatment to try, including:
the type of psoriasis
its location on the body
its severity
the person's age and medical history
A doctor--particularly a dermatologist--can provide guidance in selecting the right treatment. The traditional approach is to start with the least potent treatments (topicals, phototherapy) and move to stronger ones (such as methotrexate or biologics) until a satisfactory combination of results and risks is found. The goal is to find a treatment that has the best results and the fewest side effects. However, it is also acceptable for stronger treatments to be used right away, if a patient and a doctor decide together that this is warranted after weighing the treatment's side effects and effectiveness. This may be particularly appropriate when a person's quality of life is greatly impacted or when the psoriasis is more severe or disabling, such as pustular or erythrodermic psoriasis. The General Approach
Many safe, effective treatments can improve the condition of the skin and reduce swelling, redness, flaking and itching. Some treatments can temporarily clear the skin (this is called a "clearance" or "remission" of psoriasis). Some can be used for a period of time to reduce new flares of lesions. Because psoriasis is chronic and unpredictable, it can be challenging to treat. It often improves and worsens in a natural cycle over time. But people can usually find success by experimenting with treatments under their doctor's guidance. Psoriasis Treatments
Treatments for psoriasis can be divided into three basic categories:
topical treatment (external treatments);
phototherapy (artificial ultraviolet light, or a combination of ultraviolet light and medications);
systemic (internal) medications taken by pill or injection. TOPICAL TREATMENTS :
Topical treatments are used after determining the extent of the disease, location of disease, disability produced by the disease and person's age. Topical treatments are usually the first line of defense in treating psoriasis. Many effective treatments are in this class. Some are prescription, and others can be purchased over the counter. The physician generally works with the patient to determine which treatments to try based on the severity of the psoriasis, its location and the treatments' side effects. STERIOD TREATMENTS :
Steroids: Steroids are a class of topical medications. Also called "corticosteroids," they are among the most commonly prescribed therapies for mild to moderate
Steroids are a class of topical medications. Also called "corticosteroids," they are among the most commonly prescribed therapies for mild to moderate psoriasis. Steroids are man-made (synthetic) drugs that resemble hormones (cortisone, for example) that occur naturally in the body. They are available in many different forms, including ointments, creams, lotions, solutions, sprays, foam and tape. How do they work? Steroids slow down the overly rapid growth of skin cells, and decrease the inflammation of lesions. Steroids can quickly clear lesions, but they typically don't produce long remissions. Steroids range in strength from class 1 to class 7. Healthcare professionals frequently hear of people using low potency steroid with success after taking a high potency steroid. Weak potencies: Used on thin, sensitive skin, such as the face, groin and breasts. Should only be used under the guidance of a physician. Over-the-counter steroids are the weakest and are usually not helpful in treating psoriasis. Most experts feel the weak-to-moderate strengths are safe for children on limited parts of the body. Superpotent: Very effective in clearing lesions, but must be used with caution. Stronger steroids are more effective on thicker areas, such as the knees and elbows. Can cause skin damage if used too often. Some potent steroids are not appropriate for psoriasis in certain areas of the body (such as the skin folds or genitals). Common side effects from overuse or misuse of steroids include thinning of the skin, easy bruising and stretch marks. View a chart of steroid potency
The National Psoriasis Foundation booklet Steroids provides a chart listing the potencies of topical steroids. Friends and Members can download the booklet from the Booklets section using Adobe Acrobat Reader software. If you do not have this software installed on your computer, it is available at the Adobe Web site. How are they used? Steroids applied to lesions: A small amount is applied directly onto the lesion as often as prescribed. Occlusion: Some people cover the applied skin with airtight plastic wrap. This increases the effect of the steroid on the skin. Some steroids are too strong to occlude, so anyone trying this should check first with the physician. Pulse-dosing: This treatment consists of an intermittent dosing schedule that helps reduce steroid side effects. Once the lesions clear, the schedule is cut back. Scalp psoriasis treatment: Topical steroids are applied to the scalp. Weak to moderate strengths can be occluded. The steroids can be used safely for long periods of time. Combination therapy: Some physicians will use topical steroids with UVB treatments or with other topical medications, including coal tar, calcipotriene (brand name Dovonex), tazarotene (brand name Tazorac) and anthralin. What are the side effects? The following side effects may go away after the medication is stopped, but in some cases damage may be permanent. Skin damage: Skin thinning, easy bruising, stretch marks, steroid redness, dilated surface blood vessels. Rebounds: Psoriasis may worsen if medication is stopped too quickly. Can be avoided by gradually reducing the number of applications or lowering the potency. Facial psoriasis: Steroids on the face can cause redness, acne or visible blood vessels. Should not be used around the eyes or face unless instructed by a physician. Internal absorption: If overused on large areas of the body, steroids can be absorbed through skin and into the internal system. Rarely, can cause such side effects as high blood pressure, diabetes and muscle problems. Steroids and pregnancy: Women are usually advised to not use steroids while pregnant or nursing. Tips for using topical steroids
Use steroids exactly as your physician recommends. Have your physician check your skin periodically. One or two applications per day are usually enough. Use topical applications sparingly. Topical steroids may become ineffective as a treatment over time. If one steroid stops working, another brand or strength may be helpful. When you wish to stop the medication, taper off gradually. Internal use of steroids
A steroid medication can be given internally to treat psoriasis and psoriatic arthritis. This can be done through an injection into the psoriasis lesion (intralesional injection), a pill taken by mouth (oral steroids) and an injection into the muscle (intramuscular injection). Intralesional injection: This method is used for one or a few lesions that resist other treatments. Nail psoriasis can be treated this way. The treatment can be painful, but they have few side effects (atrophy [skin thinning] may occur) unless they are repeated too often. Oral steroids and intramuscular injection: These types of steroid treatments are called "systemic steroids" because they affect the entire body. This is a controversial treatment, because rapid withdrawal may cause a flare of pustular psoriasis. Nevertheless, some patients receive systemic steroids for arthritis flares. Coal tar: Topical coal tar preparations have helped treat the scaling, inflammation and itching of psoriasis for hundreds of years. Calcipotriene: Calcipotriene (brand name Dovonex) is a synthetic (man-made) form of vitamin D3 that is used to treat mild to moderate psoriasis. Anthralin: Anthralin is a prescription topical medication. It has been used to treat psoriasis for more than 100 years. Salicylic acid: Salicylic acid is found in keratolytic products that are used to loosen scale. Keratolytics are products that include shampoos, soaps, lotions and gels. Tazarotene: Tazarotene (brand name Tazorac) is a prescription topical retinoid (vitamin A derivative) approved for treating mild to moderate plaque psoriasis. OTHER TOPICAL TREATMENTS :
Other topicals: People with psoriasis can also reduce redness and itching by keeping their skin lubricated. Moisturizers, bath solutions and nonprescription medications, including coal tar and salicylic acid, can help skin heal by keeping it flexible. People with psoriasis can also reduce redness and itching by keeping their skin lubricated. Moisturizers: Heavy, greasy products seem to work the best. Some examples are Eucerin, Vaseline, Aquaphor and Neutrogena Norwegian Formula Hand Cream. For some individuals a light moisturizer, such as one with aloe vera, may soothe the skin. Bath solutions: Adding oil to bath water can be helpful. Oilated oatmeal, apple cider vinegar, Epsom salts or Dead Sea salts can also help remove scale and soothe itching. It is also useful to soak for 15 minutes and apply a moisturizer or oil after the bath. Nonprescription medications: Coal tar and salicylic acid are both helpful. Alternative products, including aloe vera, jojoba, zinc pyrithione and capsaicin may also help, although their effectiveness is not known. PHOTOTHERAPY TREATMENT :
Phototherapy is generally used for people with moderate to severe psoriasis who are not responding to topical treatments or who have disease too extensive for topicals. However, laser phototherapy may be used to target selected areas of the skin. Phototherapy involves exposing the skin to wavelengths of ultraviolet light under medical supervision. This is a standard treatment for patients with moderate to severe psoriasis who have not responded to topical therapies. It also may be used for patients whose psoriasis is extensive or disabling. Treatment usually takes place in a doctor's office or a psoriasis day clinic, although this option is becoming rare. UVB: This type of treatment involves exposing the skin to ultraviolet light B (UVB). It is a common, safe and very effective treatment, and generally works best when the psoriasis plaques are thin. PUVA: PUVA (psoralen plus ultraviolet light A) combines the light-sensitive medication psoralen with UVA. It is also called "photochemotherapy." This is often tried if UVB doesn't work on the plaques, or if the plaques are thick. Lasers: Excimer lasers emit a high-intensity beam of UV light similar to the light in narrow-band UVB units. Pulsed-dye lasers use short bursts of light to target blood vessels under the skin. Home phototherapy: Patients who live far from a doctor or whose schedule makes it difficult to go in for frequent light treatments in a doctor's office may consider purchasing a home UVB unit. This can be an economical choice, but it does require a physician's prescription. It also is very important that patients monitor use of the home unit with a doctor. SYSTEMIC TREATMENTS :
Systemic drugs usually are reserved for people with moderate to severe psoriasis or disabling psoriatic arthritis. They also are used for erythrodermic or pustular psoriasis. Oral or injected psoriasis treatments that circulate throughout the body’s systems, are known as systemics. Agents in this group are available by prescription only and include cyclosporine (Neoral®, Sandimmune®), methotrexate, and acitretin (Soriatane®). For warning information on pregnancy and these therapies,
PREGNANCY WARNINGS :
Any women who are pregnant or plan to get pregnant should check with their doctor before starting a new medication. Some medications listed on this site are defined by the U.S. Food and Drug Administration (FDA) as pregnancy Category X. Category X indicates medications in which studies in animals or humans demonstrate fetal abnormalities or adverse reaction reports indicate evident of fetal risk. The risk of use in prenancy clearly outweighs any benefits. These three medications include the following pregnancy warnings in their prescribing information. These are not the only warnings for these drugs. Please see the full prescribing information for additional warnings and precautions. Acitretin (Soriatane®)
Soriatane® must not be used by females who are pregnant, or who intend to become pregnant during therapy or at any time for at least 3 years following discontinuation of therapy. Soriatane® also must not be used by females who may not use reliable contraception while undergoing treatment and for at least 3 years following discontinuation of treatment. Acitretin is a metabolite of etretinate (Tegison®) and major human fetal abnormalities have been reported with the administration of acitretin and etretinate. Potentially, any fetus exposed can be affected. Nursing mothers: Studies on lactating rats have shown that etretinate is excreted in the milk. There is one prospective case report where acitretin is reported to be excreted in human milk. Therefore, nursing mothers should not receive Soriatane® prior to or during nursing because of the potential for serious adverse reactions in nursing infants. Methotrexate
Methotrexate can cause fetal death or teratogenic effects when administered to a pregnant woman. Methotrexate is contraindicated in pregnant women with psoriasis or rheumatoid arthritis and should be used in the treatment of neoplastic diseases only when the potential benefit outweighs the risk to the fetus. Women of childbearing potential should not be started on methotrexate until pregnancy is excluded and should be fully counseled on the serious risk to the fetus should they become pregnant while undergoing treatment. Pregnancy should be avoided if either partner is receiving methotrexate; during and for a minimum of three months after therapy for male patients, and during and for at least one ovulatory cycle after therapy for female patients. Nursing mothers: Because of the potential for serious adverse reactions from methotrexate in breast fed infants, it is contraindicated in nursing mothers. Tazarotene (Tazorac®)
TAZORAC® is contraindicated in women who are or may become pregnant. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, treatment should be discontinued and the patient apprised of the potential hazard to the fetus. Women of child-bearing potential should be warned of the potential risk and use adequate birth-control measures when TAZORAC® is used. The possibility that a woman of childbearing potential is pregnant at the time of institution of therapy should be considered. A negative result for pregnancy test having a sensitivity down to at least 50 mIU/mL for human chorionic gonadotropin (hCG) should be obtained within 2 weeks prior to TAZORAC® therapy, which should begin during a normal menstrual period. Nursing mothers: It is not known whether this drug is excreted in human milk. Caution should be exercised when tazarotene is administered to a nursing woman. Systemic medications usually are reserved for psoriasis that becomes extensive or disabling. They are system-wide (affect the entire body) treatments for moderate to severe psoriasis that isn't responsive to topical medications or ultraviolet light treatments. However, in cases where the psoriasis affects a person's quality of life or is disabling, the patient and doctor may decide to use a stronger treatment right away after weighing the treatment's side effects and effectiveness. BIOLOGICS TREATMENTS :
Biologic therapies are designed to target the mechanisms that cause diseases. Biologic treatments have been shown to be effective in a variety of autoimmune diseases, for example, psoriasis, rheumatoid arthritis, and Crohn’s Disease. Currently, three biologic therapies have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of chronic plaque psoriasis: AMEVIVE® (alefacept), RAPTIVA® (efalizumab), and ENBREL® (etanercept). AMEVIVE® is approved for the treatment of adults with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy. Click here for more information including important safety information. RAPTIVA® is approved for the treatment of chronic moderate-to-severe plaque psoriasis in adults age 18 or older who are candidates for systemic therapy or phototherapy. For psoriasis, ENBREL® is indicated for the treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy. T cells have been shown to play an important role in psoriasis. Both AMEVIVE and RAPTIVA work directly on T-cell activation. AMEVIVE also works by reducing the T cells that are one of the causes of psoriasis. Biologic therapies are available by prescription only. Because they are composed of naturally-derived proteins that would be broken down by the body’s digestive system if taken orally, biologic therapies must be given by injection, either into the muscle, into the skin, or into the vein. Before taking a biologic or any medication, you should discuss the benefits and risks with your physician. Click here for Important Safety Information about AMEVIVE. T cells are a part of the immune system - one of the body’s ways of fighting off cancer and infections. Because AMEVIVE reduces the number of T cells, you should have a blood test during evaluation, then every week during the dosing period to check your T cell levels. LIGHT TREATMENTS :
Light therapies are often effective psoriasis treatment options. They range from simple sunbathing, to treatments using sophisticated lamps that emit varying wavelengths of ultraviolet light. When using any type of light therapy, regularity is the key to success. If your doctor prescribes 3 – 5 treatments per week, stick to the schedule. Light therapies have common side effects. These include skin burning and rashes (short-term side effects), skin darkening, premature aging and increased potential for skin cancer (long-term side effects). A physician should supervise all light therapies. Because ultraviolet light is known to increase one’s risk for skin cancer, it is important to know the warning signs of skin cancer and to get periodic checkups from your dermatologist. Sunlight
Sunlight, a natural source of ultraviolet light, primarily ultraviolet light B (UVB), can be an effective therapy for patients with mild to moderate psoriasis. Doctors generally recommend short, multiple exposures to sunlight, taking care to give all affected areas of the skin equal and ample exposure. Avoid sunburn, which may cause psoriasis to flare. Use sunscreen to protect parts of your body not affected by psoriasis, especially the face and ears, which are at greatest risk of skin cancer. Check with your doctor before treating yourself with sunlight. Sunlight with Topicals: Be especially cautious about sunbathing if you are using tar products or topical retinoids. Both can make your skin extra sensitive to the sun’s effects, allowing for greater risk of sunburn. If you are using the topical vitamin D3 derivative calcipotriene, don’t apply it before sunbathing. It may partially block the ultraviolet light, and the rays may make the medication less effective. Ultraviolet Light B (UVB)
UVB therapy exposes the skin to artificial rays of a specific wavelength of light called ultraviolet light B. It is often used by patients who have mild, moderate or severe psoriasis. Doctors generally prescribe three to five treatments a week, for several weeks or a few months. UVB must be administered under a doctor’s supervision. Treatments are usually given in a doctor’s office or clinic, although home light units are also available with a doctor’s order. Most equipment in the U.S. emits broad-band UVB light. Newer equipment produces narrow-band light, with a wavelength that is more effective in treating psoriasis. It achieves faster results with longer remissions, but patients may burn more easily. Combination Therapy: UVB is often combined with topical therapies or systemic medications, especially methotrexate and retinoids. The Goeckerman Regimen, combines topical coal tar with UVB, and has been used for many years to treat moderate to severe psoriasis. Side Effects: Burns (sunburns), itching, redness, and tanning are immediate side effects. A not insignificant long term affect is premature aging. Psoralen and Ultraviolet Light A (PUVA)
This two-step approach involves pre-treating with oral or topical psoralen, then exposing the skin to ultraviolet A rays. It can be an effective treatment for moderate to severe psoriasis, including psoriasis of the palms and soles. PUVA must be administered under a doctor’s supervision, in the office or clinic. Two to three treatments a week, for two to three months, are usually necessary for the full benefit. ·
Combination Therapy: Using PUVA with systemic therapies, especially methotrexate and oral retinoids, can be effective, although there is a significantly increased risk of burning. For warning information on pregnancy and these therapies, click here. Side Effects: Short-term side effects include burns (sunburns), itching, tanning, brown spots and nausea from oral psoralen. Long term side effects include significantly accelerated skin aging, splotchy, irregular pigmentation, wrinkles, dark brown spots called “PUVA macules or freckles” and a greatly increased risk for skin cancer, including melanoma. The increased risk for skin cancer development lasts more than 30 years after PUVA treatments have stopped. TOPICAL TREATMENTS :
Topical psoriasis treatments are medications applied directly to the affected skin, or plaques, and are most often used in mild to moderate psoriasis. They are available in both over-the-counter and in prescription forms including creams, ointments, gels, lotions, and sprays. In some cases, mild psoriasis may be managed with over-the-counter topicals such as moisturizers and salicylic acid. More advanced plaques may require treatment with prescription products. You may use topicals alone, in combination with other topicals, or as part of a therapy that includes ultraviolet light, oral (systemic) treatments, or biologic treatments. You should use topical agents under the direction of your dermatologist. Topical psoriasis treatments include the following:
Moisturizers (Emollients): Ointments or creams, often containing petrolatum (petroleum jelly) or mineral oil that help keep the skin hydrated and serves as a barrier. Scale Removers (Keratolytics): These over-the-counter treatments soften and remove dry psoriasis scales so that other medications can more easily penetrate the plaque. Keratolytics often contain salicylic acid or urea. Topical Corticosteroids: These prescription drugs, commonly called "steroids," are topical anti-inflammatory medications and are the most frequently used treatment for mild to moderate psoriasis. You must apply them with care, as they can cause skin thinning and other skin side effects. When used on larger areas they can be absorbed into the body as well. Their effectiveness often wears off with prolonged use. Coal Tar: Available over the counter or in stronger, prescription strengths, formulations containing coal tar treat the scaling, itching and inflammation of psoriasis, while slowing down the rapid growth of cells. They have a long history of use, but can be messy, cause staining, and have an odor. Anthralin: This topical prescription is derived from tar. Purple staining of skin and clothing are common side effects. Topical Retinoid (tazarotene (Tazorac®)): This vitamin A derivative, called a topical retinoid, is odorless, non-staining and used once a day. Dryness and skin peeling/flaking are common side effects. Vitamin D3 Derivative (calcipotriene (Dovonex®)): This synthetic form of Vitamin D is used to treat mild to moderate psoriasis. It may cause irritation initially and the total amount used is restricted. Biologics: Biologic medications are developed from living sources, such as cells, rather than combinations of chemicals like traditional drugs. Cyclosporine: Cyclosporine (brand name Neoral) is a systemic medication taken by adult patients with severe, difficult-to-treat psoriasis. It, too, is useful for patients with acute pustular and erythrodermic psoriasis. Methotrexate: Methotrexate is used for extensive or disabling psoriasis, especially acute pustular and erythrodermic psoriasis. Oral Retinoids: Oral retinoids are related to vitamin A. They are synthetic (man-made) drugs that include acitretin (brand name Soriatane) and isotretinoin (Accutane). These are also useful for patients with acute pustular and erythrodermic psoriasis. OTHER SYSTEMIC TREATMENTS :
Accutane
Accutane is a prescription oral retinoid approved for treatment of severe cystic acne. Some doctors have used it successfully to treat severe psoriasis, but generally it is not as effective as Soriatane. It is sometimes combined with UVB and PUVA to speed clearing time. What are the possible side effects? Accutane has many side effects similar to Soriatane. Common side effects include eye and lip dryness and nosebleeds. Accutane can cause severe birth defects. Women who are able to get pregnant must comply with all aspects of the Accutane SMART Risk Management Program that includes having two negative pregnancy tests before starting treatment. Women must use two separate and effective forms of birth control at the same time one month before, during treatment, and for one month after stopping Accutane therapy. Less frequent, but potentially serious effects include psychiatric disorders, such as depression, psychosis and rarely, suicidal or violent thoughts and behaviors. There is no scientific evidence of a cause and effect relationship between Accutane and these disorders, however. Hydroxyurea
Hydroxyurea is an oral cancer medication that in the 1960s was found to be effective for psoriasis. It can improve stable plaque psoriasis, but has potentially dangerous side effects, including bone marrow toxicity. Long-term use has been associated with skin cancer. It can be used alone or with UVB or PUVA phototherapy. Although not as effective as methotrexate, it is less likely to cause liver damage with long-term use. Mycophenolate mofetil
This organ transplant rejection medication is also used to treat several inflammatory or autoimmune skin diseases. It can be used with cyclosporine, especially to taper patients off cyclosporine. People with compromised immune systems should not take it because it is immunosuppressive. Sulfasalazine
This oral medication is reported to be effective for some people with psoriasis and psoriatic arthritis. It is less effective than methotrexate, but tends to have less dangerous side effects. Many people cannot tolerate sulfasalazine because of allergy to sulfa or side effects, including nausea, vomiting and loss of appetite.
6-Thioguanine
Used for leukemia, and may be effective for psoriasis, including pustular psoriasis. However, this medication may suppress bone marrow. GUTTATE PSORIASIS :
Guttate: small, red, individual drops on the skin
Guttate psoriasis often starts in childhood or young adulthood. It often comes on quite suddenly. It may be triggered by strep throat, an infection of the throat. However, many other conditions, including colds, chicken pox and tonsillitis, have been found to trigger attacks of guttate psoriasis. Guttate (GUH-tate) psoriasis looks like small, red, individual drops on the skin. These lesions generally appear on the trunk and limbs, and sometimes on the scalp. They usually are not as thick or as scale-covered as plaque psoriasis. Guttate psoriasis may resolve on its own, leaving a person free of further outbreaks. Or, it may clear for a time only to reappear later as patches of plaque psoriasis. Sometimes guttate can flare throughout childhood, often due to repeated bouts of strep infection or other upper respiratory illnesses. How is it treated? Antibiotics can help prevent an infection from re-occurring and causing an outbreak of guttate psoriasis. Moisturizers or stronger topical agents can help treat moderate cases. Topical agents (coal tar, corticosteroids, topical vitamin D3 derivatives or topical retinoids) are treatments that are applied to the skin. Ointments are considered the safest treatment. Ultraviolet light treatment with UVB or PUVA can also ease an outbreak, especially when used with topical agents. In severe cases, a physician may prescribe systemic medications. Sometimes a short course of one of these agents results in rapid and long-lasting clearing. A physician may also recommend combination therapy or rotational therapy using ultraviolet light treatment with UVB or PUVA in combination with topical agents. INVERSE PSORIASIS :
Inverse: smooth, dry areas of skin, often in folds or creases, that are red and inflamed but do not have scaling
Inverse psoriasis is also called flexural psoriasis. In inverse psoriasis, smooth, dry areas of skin are red and inflamed. It is mainly found in the armpits, groin, under the breasts and in other skin folds around the genitals and buttocks. Because of its locations, rubbing and sweating can irritate the areas of inverse psoriasis. It is more common and troublesome in overweight people. It does not have the scaling associated with plaque psoriasis. Treatment can be difficult due to the sensitivity of the skin. Steroid creams and ointments
Steroids: includes cortisone cream
Considered very effective, but they should not be covered (occluded) with plastic dressings
Overuse or misuse of steroids, particularly in skin folds, can result in side effects, including thinning of the skin and stretch marks
Because skin folds are prone to fungal infections, anti-yeast or anti-fungal agents may be used with diluted topical steroids
Should be used with caution and under the direction of a physician
Topical agents
Topicals: Includes forms of vitamin D3 derivatives, retinoids, coal tar or anthralin
Can be effective in treating psoriasis in skin folds, but may also be irritating to the skin
Should be used with caution and under the direction of a physician
Systemic drugs: Methotrexate may control severe, incapacitating inverse psoriasis. Oral fluconazole (brand name Diflucan): May help control growth of yeast within inverse psoriasis. ERYTHRODERMIC PSORIASIS :
Erythrodermic: periodic, widespread, fiery redness of the skin
Erythrodermic (eh-REETH-ro-der-mik) psoriasis is a particularly inflammatory form of psoriasis that often affects most of the body’s surface. It is the least common form of the disease. Erythrodermic psoriasis can sometimes occur suddenly as the first sign of psoriasis, or come on more gradually in people with plaque psoriasis. It most commonly appears on people who have unstable plaque psoriasis, where the lesions are not clearly defined. The skin has large, red and fiery patches. Severe itching and pain may accompany the skin as it reddens and sheds. Are there serious complications? Erythrodermic psoriasis can disrupt the body's ability to control its temperature and can lead to severe illness. In severe cases, people with this type of psoriasis may need to be hospitalized if they have lost a lot of fluid, have an infection or have poor blood flow (circulation). Initial stages:
Medium-potency topical steroids and liberal moisturizers are used for the initial stages, combined with oatmeal baths and bed rest. Systemic steroids:
Methotrexate, acitretin (brand name Soriatane) or cyclosporine (brand name Neoral) can help bring severe cases under control. If used, systemic steroids should be tapered off slowly; stopping them suddenly can make the psoriasis worse. Systemic steroids combined with methotrexate can help severe cases. The physician will monitor the improvement carefully during the necessary steroid tapering-off period. Combination therapies:
Often used to avoid potentially serious side effects
Antibiotics may be added to combat infections
UVB (sometimes used in combination with coal tar) or PUVA therapies used only after the initial inflammation has subsided
After flare passes, psoriasis usually reverts to how it looked before flare
PUSTULAR PSORIASIS :
Pustular: involves either generalized, widespread areas of reddened skin, or localized areas, particularly the hands and feet (palmo-plantar pustular psoriasis)
Pustular (PUHS-choo-ler) psoriasis is known as either "generalized" or "localized." Localized pustular psoriasis may be either on the hands and feet (palmo-plantar pustulosis) or on the tips of the fingers (acropustulosis), whereas generalized pustular psoriasis occurs in random, widespread patches on the body. Generalized Pustular Psoriasis
Generalized pustular psoriasis is a rare form of psoriasis. It is spread over wide areas of the body. It is also called von Zumbusch pustular psoriasis, named after the physician who first described it in the early 1900s. Generalized pustular psoriasis can appear quickly. Within as little as a few hours after the skin becomes tender, blisters (pustules) of non-infectious pus can appear. The pus inside consists of white blood cells. It is not an infection, and it is not contagious. It can cause fever, chills, severe itching, a rapid pulse rate, exhaustion, anemia, weight loss and muscle weakness. This form rarely appears in children, although when it does, the chance of improvement is usually much better than for adults. Physicians generally avoid giving systemic (oral or injected) treatments to children because the condition may improve without those medications. Widespread areas of reddened skin (erythema) develop
Skin becomes very painful and tender
Pustules appear on the skin, then dry and peel within two days, leaving the skin with a glazed, smooth appearance
Pustules may reappear and erupt every few days or weeks
What causes it? A person can have a history of plaque psoriasis for years and then develop recurrent episodes of generalized pustular psoriasis. It can also be triggered by the following:
Infection
Sudden withdrawal of steroids (usually systemic)
Pregnancy (this form is sometimes called "impetigo herpetiformis")
Drugs such as lithium, propanolol (Inderal) and other beta-blockers, iodides or indomethacin (Indocin)
How is it treated? Treatment aims to restore the skin's barrier function, prevent further loss of fluid, stabilize the body's temperature and restore the skin's chemical balance. Chemical imbalances can put excessive pressure on the heart and kidneys, especially in older people. Because this form can be life-threatening, medical care must begin immediately. Hospitalization: Bed rest, mild sedation, topical therapy, rehydration and avoidance of excessive heat loss can improve severe cases. If an infection is present, antibiotics may be prescribed. Systemic drugs: Used in severe cases when a person becomes exhausted from recurring outbreaks. Acitretin (Soriatane) or methotrexate is often prescribed
Cyclosporine (Neoral): FDA approved only for severe plaque psoriasis, but has been successful in some cases of pustular psoriasis
Oral steroids: Prescribed when other treatments fail or when patient is very ill; use is controversial because sudden withdrawal of steroids can trigger generalized pustular psoriasis
PUVA: Used after severe stage has passed
Localized Pustular
In localized pustular psoriasis, the pustules only occur on certain areas of the body, particularly the hands and feet. It includes two types: palmo-plantar pustulosis (PPP) and acropustulosis (also known as "acrodermatitis continua of Hallopeau"). Palmo-plantar pustulosis (PPP)
PPP generally strikes people between the ages of 20 and 60. Infection and stress may trigger it. This type of psoriasis affects females more than males. The course of PPP is usually cyclical, with new crops of pustules followed by periods of low activity. Large pustules develop in fleshy areas of the hands and feet, such as the base of the thumb and the sides of the heels
Pustules may be up to .5 cm, or about the size of a pencil eraser
Pustules appear in a studded pattern throughout reddened plaques of skin, then turn brown and peel
How is it treated? PPP often proves stubborn to treat. Topical treatments, such as corticosteroids, are usually prescribed first. PUVA, acitretin (Soriatane), methotrexate or cyclosporine (Neoral) sometimes must be used to clear this form. Combination treatment with PUVA and Soriatane (called RePUVA) may also be effective for PPP. Acropustulosis
In this type, skin lesions develop on the ends of the fingers and sometimes the toes. The lesions can be painful and disabling, with nail deformities and, in severe cases, changes to the bone. Acropustulosis occasionally starts after the skin is injured or infected. This form has traditionally been hard to treat. Tar preparations under occlusion help some patients. Oral retinoid drugs, such as acitretin (Soriatane), may help clear the lesions and restore the nails. PUVA may also be used. Typically, people have only one form of psoriasis at a time. Sometimes two different types can occur together, one type may change to another type, or one type may become more severe. For example, a trigger may convert plaque psoriasis to pustular. Although the reasons for the changes are not well understood, some triggers may include abrupt withdrawal of medications; an allergic, drug-induced rash that brings on the Koebner response (psoriasis appearing on the site of skin injuries); and severe sunburning. The different types of psoriasis not only have different appearances, but also may require different types of treatment. It is very important that you talk with your physician about what course of action to take with your type of psoriasis. What are the most irritating locations for psoriasis? SCALP PSORIASIS :
Scalp: Scalp psoriasis occurs in at least half of all people with psoriasis. It can range from very mild with fine scaling to very severe with thick, crusted plaques. Scalp psoriasis occurs in at least half of all people with psoriasis. Scalp psoriasis may appear as lesions that extend from the hairline onto the forehead and the nape of the neck. It is common for the psoriasis to appear behind the ears. Scalp psoriasis usually accompanies plaques in other areas of the body. Scalp psoriasis scales appear powdery with a silvery sheen. What can it cause? Hair loss: Scalp treatments and severe psoriasis can both cause temporary hair loss. Itching: Picking and scratching lesions can worsen the psoriasis by causing a Koebner phenomenon (psoriasis appearing on the site of skin injuries). Shampoos: Medicated shampoos that contain salicylic acid will help loosen and remove scales from scalp lesions. Tar shampoos will help to slow skin-cell growth, but it is necessary to use them repeatedly for best results. Topical steroids: Available as liquids, lotions, creams, foams and in oils. Placing a cap over the scalp after applying the topical oil may improve its effectiveness. Foam-based steroids: Includes Luxiq, which contains a mid-potency steroid, and Olux, which contains a superpotent steroid. The foam reaches the skin and melts on contact. Dovonex: Comes in a liquid for treating scalp psoriasis and has few side effects, but it may cause irritation in some people. May be used with a steroid or as maintenance therapy. However, Dovonex should not be used with products containing salicylic acid, because they will make the medication ineffective. Tazorac: Available as a cream or gel and usually applied once daily. As with Dovonex, Tazorac is effective when used with other medications, and may prevent some of the side effects of steroids. Using a good moisturizer can help alleviate dryness caused by Tazorac. UV light: May be helpful when topical treatments stop working. Can be administered to the scalp with special comb attachments. May also be used with other treatments. Systemic medications: Methotrexate, oral vitamin A derivatives (retinoids) or cyclosporine may be helpful for moderate to severe psoriasis. These drugs may also clear scalp psoriasis, but the benefits must be weighed against the potential side effects. What can you do? Avoid picking or scratching: Be gentle when treating the scalp; injury can make psoriasis worse. Occlusion may be useful under your doctor's guidance. This involves covering the treatment with a cap. Shampoo properly: Be sure to rub medicated shampoos into the scalp and not just the hair. Thin plaques: A steroid in combination with Dovonex and a tar-based shampoo may be useful. Thick psoriasis: A medicated shampoo, then a tar shampoo, and follow up with a topical steroid may help. Genitals: Genital psoriasis acts similar to other affected parts of the body. But because of the sensitivity of the skin, this type may require special considerations. Hands and Feet: Pustular psoriasis can impair a person's ability to work. Plaque psoriasis can dry out the skin and cause cracking and bleeding. Nails: Nail changes occur in about half of those with psoriasis and 80 percent of those with psoriatic arthritis. The nails may have small holes (pitting), a changed shape (deformation), separation from the skin (oncholyosis) and discoloration. PALMOPLANTOR PSORIASIS :

Red, scaling plaques with small pustules that develop on the palms and the soles of the feet. The pustules are 1–10mm (pin- to dime-sized) in diameter and are often painful, interfering with daily functioning. It predominately affects women. PSORIATIC ARTHRITIS :

Psoriatic arthritis usually appears between the ages of 30 and 50. Its symptoms usually include at least one of the following:
Pain in one or more joints
Movement that is restricted by pain in the joint or surrounding areas
Morning stiffness
Eye pain or redness
Psoriatic arthritis is a specific type of arthritis. It causes inflammation in and around the joints, usually the wrists, knees, ankles, lower back and neck. Psoriatic arthritis is a specific type of arthritis that has been diagnosed in approximately 23 percent of people who have psoriasis, according to the Psoriasis Foundation’s 2001 Benchmark Survey. It commonly affects the ends of the fingers and toes. It can also affect the spine. The disease can be difficult to diagnose, particularly in its milder forms and earlier stages. Early diagnosis, however, is important for preventing long-term damage to joints and tissue. Most people with psoriatic arthritis also have psoriasis. Rarely, a person can have psoriatic arthritis without having psoriasis. What are the symptoms? Stiffness, pain, swelling and tenderness of the joints and surrounding soft tissue
Reduced range of motion
Morning stiffness and tiredness
Nail changes, including pitting (small indentations in the nail) or lifting of the nail—found in 80 percent of people with psoriatic arthritis
Redness and pain of the eye, similar to conjunctivitis
How does it develop? Psoriatic arthritis can develop at any time. On average, it appears about 10 years after the first signs of psoriasis. For most people it appears between the ages of 30 and 50. It affects men and women equally. In about one of seven people with psoriatic arthritis, arthritis symptoms occur before any skin lesions. Like rheumatoid arthritis, psoriatic arthritis is thought to be caused by a malfunctioning immune system. Psoriatic arthritis is usually milder than rheumatoid arthritis, but some patients with psoriatic arthritis have as severe a disease as patients with rheumatoid arthritis. Psoriatic arthritis can start slowly with mild symptoms, or it can develop quickly. It is very important to have as early and accurate a diagnosis as possible. Left untreated, psoriatic arthritis can be a progressively disabling disease. In fact, half of those with psoriatic arthritis already have bone loss by the time the disease is diagnosed. How is it diagnosed? There is no definitive test for psoriatic arthritis, but the following steps are usually involved:
Person with psoriatic arthritis talks to physician
Physician may refer person to rheumatologist, who specializes in arthritis
Diagnosis is done by process of elimination using medical history, physical examination, blood tests to rule out other diseases and X-rays of the affected joints
TYPES OF PSORIATIC ARTHRITIS :

There are five types of psoriatic arthritis: symmetric, asymmetric, distal interphalangeal predominant (DIP), spondylitis and arthritis mutilans. Symmetric Arthritis
Occurs in about half of those with psoriatic arthritis
Similar to rheumatoid arthritis, but generally milder with less deformity
Usually affects joints on both sides of body
Can be disabling in about half of all cases
Psoriasis that occurs at the same time is often severe
Asymmetric Arthritis
Effects about 35 percent of people with psoriatic arthritis
Generally mild, although some people will develop disabling disease
Not occurring in the same joints on both sides of the body
Usually involves only one to three joints, such as the knee, hip, ankle or wrist
Could involve just one finger or a number of them
Hands and feet have enlarged "sausage" digits, caused by swelling and inflammation of tendons
Joints may be warm, tender and red
Periodic joint pain usually responds to medical therapy
Distal Interphalangeal Predominant (DIP)
Occurs in about 5 percent of people with psoriatic arthritis
Primarily involves the joints closest to the nail of the fingers and toes
Sometimes confused with osteoarthritis, but nail changes are usually prominent
Spondylitis
Inflammation with stiffness of the neck, lower back, pelvic area or spinal vertebrae are common symptoms
Motion is painful and difficult
In about 5 percent of individuals, inflammation of the spinal column is the predominant symptom
May also occur in the hands, arms, hips, legs and feet
When severe, may be associated with generalized symptoms
May lead to iritis—an inflammation of the eye that results in redness and sensitivity
Arthritis Mutilans
Affects fewer than 5 percent of people with psoriatic arthritis
Severe, deforming and destructive arthritis
Principally affects the small joints of the hands and feet
May also cause neck or lower back pain
Can progress over months and years
Arthritic flares and remissions tend to coincide with skin flares and remissions
PSORIATIC ARTHRITIS TREATMENTS :
Approach to Therapies
Current therapy for psoriatic arthritis can relieve pain, reduce swelling, help keep joints working properly and possibly prevent further tissue damage. Physicians will choose treatments based on the type of psoriatic arthritis, its severity and an individual's reaction to treatment. It is important for people who seem to be developing severe psoriatic arthritis to begin appropriate treatment. Early treatment can help slow the disease, and preserve function and range of motion. Some early indicators of severe disease include onset at a young age, spinal involvement and the results of certain blood studies. Categories of Treatment
A physician must evaluate each psoriatic arthritis case individually. The following treatments are not listed in order of importance. Drugs for the treatment of psoriatic arthritis can be divided into the following categories:
Nonsteroidal anti-inflammatory drugs (NSAIDs): This includes over-the-counter medications such as aspirin and ibuprofen as well as prescription products; the main purpose of these medications is to decrease the symptoms of psoriatic arthritis, including inflammation, joint pain and stiffness. Disease-modifying antirheumatic drugs (DMARDs): These medications relieve more severe symptoms and attempt to slow or stop joint and tissue damage and progression of psoriatic arthritis. Biologics: These are new drugs that block the immune system from producing the inflammation that may lead to joint and tissue damage. Other Approaches: Heat for stiffness, warm water soaks; ice for swelling; exercise programs and physical therapy also are used in the treatment of psoriatic arthritis. Alternative Methods: While generally not included in a patient's medical plan, some people have found relief through through alternative treatments. PSORIASIS IS NOT JUST SKIN DEEP :
The Emotional Toll of Psoriasis
WebMD Medical Reference
As a lot of people with psoriasis know, one of the worst aspects of having the condition is coping with other people's reaction to it. Depending on where it is on your body, psoriasis can be an embarrassing disease. People around you may not understand your condition and be frightened by it. Even your good friends may refuse your offers to help them out in the kitchen by chopping vegetables. You may find that you don't get invited to beach parties anymore. You may feel like some people avoid you. "Unfortunately, people's ignorance of this disease is hard to overcome," says Bruce E. Strober, MD, PhD, co-director of the Psoriasis and Psoriatic Arthritis Center at New York University. "It happens all the time that people with psoriasis won't be allowed in a swimming pool, or that others will move away from them on a crowded train. It's a shame." The Psychological Cost of Psoriasis
Psoriasis can make you feel deeply isolated and excluded, and that can have serious psychological costs. When it's combined with the chronic discomfort that psoriasis can cause, your emotions can be difficult to handle. Coping with psoriasis can create stress, and stress can make psoriasis get worse. There's even some evidence that worrying about your psoriasis may make treatment less effective. This can become a vicious cycle. "Psoriasis has a tremendous impact on quality of life," says Strober. He says studies have shown that psoriasis detracts more from quality of life than any other condition except depression -- and that's including life-threatening illnesses such as heart disease and diabetes. A recent survey found that some people with psoriasis - 8% to 10% -- have thought about suicide because of their condition. Obviously, psoriasis is much more than just a skin condition. Coping With People's Reactions
So what should you do? While it might seem like great advice to ignore other people's reactions, that's not realistic for most people. We're all dependent on others, and even the most self-confident among us are affected by how others perceive us. One thing that might help is to try to explain psoriasis to other people. Explain that it's not contagious and that it has nothing to do with hygiene. Explain that it's an incurable lifelong condition but that you're being treated for it. It's especially important that your family and friends understand this. Educating people, of course, isn't practical in every casual situation. There are times when you'll have to ignore the stares. No one should have to spend his or her life being a cheerful spokesperson for psoriatic understanding. Getting Help
If you feel like your psoriasis is detracting from your life and making you miserable, try to seek professional help. If possible, find a therapist who's treated people with psoriasis before -- your doctor might be able to make a recommendation. In some cases, antidepressant medications may also help you cope. Another option is to seek out a support group, either in person or on the Internet. Ask your doctor for suggestions. Talking to people dealing with your condition might make you feel a lot better and less lonely. You might also learn good tips from others about dealing with and treating this condition. One of the best things you can do is to keep going to your doctor. Feeling depressed may make you want to give up and retreat from life, but that isn't a real option. You have to keep fighting and stay involved in your treatment. "People with psoriasis have to know that they're not alone," says Jeffrey M. Weinberg, MD, director of the Clinical Research Center at St. Luke's-Roosevelt Hospital Center in New York City. "And although we can't offer a cure at this time, we do have the options to improve it." PSORIASIS STATISTICS :
The numbers tell the story about psoriasis and psoriatic arthritis. National Health Concern
About 2.1 percent of the U.S. population has psoriasis
More than 4.5 million American men, women and children have psoriasis, or about one in 50 Americans
Age
Often appears between the ages of 15 and 35, but can develop at any age
Average age of onset is 28
10 percent to 15 percent of those with psoriasis get it before age 10
Some infants have psoriasis, although this is considered rare
Annually, 20,000 children under 10 years of age are diagnosed with psoriasis
Severity of Psoriasis
About 30 percent of people with psoriasis have cases that are considered moderate to severe (generally meaning it covers more than 3 percent of their body)
More than 1.5 million Americans have moderate to severe psoriasis
Severe types of psoriasis can compromise the skin's ability to control body temperature and prevent infections
30 percent of patients under a dermatologist's care have psoriasis so extensive or difficult to control that prescription topical (rub on) therapies are not adequate
Quality of Life Impact
75 percent of people with moderate to severe psoriasis report that their disease has a moderate to large impact on their everyday lives:
26 percent alter their normal daily activities
21 percent stop their normal daily activities
40 percent say their psoriasis affects their clothing choices (avoiding dark colors, covering up arms and legs)
36 percent say it affects how they sleep
36 percent report bathing more than normal
(based on results of National Psoriasis Foundation 2001 Benchmark Survey on Psoriasis and Psoriatic Arthritis; link is to Adobe Acrobate PDF)
Facts
Psoriasis appears to be slightly more prevalent in women than in men
Psoriasis may disqualify a person from serving in the U.S. military
ON AVERAGE , 400 PEOPLE DIE FROM PSORIASIS OR COMPLICATIONS OF ITS TREATMENTS ANNUALLY
400 People a year are granted disability by Social Security Administration because of PSORIASIS
Psoriatic Arthritis
About 1 million the U.S. population have psoriatic arthritis; that equals about 0.5 percent of the country
Between 10 percent and 30 percent of the people with Psoriasis develope posriatic develop psoriatic arthritis
Psoriatic arthritis usually develops between the ages of 30 and 50, but it can develop at any time
Generally psoriasis appears before the psoriatic arthritis, but it can develop without the characteristic skin lesions
There are five types of psoriatic arthritis
Psoriasis Patients
Psoriasis patients make nearly 2.4 million visits to dermatologists each year
Overall costs of treating psoriasis may exceed $ 3 Billion annually
150,000 to 260,000 cases of psoriasis are diagnosed each year
Genetic
If one parent has psoriasis, children have a 10 percent to 25 percent chance of developing psoriasis
If both parents have psoriasis, children have a 50 percent chance
Worldwide
Psoriasis affects an estimated 1 percent to 3 percent of the world's population

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