When you have psoriasis, your skin cells run amok. While it normally takes about 30 days for new cells to reach the surface of your skin, in psoriasis they surface in just 3 days – much too fast to be shed. These out-of-control skin cells form plaques – pink, raised patches covered by silvery white scales.
Experts aren’t sure what the psoriasis causes are, but they do know it tends to run in families and most commonly hits in the teen years or middle age. Psoriasis tends to ebb and flare, although obesity, stress, smoking, certain drugs (Quinidine, a heart medication, and Inderal, a high blood pressure medication, to name two) or even a simple infection like a sore throat can aggravate outbreaks. Or you could go years without a flare-up; that’s the nature of this chronic but very unpredictable condition.
Psoriasis can be mild or extremely severe. Fortunately, most people escape with a few small patches on their elbows, knees or scalp. About 90 percent of people with psoriasis will also develop a form of arthritis associated with psoriasis that resembles rheumatoid arthritis.
Rx Mission: Remission
Having a doctor monitor your condition can make it easier for you to cope with psoriasis – emotionally as well as physically. “Everyone with severe psoriasis should get medical help,” says Albert M. Kligman, M.D., Ph.D.
The three most common treatments for psoriasis are topical treatments (applied to the skin), light therapy (called phototherapy) and oral drugs. Topical treatments, including steroids, calcipotriene (a cream-based derivative of vitamin D) and anthralin, reduce scaling and inflammation. Phototherapy, or exposure to ultraviolet-B light, helps clear psoriasis, while another form of light therapy, PUVA (psoralens and ultraviolet-A light), reduces cell growth. Oral drugs like methotrexate and cyclosporine also inhibit cell growth and reduce inflammation.
The treatments that work best, however, may also cause serious side effects. Taken in excess, methotrexate may cause liver disease, while PUVA ups the risk of skin cancer and steroids can thin the skin and occasionally aggravate the psoriasis itself. Moreover, the effectiveness of these treatments tends to decrease over time as your skin builds up a resistance to them for psoriasis causes.
To lower the risks and heighten effectiveness, these treatments are often juggled or used in alternating combinations – a strategy called rotational therapy. “Psoriasis can go into remission with any of these treatments, but the goal is to find combination treatments that make the remissions last longer,” says Alan Menter, M.D., clinical director of the National Psoriasis Tissue Bank at Baylor University Medical Center in Dallas and chairman of the dermatology department of that university. Currently under development are a vitamin A-based gel that eases psoriasis without the side effects of steroids and a topical version of methotrexate, which may be less risky, since less of the drug is absorbed through the skin.
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