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PSORIASIS: Common Community Problem, Uncommon Community Solutions!
by Lewis H. Kaminester, M.D.

F.A.A.D., F.A.C.P., Board Certified, Dermatologist

If you have noticed patches of raised red skin covered by white flakes on your skin, along with itching and burning, you may be one of the more than 4.5 million adults in the United States that have Psoriasis (sore-I-ah-sis). Most researchers now conclude that it is related to the immune system (psoriasis is often called an "immune-mediated" disorder).

Psoriasis is a disease that affects over two percent of our population. It can be just an annoying rash affecting the elbows, knees and fingernails, or it can extend to involve more than half of the body, being a chronic curse to the sufferer.

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 this susceptibility. Some triggers may work together to cause an outbreak of psoriasis; this makes it difficult to identify individual factors.

Possible psoriasis triggers include emotional stress, injury to the skin, some types of infection and 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.

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% to 15% of those with psoriasis get it before age 10, and occasionally it appears in infancy. Psoriasis is not contagious ó no one can "catch" it from another person.

Traditional treatment for psoriasis has included simple sun exposure, topical steroids rubbed on the skin, and tar or salicylic acid shampoos. Some new topical creams use vitamin D derivates. Light box treatments with either ultraviolet B or UVA require repeated frequent visits to the dermatologistís office. There is no "cure" for psoriasis!

Now, however, there are new treatments and new hope for psoriasis sufferers.We have now recognized that psoriasis can be considered an autoimmune disease, whereby the body is reacting to its own body cells. New medications and biologicals act on this theory. Patients with moderate to severe psoriasis, defined at having 10% or more total body surface involvement, may be helped with new prescription biologicals or by entering research studies using the latest findings to control widespread disease with minimal risk.

The Federal Drug Administration (FDA) conducts such studies to confirm the efficacy of treatments prior to the medication being released as a prescription to the public. A number of Palm Beach County residents are currently enrolled in a new international study using simple oral medication for control of psoriasis. The oral medication does not cross react with any other medications, which is a great benefit. Moreover, its side effects appear to be few. This is in contrast to some biological medications recently released for prescription use, which can have serious side effects affecting many organ systems.

Psoriasis sufferers with limited involvement can use a combination of topical agents, including corticosteroids and vitamin D analogues. Persons with more severe involvement should carefully consider newer methods of treatment, and reserve therapy with methotrexate and other cell poisons as a last resort for treatment of what can be a most unpleasant and life long affliction.


For more information about psoriasis, contact the National Psoriasis Foundation
at 800-723-9166 or visit their website at www.psoriasis.org




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