Back To CoursePathophysiology: Help and Review
21 chapters | 325 lessons
Shara has taught nursing in both AD and BSN programs and holds a master's degree in nursing.
Psoriasis is a difficult-to-treat condition that leads to scaly, dry, and itchy patches on the skin. It affects approximately 1-3% of the U.S. population, and people of all ages can have this condition, though its occurrence peaks in adolescence and when adults are in their 50s and 60s. Incidence is higher in white people and those with close relatives with the disorder but lower in warm and sunny parts of the country.
This is a chronic condition, meaning it is ongoing, unlike an acute condition, such as a cold or the flu, which is short-lived. It may be mild or dormant at times, but becomes worse when a trigger, like stress or illness, activates it.
Psoriasis skin lesions are red, raised, and often covered with white scales. These lesions are itchy; in fact, the word 'psoriasis' comes from a Greek word meaning 'itchy.' The lesions typically appear on the elbows, knees, and scalp, but they can appear anywhere on the body, even the nail beds.
In addition, the condition can cause an inflammatory joint arthritis in about one-third of psoriasis patients. Joint arthritis impacts the patient's daily functioning, especially when it affects the extremities, hips, back, or spine.
There are several forms of psoriasis, the most common being psoriasis vulgaris.
The cause of psoriasis is believed to be an autoimmune response, specifically a T-cell response to some unidentified antigen, similar to an allergic response. Precipitating factors such as stress, illness, medications, infection, or skin trauma (for example, from a fall or burn) may cause eruption of psoriatic lesions. The body's response to this immune system reaction appears to shorten the typical development of skin cells (keratinocytes) from their normal 14 days to only 4 days, resulting in lesions. Researchers believe you are at higher risk for psoriasis if a close relative has the disease.
For years, there was a commercial on television advertising an over-the-counter medication used to treat the 'heartbreak of psoriasis.' Beyond the obvious physical discomforts, there is a tremendous psychological and emotional impact on the patient. It is difficult to be seen in public with raised, red lesions - others may think you are contagious, so they don't want to come in contact with you.
Working is a necessity, yet at the same time it is a challenge since treatments can easily consume a large portion of the patient's day. A stressful work situation could also contribute to the problem. Patients can become socially isolated and depressed. Furthermore, psoriasis places the patient at an increased risk for other chronic conditions, including obesity, Crohn's disease, osteoporosis, inflammation of the eyes, liver and cardiovascular disease, cancer, metabolic syndrome, and diabetes.
Psoriasis treatment usually requires a multi-tiered approach; each type of treatment is used for a while then rotated to another. That's because some treatments work only for a short while then become less effective, while other treatments may cause side effects or even complications, so doctors limit their use. Treatment goals are to reduce itching, improve skin integrity, avoid secondary skin infections caused by bacteria or fungus getting into a lesion, as well as fostering a healthy, well-balanced life style.
The primary medical treatments can be divided into three groups.
1. Topical medications and therapies
Excellent skin care is important; heavy moisturizers keep the skin more pliable and lubricated. Aloe vera, vitamin E oil, and jojoba oil are natural products that moisturize lesions, and even sunlight helps reduce lesions. Bath solutions containing oils soften the white scales, while mineral salts may remove the scales as well as reduce itching.
Coal tar products promote healing and can be found in shampoos, bath products, and creams. Topical steroids are used to reduce inflammation, and synthetic vitamin D3 is often used alongside a topical steroid. Finally, occlusion therapy may be helpful for stubborn lesions; a topical steroid followed by a waterproof, airtight bandage are applied, usually overnight.
The disadvantages of some of these topical treatments are that they are time-consuming, greasy, and may stain clothes or bed linens. The National Psoriasis Foundation has placed a Seal of Recognition on trusted topical products to help consumers.
Excimer lasers, high-intensity ultra violet B (UVB) wave light therapy devices or UVB home therapy are often effective for treating psoriasis. UVB light is found in sunlight, and the pulsed dye laser uses a different light wave and dye to target tiny blood vessels in lesions.
Some patients have light therapy as often as five times a week for one to two months. A medication called psoralene, can be used to increase the patient's sensitivity to ultra violet A (UVA) light, also found in sunlight, which is very effective in treating these lesions.
Tanning beds are not recommended as they increase the risk for skin cancer.
3. Systemic Medications
You have probably seen commercials on television for biological agents that target treatment at the immune system. Often given by injection or intravenously, common medications include Humira, Enbrel, and Stelara.
Cyclosporine, an immunosuppressant often given to transplant patients, may also be given for severe psoriasis. Mexate, a medication that interrupts cell division to reduce lesion formation, is given both for psoriasis or psoriatic arthritis.
New 'small-molecule' medications that target the immune response are also effective in reducing the inflammatory response. Patients with psoriatic arthritis may be treated with anti-rheumatic drugs.
These systemic medications that work throughout the body are used when topical or light therapy is not effective, but they may cause serious side effects, so physicians must monitor patients on these medications closely.
Support and education groups greatly benefit psoriasis patients. Physicians should encourage patients to join the National Psoriasis Foundation as well as a local psoriasis support group. Education about the cause of the condition and understanding their personal triggers can help patients learn to avoid them as much as possible.
Psoriasis is a chronic condition caused by a T-cell response to an antigen resulting in itchy skin lesion formation. The incidence of psoriasis is highest among whites and people in either adolescence or 50-60 years of age. About one-third of patients develop chronic inflammation of the joints. The greatest impact of psoriasis, the 'heartache,' is related to social functioning, including work, physical activities, and going out in public.
Medical Disclaimer: The information on this site is for your information only and is not a substitute for professional medical advice.
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Back To CoursePathophysiology: Help and Review
21 chapters | 325 lessons