Friday, May 20, 2011

There's more to Psoriasis than meets the eye...


What is Psoriasis?  Psoriasis is a chronic skin disorder which typically is characterized by plaques (patches of red raised skin) with a silver coat or scale. Recently, this skin disease has been associated with heart disease and can also be associated with life-threatening presentations. It affects men and women the same and is seen in all races. It peaks in age between age 20-30 with a second peak between 50-60. It is also interesting to note that psoriasis is even now being seen in children.

Who is at risk? Risk factors include family history (the disease is 100x more likely to occur among family members than unrelated people) but there are also many triggers. These include infections, stress- both physical and emotional, and as well certain medications. Several drugs are associated with worsening psoriasis such as beta-blockers, lithium, or ant-malarial drugs. Ibuprofen may but has not been fully proven.   Smoking increases one’s risk of getting this skin disease. The worst kind of psoriasis, called pustular psoriasis is strongly associated with smoking. It also associated with obesity. In fact the greater the obesity, the worse the skin. This is also true of alcohol consumption.  The greater the consumption, the worse the condition of the skin.  A number of people also have nail involvement called psoriatic arthritis. The sun helps with the UV exposure. 

Some Types of Psoriasis

Plaque psoriasisSa

The most common form of psoriasis is called plaque psoriasis accounting for about 80%. This is characterized by plaque in the scalp, elbows, knees, and back. The plaques are red with sharply defined margins that are raised. A thick silvery scale is usually present. Other areas are the intergluteal cleft and belly button.

Pustular psoriasis

A severe form is called pustular  psoriasis. This can be severe and life-threatening. In addition to the usual plaques, there are sheets of superficial pustules (small elevation of skin filled with fluid called pus). It can associated with fever, weakness and diarrhea. It can be caused by pregnancy or the withdrawl of oral steroids, such as prednisone.

What causes it?    We do not know what causes psoriasis but it likely immune related. This link has triggered breakthrough treatments. This is especially true of the newer family of drugs called biologics.  Some patients after having undergone bone marrow transplantation have had a complete resolution of this disease.

What are other potential concerns if I have psoriasis?  Even though psoriasis is a skin disease, it is also an independent risk factor for the heart attacks. The worse the skin condition, the higher the heart risk. This also makes psoriasis a higher risk of death. Certainly, this can be more than just affected skin! See your doctor to discuss this. It is important to have normal cholesterol numbers as well as blood pressure. Not to mention stop smoking and lose weight. It all goes together.

Finally, there has been much discussion of an increased risk of cancer in individuals who have psoriasis. It is due to the immune process of the underlying disease or the treatment? Not known. But, if you have psoriasis it should mean getting it treated and seeing your doctor on a regular basis.


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Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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