What is psoriasis? Psoriasis is a common, chronic condition in which the skin develops red, itchy patches and thick, silvery scales. Autoimmunity is suspected as the core problem, and the course of the disease typically involves periods of symptom flares alternating with periods of remission. Psoriasis can range in severity from annoying to disabling.
What are the symptoms? The hallmark of psoriasis is the appearance of one or more small patches of thick skin on the elbow, knees or back. These areas are usually not painful, but they are readily visible and often embarrassing. The psychological toll can be quite severe, with disrupted social interactions and self-image issues frequently accompanying the disease.
There are five main types of psoriasis, each of which has specific symptoms:
Erythrodermic: intense red, peeling rash covering a large area of the body
Guttate: small, reddish pink sores or spots on the trunk, arms, legs, and/or scalp
Inverse: smooth patches of redness and irritation on the skin of the armpits and groin
Plaque: thick, red patches of skin covered with silvery white skin; this is the most common form of psoriasis
Pustular: blisters surrounded by irritated skin; may also cause fever, chills and fatigue.
Psoriasis can also cause psoriatic arthritis, which results in pitted, discolored nails and swollen, painful joints.
What are the causes? Psoriasis is considered by many to be an autoimmune disorder in which the body's immune cells attack normal skin cells. The cells that are targeted are formed and grow below the skin, and normally rise to the skin's surface over the course of a month. In psoriasis, the growth rate of new cells is sped up, resulting in dead skin cells building up on the surface of the skin. The exact cause of psoriasis is unknown, but may include a combination of genetics and environment. Certain factors appear to trigger episodes of psoriasis:
Infections, such as sore throat
Injury, such as sunburn, cuts, or scrapes
Dry or cold air
Lack of sunlight
Heavy alcohol consumption
Certain medications, such as lithium, beta blockers, and anti-malarial drugs
Who is likely to develop psoriasis? Psoriasis is usually diagnosed in those aged 10 to 40, and is most common in people with a family history of the disease. People with HIV/AIDS and children with recurring infections such as strep throat are also at higher risk. Being overweight increases the odds of developing inverse psoriasis.
How is psoriasis diagnosed? Physicians can often diagnose psoriasis by performing a physical exam and medical history. In some cases, the doctor may take a small skin sample (biopsy) to rule out similar conditions such as eczema.
What is the conventional treatment? The goals of conventional treatment for psoriasis are to control symptoms and prevent complications. Treatments depend on the severity of the condition and include:
Topical medications. In addition to moisturizers, a variety of creams and ointments can be used to treat mild to moderate psoriasis or combined with oral drugs or light therapy for more severe psoriasis. Topical options include steroids, vitamin D analogues, topical retinoids, and coal tar.
Oral medications. Oral drugs used to treat severe or stubborn psoriasis include retinoids, cyclosporine, methotrexate, hydroxyurea, and other immunomodulators.
Light therapy. Natural and artificial light, including ultraviolet light, can be used to treat psoriasis. The most recent therapies developed use ultraviolet B, which is effective without having to take medications that increase sensitivity to sunlight.
What therapies does Dr. Weil recommend for psoriasis? In addition to the measures described above, which may be necessary in severe cases, Dr. Weil recommends the following approaches to psoriasis:
Dietary changes: Follow an anti-inflammatory diet, making sure to get plenty of fresh fruits and vegetables, particularly those rich in carotenoids (mangoes, corn, sweet potatoes, carrots and squash, as well as leafy greens and tomatoes).
Exercise: Regular physical activity may help.
Mind/body: Learn breathing exercises, yoga or visualization, or keep a journal recording experiences, feelings, and skin symptoms. Since the skin is very responsive to hypnotic suggestion, hypnotherapy is definitely worth exploring.
Supplements: Take supplemental omega-3 fatty acids (1-2 grams a day) and of evening primrose oil (500 mg twice a day), a natural source of GLA (gamma-linolenic acid), a fatty acid that promotes healthy growth of skin, hair and nails. Take extract of milk thistle (Silybum marianum), two capsules twice a day for at least three months.
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