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Psoriasis

Psoriasis

You should see your doctor or health care practitioner if you have symptoms of psoriasis, such as red raised patches of skin with silvery scales, and do not feel comfortable with how your skin looks or feels. Psoriasis is usually a mild inconvenience to most people. However, for others, it may be disabling or painful. The doctor can prescribe treatments that help. If symptoms are treated when they first appear, the condition will usually not progress.

When someone with psoriasis visits the doctor, he or she is usually concerned about raised, itchy, red areas on the skin that are scaly or peeling. The individual is typically self-conscious about the plaques or scaly areas and uses clothing to cover the affected skin to avoid being embarrassed in public.

Those with psoriasis commonly recognize that new areas of psoriasis occur within 7-10 days after the skin has been injured. This has been called the Koebner reaction. Sometimes, the reverse occurs in which psoriasis clears after injury to the skin.

You should always see your doctor if you have psoriasis and develop significant joint pain  , stiffness, or deformity. You may be in the reported 10% of individuals with psoriasis that develop psoriatic arthritis.

You You also should always see your doctor if signs of infection develop. Common signs of infection are red streaks or pus from the red areas, fever with no other cause, or increased pain.

See your doctor if you have serious side affects from your medications. (See Understanding Psoriasis Medications.)

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Self-Care at Home
  • Exposure to sunlight helps many people with psoriasis.
  • Keeping the skin soft and moist is helpful. Apply heavy moisturizers after bathing.
  • Do not use irritating cosmetics or soaps.
  • Avoid scratching or itching that can cause bleeding or excessive irritation.
  • Soaking in bath water with oil added and using moisturizers may help. Bath soaks with coal tar or other agents that remove scales and reduce the plaque may also help.
  • Cortisone creams can reduce the itching of mild psoriasis and are available without a prescription.
  • Some people use an ultraviolet B unit at home under a doctor's supervision. A dermatologist may prescribe the unit and instruct the patient on home use, especially if it is difficult for the patient to get to the doctor's office for phototherapy treatment.
Other Therapy

Conventional therapy has been tested with clinical trials. The FDA has approved conventional drugs for the treatment of psoriasis. Some look to alternative therapy  , diet changes, supplements, or stress reducing techniques to help reduce symptoms. For the most part, alternative therapies have not been tested with clinical trials, and the FDA has not approved dietary supplements for treatment of psoriasis. However, some other therapies can be found on the National Psoriasis Foundation Web site. Individuals should check with their doctors before starting any therapy.

Follow-up

Plaque psoriasis is a chronic disease that goes away and returns. Follow-up care depends on the severity of the disease at any given time.

If a patient has evidence of psoriatic arthritis, a consultation with a rheumatologist (one who specializes in arthritis) is helpful.

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Prevention
  • Avoiding environmental factors that trigger psoriasis, such as smoking, sun exposure, and stress, may help prevent or minimize flare-ups of psoriasis. Sun exposure may help in many cases of psoriasis and aggravate it in others.
  • Alcohol is considered a risk factor for psoriasis in young to middle-aged men. Avoid or minimize alcohol use if you have psoriasis.
  • Specific dietary restrictions or supplements other than a well-balanced and adequate diet are unimportant in the management of plaque psoriasis.
Outlook

Psoriasis is more of an inconvenience in most cases than it is threatening. However, it is a chronic disease and reoccurs. The itching, peeling, and splitting of skin at joints can lead to significant pain and self-esteem issues. By far, the patient's quality of life is affected most with plaque psoriasis. Self-consciousness and embarrassment about appearance, inconvenience, and high costs of treatment options all affect one's outlook when living with psoriasis.

Complications of the disease are relatively uncommon. Many of the complications of plaque psoriasis are related to the treatments used for the disease. Overly aggressive use of topical steroids could lead to more severe forms of psoriasis (from plaque to pustular for example). Bandages should not be used with topical steroids because inflammation and swelling may occur. Oversensitivity to the sun is possible with many of the treatment options (especially phototherapy).

About 10% percent of all cases of plaque psoriasis are associated with psoriatic arthritis.

Anxiety  , depression  , or stress may worsen symptoms and increase the tendency to itch.

Methotrexate, PUVA, cyclosporine, and oral retinoid all have helped to induce and maintain remission in severe cases of plaque psoriasis

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