Research Assessment #8

Date: ​December 01, 2017

Subject: ​ Dermatology

MLA Citation:

Source #1: ​“Psoriasis Statistics.” ​MG217​,

www.mg217.com/your-psoriasis/statistics-about-psoriasis/

Source #2: ​“Psoriasis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 12

May 2017, ​www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840​.

Source #3: ​“Psoriasis.” ​Mayo Clinic​, Mayo Foundation for Medical Education and Research, 12

May 2017,

www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845​.

Analysis: Psoriasis is the last on the list of ​The Five Most Common Skin Disorders.

Psoriasis is confused with many different types of skin disorders such as, rashes, dry skin,

fungal infections, dandruff and eczema. However, psoriasis is the same as the skin disorders

​ soriasis is a chronic
listed above. As stated on ​American Academy of Dermatology, p

(long-lasting) disease. It develops when a person’s immune system sends faulty signals that tell

skin cells to grow too quickly. New skin cells form in days rather than weeks. The body does not

shed these excess skin cells. The skin cells pile up on the surface of the skin, causing patches

of psoriasis to appear. There is not a definite cause for psoriasis, but through some research,

psoriasis is said to be related to an immune system problem with T cells and other white blood

cells known as, neutrophils in your body. The normal function of T cells is to defend the body

against foreign substances, such as bacteria and viruses. However, a person with psoriasis,

their T cells cannot recognize the healthy cells and attack them by accident, as if to heal a
wound or to fight an infection. When there is overactivity in T cells, it triggers an increased

production of healthy skin cells, more T, cells and other white blood cells, especially neutrophils.

These travel into the skin causing redness and sometimes pus in pustular lesions. Dilated blood

vessels in psoriasis-affected areas create warmth and redness in the skin lesions. Skin cells

build up in thick, scaly patches on the skin's surface, continuing until treatment stops the cycle.

The cause of T cell malfunction in people with this skin disorder in not entirely clear. But

researchers believe both both genetics and environmental factors play a role. Psoriasis may

look contagious, but it's not. This is disorder is the most prevalent autoimmune disease in the

United states, and it affects as many as 7.5 million Americans, in other words, 2.2% of the

population has some type of psoriasis. But, 2%-3% of the total population of the world has

psoriasis, which is around 125 million people, according to the World Psoriasis Day consortium.

The reason that psoriasis is confused with the above listed skin disorders varies from the

symptoms, to the the way it appears on the skin. Beginning with eczema, the symptoms of the

two are very similar in that, they both are extremely itchy, red and very scaly on the skin.Also,

the location of the two, the buttocks, face, knees, scalp, and elbows. Next up is fungal infections

or also known as ringworms. Unlike eczema, fungal infection is not as similar to psoriasis, in

that,fungal infections are typically superficial and can affect your hair, skin, nails, or anywhere

you come into contact with the fungus. They’re very contagious and can be picked up from

people with fungal infections, public restrooms, infected animals plus more. Fungal infections

are confused for psoriasis because of how ringworms appear, red, flaky and a scale like feeling.

Dry skin, which is medically known as xerosis cutis, means molecules known as lipids that make

up skin cells with oils and other essentials are low and the moisture is sapped from the
outermost layer of your skin, while, psoriasis is an autoimmune disease that causes flares of

rapid skin cell growth.

Along with other skin disorders that look like psoriasis, there are in fact several different

types of psoriasis. The different types of psoriasis include, plaque psoriasis (psoriasis vulgaris),

nail psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, erythrodermic psoriasis,

and lastly psoriatic arthritis. Plaque psoriasis is the most common form of psoriasis. It causes

dry, raised, red skin lesions, which is covered with silvery scales. The plaques may be itchy and

painful and these can appear anywhere on the body, including genitals and inside the mouth.

Nail psoriasis affects the fingernails and toenails which causes abnormal growth and

discoloration. This type of psoriasis can cause the nail to loosen and separate the nail bed

(onycholysis). People with this type of psoriasis have yellowish/brownish colored nails. The

next type of psoriasis is guttate psoriasis and it mainly affects children and young adults and is

triggered by a bacterial infection such as strep throat. Guttate can be identified by a small, scaly

water-drop shaped lesion on your arms, legs and scalp. Inverse psoriasis is found in the folds

like of the underarms, navel, groin, and buttocks. In inverse psoriasis, genital lesions, especially

in the groin and on the head of the penis, are common. Psoriasis in moist areas like the navel or

the area between the buttocks (intergluteal folds) may look like flat red plaques without much

scaling. Another type of psoriasis is pustular psoriasis is small pus-filled yellowish blisters.

When patients have psoriasis on the palms of their hands and the soles of their feet, it is known

as, palmoplantar psoriasis. Lastly, in erythrodermic psoriasis, the entire skin surface is involved

with the disease. Patients with this form of psoriasis often feel cold and may develop congestive

heart failure if they have a pre-existing heart problem.

These types of psoriasis are caused by many different triggers that may vary from

person. Some certain triggers can make the psoriasis worse than it is. These triggers include:
Cold, dry weather, some medications “beta-blocker drugs”, these drugs treat, heart disease,

bipolar disorder, lithium and many more. Stress can also cause flare-ups, and so can infections

like strep throat and tonsillitis. Skin injury (tattoos, bug bites, cuts, bruises, and burns etc) can

also cause an outbreak. Lastly, drugs and alcohols can cause breakouts or worsen symptoms

and interfere with treatments. Although there are a number of triggers of psoriasis, there are

twice as many treatments. ​Psoriasis treatments reduce inflammation and clear the skin.

Treatments can be divided into three main types: topical treatments, light therapy and systemic

medications. According to the Mayo Clinic,

1. Topical treatments: ​Used alone, creams and ointments that you apply to your skin can

effectively treat mild to moderate psoriasis. When the disease is more severe, creams

are likely to be combined with oral medications or light therapy. Topical psoriasis

treatments include:

a. Topical corticosteroids.

b. Vitamin D analogues.

c. Anthralin.

d. Topical retinoids.

e. Calcineurin inhibitors.

f. Salicylic acid.

g. Coal tar.

h. Moisturizers.

2. Light therapy (phototherapy)​: This treatment uses natural or artificial ultraviolet light.

The simplest and easiest form of phototherapy involves exposing your skin to controlled

amounts of natural sunlight. Other forms of light therapy include the use of artificial
 ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with

medications.

a. Sunlight.

b. UVB phototherapy

c. Narrow band UVB phototherapy

d. Goeckerman therapy

e. Psoralen plus ultraviolet A (PUVA)

f. Excimer laser

3. Oral or injected medications: ​If you have severe psoriasis or it's resistant to other

types of treatment, your doctor may prescribe oral or injected drugs. This is known as

systemic treatment. Because of severe side effects, some of these medications are used

for only brief periods and may be alternated with other forms of treatment.

a. Retinoids

b. Methotrexate

c. Cyclosporine

These treatments have be shown to be very effective and the patients begin to feel better about

them. Like the previous skin disorders, psoriasis patients suffer from mental illnesses. Since

people are becoming more educated on this skin disorder, there are many ways people with

psoriasis are helped mentally, like having support groups. This allows the patients to be

surrounded by people who are going through the same thing and where they fit in and find joy.

An example of an online support group is: ​http://www.psoriasisnetwork.org​/.

This brings me to the conclusion of the series ​The Five Most Common Skin Disorders. ​I

have learned so much about Acne, Eczema, Seborrheic Eczema, Skin Cancer and Psoriasis. I

enjoyed doing research on each topic especially, skin cancer and psoriasis. In this series, each
skin disorder was different in comparison to the others, however, they are all similar by that,

patients with these disorders have slight mental illnesses to major illnesses. This is very

interesting. Now that we are thinking about our final product, I think I want to do something that

impacts people with these 5 disorders both in their physical appearance and mentally.
 Statistics About Psoriasis
Prevalence
● Psoriasis is the most prevalent autoimmune disease in the United States.

● According to current studies, as many as 7.5 million Americans – approximately

2.2% of the population – have psoriasis.

● 125 million people worldwide – 2% to 3% of the total population – have psoriasis,

according to the World Psoriasis Day consortium.

● Studies show that between 10% and 30% of people with psoriasis also develop

psoriatic arthritis.

● Psoriasis prevalence in African Americans is 1.3% compared to 2.5% of Caucasians.

 Overview

●
● How psoriasis develops

Psoriasis is a common skin condition that speeds up the life cycle of skin cells. It causes cells to
build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that
are itchy and sometimes painful.

Psoriasis is a chronic disease that often comes and goes. The main goal of treatment is to stop
the skin cells from growing so quickly.

There is no cure for psoriasis, but you can manage symptoms. Lifestyle measures, such as
moisturizing, quitting smoking and managing stress, may help.

Symptoms
●
● Psoriasis

●
● Guttate psoriasis
●
● Scalp psoriasis

●
● Inverse psoriasis
●
● Nail psoriasis
●
● Pustular psoriasis
 ●
● Erythrodermic psoriasis

Psoriasis signs and symptoms are different for everyone. Common signs and symptoms
include:

● Red patches of skin covered with thick, silvery scales

● Small scaling spots (commonly seen in children)
● Dry, cracked skin that may bleed
● Itching, burning or soreness
● Thickened, pitted or ridged nails
● Swollen and stiff joints
Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that
cover large areas.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for
a time or even going into complete remission.

There are several types of psoriasis. These include:

● Plaque psoriasis. The most common form, plaque psoriasis causes dry, raised, red
skin lesions (plaques) covered with silvery scales. The plaques might be itchy or
painful and there may be few or many. They can occur anywhere on your body,
including your genitals and the soft tissue inside your mouth.
 ● Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting,
abnormal nail growth and discoloration. Psoriatic nails might loosen and separate
from the nail bed (onycholysis). Severe cases may cause the nail to crumble.
● Guttate psoriasis. This type primarily affects young adults and children. It's usually
triggered by a bacterial infection such as strep throat. It's marked by small,
water-drop-shaped, scaling lesions on your trunk, arms, legs and scalp.
● The lesions are covered by a fine scale and aren't as thick as typical plaques are.
You may have a single outbreak that goes away on its own, or you may have
repeated episodes.
● Inverse psoriasis. This mainly affects the skin in the armpits, in the groin, under the
breasts and around the genitals. Inverse psoriasis causes smooth patches of red,
inflamed skin that worsen with friction and sweating. Fungal infections may trigger
this type of psoriasis.
● Pustular psoriasis. This uncommon form of psoriasis can occur in widespread
patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or
fingertips.
● It generally develops quickly, with pus-filled blisters appearing just hours after your
skin becomes red and tender. The blisters may come and go frequently.
Generalized pustular psoriasis can also cause fever, chills, severe itching and
diarrhea.
● Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic
psoriasis can cover your entire body with a red, peeling rash that can itch or burn
intensely.
● Psoriatic arthritis. In addition to inflamed, scaly skin, psoriatic arthritis causes
swollen, painful joints that are typical of arthritis. Sometimes the joint symptoms are
the first or only manifestation of psoriasis or at times only nail changes are seen.
Symptoms range from mild to severe, and psoriatic arthritis can affect any joint.
Although the disease usually isn't as crippling as other forms of arthritis, it can
cause stiffness and progressive joint damage that in the most serious cases may
lead to permanent deformity.
When to see a doctor
If you suspect that you may have psoriasis, see your doctor for an examination. Also, talk to
your doctor if your psoriasis:

● Causes you discomfort and pain

● Makes performing routine tasks difficult
● Causes you concern about the appearance of your skin
● Leads to joint problems, such as pain, swelling or inability to perform daily tasks
Seek medical advice if your signs and symptoms worsen or don't improve with treatment. You
may need a different medication or a combination of treatments to manage the psoriasis.

Causes

The cause of psoriasis isn't fully understood, but it's thought to be related to an immune system
problem with T cells and other white blood cells, called neutrophils, in your body.

T cells normally travel through the body to defend against foreign substances, such as viruses
or bacteria.

But if you have psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound
or to fight an infection.

Overactive T cells also trigger increased production of healthy skin cells, more T cells and other
white blood cells, especially neutrophils. These travel into the skin causing redness and
sometimes pus in pustular lesions. Dilated blood vessels in psoriasis-affected areas create
warmth and redness in the skin lesions.

The process becomes an ongoing cycle in which new skin cells move to the outermost layer of
skin too quickly — in days rather than weeks. Skin cells build up in thick, scaly patches on the
skin's surface, continuing until treatment stops the cycle.

Just what causes T cells to malfunction in people with psoriasis isn't entirely clear. Researchers
believe both genetics and environmental factors play a role.
Psoriasis triggers

Psoriasis typically starts or worsens because of a trigger that you may be able to identify and
avoid. Factors that may trigger psoriasis include:

● Infections, such as strep throat or skin infections

● Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn
● Stress
● Smoking
● Heavy alcohol consumption
● Vitamin D deficiency
● Certain medications — including lithium, which is prescribed for bipolar disorder,
high blood pressure medications such as beta blockers, antimalarial drugs, and
iodides
Risk factors

Anyone can develop psoriasis, but these factors can increase your risk of developing the
disease:

● Family history. This is one of the most significant risk factors. Having one parent
with psoriasis increases your risk of getting the disease, and having two parents
with psoriasis increases your risk even more.
● Viral and bacterial infections. People with HIV are more likely to develop psoriasis
than people with healthy immune systems are. Children and young adults with
recurring infections, particularly strep throat, also may be at increased risk.
● Stress. Because stress can impact your immune system, high stress levels may
increase your risk of psoriasis.
● Obesity. Excess weight increases the risk of psoriasis. Lesions (plaques)
associated with all types of psoriasis often develop in skin creases and folds.
● Smoking. Smoking tobacco not only increases your risk of psoriasis but also may
increase the severity of the disease. Smoking may also play a role in the initial
development of the disease.
Complications

If you have psoriasis, you're at greater risk of developing certain diseases. These include:

● Psoriatic arthritis. This complication of psoriasis can cause joint damage and a loss
of function in some joints, which can be debilitating.
● Eye conditions. Certain eye disorders — such as conjunctivitis, blepharitis and
uveitis — are more common in people with psoriasis.
● Obesity. People with psoriasis, especially those with more severe disease, are
more likely to be obese. It's not clear how these diseases are linked, however. The
inflammation linked to obesity may play a role in the development of psoriasis. Or it
may be that people with psoriasis are more likely to gain weight, possibly because
they're less active because of their psoriasis.
● Type 2 diabetes. The risk of type 2 diabetes rises in people with psoriasis. The
more severe the psoriasis, the greater the likelihood of type 2 diabetes.
● High blood pressure. The odds of having high blood pressure are higher for people
with psoriasis.
● Cardiovascular disease. For people with psoriasis, the risk of cardiovascular
disease is twice as high as it is for those without the disease. Psoriasis and some
treatments also increase the risk of irregular heartbeat, stroke, high cholesterol and
atherosclerosis.
● Metabolic syndrome. This cluster of conditions — including high blood pressure,
elevated insulin levels and abnormal cholesterol levels — increases your risk of
heart disease.
● Other autoimmune diseases. Celiac disease, sclerosis and the inflammatory bowel
disease called Crohn's disease are more likely to strike people with psoriasis.
● Parkinson's disease. This chronic neurological condition is more likely to occur in
people with psoriasis.
● Kidney disease. Moderate to severe psoriasis has been linked to a higher risk of
kidney disease.
● Emotional problems. Psoriasis can also affect your quality of life. Psoriasis is
associated with low self-esteem and depression. You may also withdraw socially.
 Diagnosis

In most cases, diagnosis of psoriasis is fairly straightforward.

● Physical exam and medical history. Your doctor usually can diagnose psoriasis by
taking your medical history and examining your skin, scalp and nails.
● Skin biopsy. Rarely, your doctor may take a small sample of skin (biopsy). He or
she will likely first apply a local anesthetic. The sample is examined under a
microscope to determine the exact type of psoriasis and to rule out other disorders.
Treatment

Psoriasis treatments reduce inflammation and clear the skin. Treatments can be divided into
three main types: topical treatments, light therapy and systemic medications.

Topical treatments

Used alone, creams and ointments that you apply to your skin can effectively treat mild to
moderate psoriasis. When the disease is more severe, creams are likely to be combined with
oral medications or light therapy. Topical psoriasis treatments include:

● Topical corticosteroids​. These drugs are the most frequently prescribed

medications for treating mild to moderate psoriasis. They reduce inflammation and
relieve itching and may be used with other treatments.
● Mild corticosteroid ointments are usually recommended for sensitive areas, such
as your face or skin folds, and for treating widespread patches of damaged skin.
● Your doctor may prescribe stronger corticosteroid ointment for smaller, less
sensitive or tougher-to-treat areas.
● Long-term use or overuse of strong corticosteroids can cause thinning of the skin.
Topical corticosteroids may stop working over time. It's usually best to use topical
corticosteroids as a short-term treatment during flares.
● Vitamin D analogues.​ These synthetic forms of vitamin D slow skin cell growth.
Calcipotriene (Dovonex) is a prescription cream or solution containing a vitamin D
analogue that treats mild to moderate psoriasis along with other treatments.
Calcipotriene might irritate your skin. Calcitriol (Vectical) is expensive but may be
equally effective and possibly less irritating than calcipotriene.
● Anthralin​. This medication helps slow skin cell growth. Anthralin (Dritho-Scalp) can
also remove scales and make skin smoother. But anthralin can irritate skin, and it
stains almost anything it touches. It's usually applied for a short time and then
washed off.
● Topical retinoids. ​These are vitamin A derivatives that may decrease inflammation.
The most common side effect is skin irritation. These medications may also
increase sensitivity to sunlight, so while using the medication apply sunscreen
before going outdoors.
● The risk of birth defects is far lower for topical retinoids than for oral retinoids. But
tazarotene (Tazorac, Avage) isn't recommended when you're pregnant or
breast-feeding or if you intend to become pregnant.
● Calcineurin inhibitors. ​Calcineurin inhibitors — tacrolimus (Prograf) and
pimecrolimus (Elidel) — reduce inflammation and plaque buildup.
● Calcineurin inhibitors are not recommended for long-term or continuous use
because of a potential increased risk of skin cancer and lymphoma. They may be
especially helpful in areas of thin skin, such as around the eyes, where steroid
creams or retinoids are too irritating or may cause harmful effects.
● Salicylic acid.​ Available over-the-counter (nonprescription) and by prescription,
salicylic acid promotes sloughing of dead skin cells and reduces scaling.
Sometimes it's combined with other medications, such as topical corticosteroids or
coal tar, to increase its effectiveness. Salicylic acid is available in medicated
shampoos and scalp solutions to treat scalp psoriasis.
● Coal tar.​ Derived from coal, coal tar reduces scaling, itching and inflammation.
Coal tar can irritate the skin. It's also messy, stains clothing and bedding, and has
a strong odor.
● Coal tar is available in over-the-counter shampoos, creams and oils. It's also
available in higher concentrations by prescription. This treatment isn't
recommended for women who are pregnant or breast-feeding.
 ● Moisturizers​. Moisturizing creams alone won't heal psoriasis, but they can reduce
itching, scaling and dryness. Moisturizers in an ointment base are usually more
effective than are lighter creams and lotions. Apply immediately after a bath or
shower to lock in moisture.
Light therapy (phototherapy)

This treatment uses natural or artificial ultraviolet light. The simplest and easiest form of
phototherapy involves exposing your skin to controlled amounts of natural sunlight.

Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB)
light, either alone or in combination with medications.

● Sunlight.​ Exposure to ultraviolet (UV) rays in sunlight or artificial light slows skin
cell turnover and reduces scaling and inflammation. Brief, daily exposures to small
amounts of sunlight may improve psoriasis, but intense sun exposure can worsen
symptoms and cause skin damage. Before beginning a sunlight regimen, ask your
doctor about the safest way to use natural sunlight for psoriasis treatment.
● UVB phototherapy. ​Controlled doses of UVB light from an artificial light source may
improve mild to moderate psoriasis symptoms. UVB phototherapy, also called
broadband UVB, can be used to treat single patches, widespread psoriasis and
psoriasis that resists topical treatments. Short-term side effects may include
redness, itching and dry skin. Using a moisturizer may help decrease these side
effects.
● Narrow band UVB phototherapy.​ A newer type of psoriasis treatment, narrow band
UVB phototherapy may be more effective than broadband UVB treatment. It's
usually administered two or three times a week until the skin improves, and then
maintenance may require only weekly sessions. Narrow band UVB phototherapy
may cause more-severe and longer lasting burns, however.
● Goeckerman therapy. ​Some doctors combine UVB treatment and coal tar
treatment, which is known as Goeckerman treatment. The two therapies together
are more effective than either alone because coal tar makes skin more receptive to
UVB light.
● Psoralen plus ultraviolet A (PUVA).​ This form of photochemotherapy involves
taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA
 light penetrates deeper into the skin than does UVB light, and psoralen makes the
skin more responsive to UVA exposure.
● This more aggressive treatment consistently improves skin and is often used for
more-severe cases of psoriasis. Short-term side effects include nausea, headache,
burning and itching. Long-term side effects include dry and wrinkled skin, freckles,
increased sun sensitivity, and increased risk of skin cancer, including melanoma.
● Excimer laser. ​This form of light therapy, used for mild to moderate psoriasis, treats
only the involved skin without harming healthy skin. A controlled beam of UVB light
is directed to the psoriasis plaques to control scaling and inflammation. Excimer
laser therapy requires fewer sessions than does traditional phototherapy because
more powerful UVB light is used. Side effects can include redness and blistering.
Oral or injected medications

If you have severe psoriasis or it's resistant to other types of treatment, your doctor may
prescribe oral or injected drugs. This is known as systemic treatment. Because of severe side
effects, some of these medications are used for only brief periods and may be alternated with
other forms of treatment.

● Retinoids.​ Related to vitamin A, this group of drugs may help if you have severe
psoriasis that doesn't respond to other therapies. Side effects may include lip
inflammation and hair loss. And because retinoids such as acitretin (Soriatane) can
cause severe birth defects, women must avoid pregnancy for at least three years
after taking the medication.
● Methotrexate. ​Taken orally, methotrexate (Rheumatrex) helps psoriasis by
decreasing the production of skin cells and suppressing inflammation. It may also
slow the progression of psoriatic arthritis in some people. Methotrexate is generally
well-tolerated in low doses but may cause upset stomach, loss of appetite and
fatigue. When used for long periods, it can cause a number of serious side effects,
including severe liver damage and decreased production of red and white blood
cells and platelets.
● Cyclosporine.​ Cyclosporine (Gengraf, Neoral) suppresses the immune system and
is similar to methotrexate in effectiveness, but can only be taken short-term. Like
other immunosuppressant drugs, cyclosporine increases your risk of infection and
 other health problems, including cancer. Cyclosporine also makes you more
susceptible to kidney problems and high blood pressure — the risk increases with
higher dosages and long-term therapy.
● Drugs that alter the immune system (biologics). Several of these drugs are
approved for the treatment of moderate to severe psoriasis. They include
etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), ustekinumab
(Stelara), golimumab (Simponi), apremilast (Otezla), secukinumab (Cosentyx) and
ixekizumab (Taltz). Most of these drugs are given by injection (apremilast is oral)
and are usually used for people who have failed to respond to traditional therapy or
who have associated psoriatic arthritis. Biologics must be used with caution
because they have strong effects on the immune system and may permit
life-threatening infections. In particular, people taking these treatments must be
screened for tuberculosis.
● Other medications. Thioguanine (Tabloid) and hydroxyurea (Droxia, Hydrea) are
medications that can be used when other drugs can't be given.