PSORIASIS
WHAT IS IT?
It is a common skin condition that at sometime and to a
varying extent, affects well over a million-and-a-half people
in the United Kingdom and Ireland and approximately eighty
million people Worldwide.
Psoriasis is in simple terms only a vast acceleration of
the usual replacement processes of the skin. Normally a
skin cell matures in twenty one to forty days during its
passage to the surface where a constant invisible shedding
of dead cells, as scales takes place.
Psoriatic cells, however, are believed to turn over in
two to three days and in such chaotic profusion that even
live cells reach the surface and accumulate with the dead
ones in visible layers.
WHAT DOES IT LOOK LIKE?
It appears as raised red patches of skin covered with silvery
scales. It can occur on any part of the body, although knees,
elbows and the scalp are usual sites. There is often accompanying
irritation.
IS IT CATCHING?
Definitely not. It cannot be caught from other people, nor
can it be transferred from one part of the body to another.
WHAT CAUSES IT?
Basic causes are as yet unknown. Hereditary factors are
thought to play an important part and much research is being
carried out into this aspect.
It does however appear as if a genetic tendency is triggered
off by such things as injury, throat infection, certain
drugs and both physical and emotional stress.
WHO GETS IT?
Psoriasis affects both sexes equally. It may appear for
the first time at any age, although it is more likely to
appear between 11 and 45.
HOW SERIOUS IS IT?
Psoriasis is known as a waxing and waning condition, and
there may therefore be considerable variations in its intensity.
There are also many clinical forms with skin involvement
varying from a few psoriatic patches to, at its worst and
very rarely, a widespread and serious eruption. Most sufferers,
however, have only small patches which either get better
spontaneously or need very little treatment.
The more severe forms that produce general involvement may
demand intensive medical and nursing care.
Widespread ignorance as to the nature of psoriasis and the
real or imagined reactions and attitudes of non-sufferers
may also lead to a withdrawal from society and to feelings
of isolation, depression and defensive shyness.
IS THERE A CURE
At the moment a permanent cure has not been found. Scientists
know much about the cellular changes that occur and have
identified many of the triggers. Many cases are controlled
or improved by treatment of the visible effects rather than
the unknown basic causes. These urgently need to be identified.
A great variety of treatments exist, and work continues
to find more cosmetically acceptable ones. However, at least
one-third of psoriatics lose the condition naturally for
long periods of time or even entirely. Education about the
condition has also been shown to be very beneficial.
It is exceedingly rare for babies to have Psoriasis, particularly
when there is no history in the family. Rashes in the napkin
area are sometimes thought to be Psoriasis, i.e. those provoked
by a thrush infection. However, occasionally rashes appearing
in a baby of a psoriatic family may be true Psoriasis, the
child later developing typical lesions.
Psoriasis of the usual type rarely begins before the age
of about four or five. The onset is often an outbreak of
what is called Guttate Psoriasis, gutta being the Latin
word for a drop. Guttate Psoriasis consists of many very
small scaly patches affecting the trunk, limbs and sometimes
the scalp. There may be a few rather larger patches, or
such patches may in time develop. This type of rash often
follows an infection, often one caused by streptococci in
the throat; usually the rash clears well (in several weeks
or months), but in some children patches will linger on
indefinitely.
If a child has a tendency to tonsillitis, the rash may come
back with each attack. Fortunately, serious involvement
and the linked form of arthritis are exceedingly rare.
Research is beginning to unravel the genetic aspects of
psoriasis. Eventually it will be possible to identify those
who have a tendency to it before they actually develop signs
of it. Since onset may be late in life and the actual rash
minimal, many people will have died without being noted
as sufferers.
Having one parent with Psoriasis will increase the chance
of a child’s developing Psoriasis. If both parents
have it, the chance will increase further. It is also probable
that with such a background the psoriasis will tend to arise
fairly early in life.
Sometimes it will be possible for these methods to be demonstrated,
in combination with general guidance and support, in out-patient
visits to a ward or a clinic.
The more ‘dramatic’ treatments for Psoriasis,
such as methotrexate, acitretin and PUVA are not given to
children except under very special circumstances.
All the usual immunisation procedures may safely be given,
but it is worth remembering that a patch of psoriasis may
come up at any site where the skin has been ‘injured’,
for example following immunisation with BCG.
It is important to keep teachers informed of the child’s
psoriasis at all stages of education.
The child should lead a life as normal as possible. However
games and physical education may occasionally have to be
missed when the lesions are at their worst.
Cotton underwear, sleepwear, etc., is more comfortable,
especially in warm summer weather.
Care should be taken that the child does not suffer sunburn.
Tender loving care from family and friends will help the
child cope with many of the problems connected with his
or her psoriasis.
Information Courtesy of:
The PSORIASIS Association
MILTON HOUSE
7 MILTON STREET
NORTHAMPTON
NN2 7JG
Tel: (0604) 711129
Fax: (0604) 792894
Registered Charity No. 257414
Psoriatic arthritis
What is it?
Psoriatic arthritis is a particular pattern of arthritis
seen in association with psoriasis. There may be inflammation
of one of several joints either in the hands, feet or larger
joints or the spine. Typically only one set of joints is
involved, although in rare cases it can become widespread.
About 80% of those affected develop inflammation in their
joints after the onset of psoriasis, but in about 20% the
arthritis may be present first before psoriasis. The joints
affected may become tender, swollen and stiff. There is
some evidence that inflammation of the tendons (tendonitis)
without obvious inflammation of the joints (arthritis) may
also be more common.
How does it differ from other forms of arthritis?
In some cases it may mimic other forms of chronic arthritis
and indeed having psoriasis does not preclude individuals
from developing other forms of arthritis. However typically
the pattern of joints that becomes inflamed is characteristic
of psoriatic arthritis. For example if an entire finger
or toe becomes swollen rather than an individual joint,
this is very suggestive of psoriatic arthritis. Other typical
features may be involvement of the neck in those who suffer
from the spinal form of arthritis or involvement of the
very end joints of the fingers in those whose hands are
involved.
Is there any particular age of onset?
It can come on at any age from early childhood and teenage
years to later in life. However there is some evidence that
in females both following childbirth and during menopause
there may be certain hormone related changes that trigger
the onset of arthritis.
Is it permanently disabling?
It is unlikely that psoriatic arthritis will lead to permanent
disability. In general the outlook is better than for many
other forms of arthritis such as rheumatoid disease.
Which joints are involved?
Potentially any joint in the body can be involved, but it
is unheard of for all of them to become inflamed in any
one individual. Most usually only one set of joints is involved,
although there is a chance that other, but not all joints
may become involved at a later stage.
Is it Psoriatic Arthritis?
In most cases the diagnosis can be established without too
much difficulty by taking into account the pattern of joints
involved. It may be slightly more difficult when the arthritis
precedes development of psoriasis however.
Is there any division between the sexes?
Males and females are almost equally affected. However it
would seem that males are more prone to developing arthritis
of the spine and females more severe disease of other joints.
Nail Pitting
Psoriatic nail disease is present in about 80% of those
with psoriatic arthritis in contrast to about 30% of those
with psoriasis alone. Therefore in any individual with possible
psoriatic arthritis, who has not yet developed psoriasis,
examination of the nails is important.
Treatments
There are many forms of treatment for psoriatic arthritis
depending of course on the type and severity Treatment may
range from rest and splintage for acutely inflamed joints,
physiotherapy with mobilisation and exercises for less actively
inflamed joints and medications that can reduce inflammation.
Perhaps the most important part of treatment however is
proper counselling and education.
How can I help myself
By learning about arthritis in order to know what to expect
, to allay any fears that may be unfounded. Get the right
balance of rest and exercise. Keep warm on cold days. Take
medical advice for colds, influenza etc. Eat
a good balanced diet.
Is there any research?
Yes, there is research into psoriatic arthritis, although
surprisingly not as much as some other forms of arthritis.
However this may not be crucial as lessons learned from
scientific advances in a number of other areas will help
with understanding the cause of psoriatic arthritis and
hopefully lead to better treatment.
The Association supported work at Guy’s Hospital a
few years ago and in 1994 awarded a Grant of £16,975
for a Project in Bath, which is still proceeding.
Information Courtesy of:
The PSORIASIS Association
MILTON HOUSE
7 MILTON STREET
NORTHAMPTON
NN2 7JG
Tel: (0604) 711129
Fax: (0604) 792894
Registered Charity No. 257414
