Psoriasis Treatment

Psoriasis and Related Skin Conditions

Psoriasis

-	Literally means "itchy condition".

-	Characterised by sharply bordered reddened patches of skin covered with overlapping silvery scales.

-	Commonly affected areas included scalp, elbows, knees, wrists, ankles and forearms.

-	Nearly 13 million people worldwide suffer from psoriasis.

-	Highest incidence in white European populations (2 to 3%), less with other races. Lowest in natives of North and South America respectively.

-	Equal incidence in males and females, although more females report their condition as severe.

-	Psoriasis has a strong genetic component [1], [2] (about 36% of psoriasis patients have one or more family members with the disease). In spite of this genetic link there are many environmental factors which strongly affect psoriasis, particularly diet. Incomplete or poor digestion, particularly of proteins, lead to the formation of toxins (polyamines) which worsen psoriasis. Microscopic damage to the gut has also been linked to the severity of psoriasis.

-	Diet can be a valuable part of an affective psoriasis treatment programme. Foods to avoid include alcohol, gluten (a wheat protein), meats (particularly pork), processed foods, animal fats and candy/sweets. Foods to increase include fresh fruit, vegetables, whole grains, unprocessed foods, fish oil, cold water fish (mackerel, herring, tuna, salmon). Fish oil supplements have been shown in trials to give significant improvement in psoriasis [3], [4], [5].

-	Decreased levels of vitamin A and zinc are common in psoriasis patients [6], [7], [8]. Both vitamin A and zinc play a critical role in skin health.

-	Other vitamins/trace elements of interest are vitamin E, chromium and selenium. Consult your doctor, pharmacist or naturopath for more information about vitamin, mineral and herbal supplements for psoriasis.

-	Psoria ointment is suitable for symptomatic relief of psoriasis. It contains the potent anti-inflammatory essential oil Chamomile german in a specially stabilised ointment base. Psoria also contains vitamin D which has a role in controlling the rate of new skin cell production.

-	Up to 40% of patients also suffer from psoriatic arthritis. In 10% of cases, joint problems pre-date any skin involvement. Fingers and toes are especially affected with this form of arthritis. The spine may also be involved.

-	Nails are often involved in the disease process and have a dimpled appearance like the surface of a thimble ("oil drop" stippling).

-	75% of psoriasis cases are early onset (type 1). Average age of onset: females 16 years, males 22 years. 25% of cases are late onset (type 2) where the average age of onset is 56 years for both men and women.

-	Stress - 39% of patients who have psoriasis report that a specific stressful event occurred within one month prior to their initial episode of psoriasis. Patients with a psychological trigger of their psoriasis have a better prognosis than patients whose psoriasis is unaffected by stress [9].

-	Period spent at health resorts at the Dead Sea (Middle East) have indicated beneficial results due to the high level of salinity. Regular bathing in salt water appears to have similar results.

-	Methods of relaxation therapy such as meditation or biofeedback may help with the treatment of psoriasis.

-	Sunlight is very beneficial for psoriasis treatment. Ultra sound heating as well as heating pads have been shown to be of benefit [10].


Types of Psoriasis

-	Psoriasis Vulgaris - The most common form (80% of cases). Sharply edged, reddened scaly patches, typically on the scalp, elbows, knees and between the buttocks.

-	Guttate Psoriasis - Often occurs after streptococcal infection. Numerous reddened, slightly raised small lesions appear on the trunk. Often reappears if strep reinfection occurs.

-	Inverse Psoriasis - The inner aspect of joints is involved rather than the usual outer areas. Armpits and creases of the knees and elbows are often affected with reddened scaly patches.

-	Von Zumbusch Psoriasis - Sterile pustules (raised lesions containing pus) cover large portions of the trunk and extremities. The skin's protective function can be impaired, making patients susceptible to infection. Severe cases require hospitalisation.

-	Palmoplantar Pustular Psoriasis (hand and foot psoriasis) - Pus containing lesions are limited to the hands and feet. This condition can restrict walking and use of hands.

-	Koebners Phenomenon - Psoriasis lesions formed in response to local trauma such as scratching.


Related Skin Problems

-	Eczema (dermatitis) - Inflamed, red, itchy, dry and scaly skin often seen on the front of the wrists and elbows and the back of the knees. A common condition (2 to 7% of the population).

-	Contact Dermatitis - There are many chemicals in today's environment that can cause contact dermatitis. Common allergens include:

	nickel	watches, insecticides

	latex	synthetic resins, artificial nails

	chromates	inks and paints

	formaldehyde	cosmetics, shampoos, nail polish, paper products

	fragrances	perfumes, cosmetics

	plants	cashews, mango, philodendron, sesame seeds, chrysanthemum, dieffenbachia

	vegetables	garlic, onions, tomato, celery, cucumber

-	Atopic Dermatitis - Chronic itchy inflamed skin. Usually associated with a family history of hayfever, asthma or other allergic disorders.

-	Seborrheic Dermatitis - Inflamed scaly skin most commonly on the face and neck. Lesions on the scalp may be yellow. May occur in infancy or adulthood. Despite the name, the skin's sebum production is usually normal.

-	Nummular Dermatitis - Coin shaped crusted lesions, mostly appearing on the legs. Most commonly seen in emotionally stressed middle aged individuals.

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[1] M. Proctor et al., “Lowered Cutaneous and Urinary Levels of Polyamines with Clinical Improvement in Treaded Psoriasis”, Arch Dermatol, 115 (1979): pages 945-9.
[2] Editorial “Polyamines and Psoriasis”, Arch Dermatol, 115 (1979): pages 945-9.
[3] S.B. Bittiner, et al., “A Double Blind, Randomized, Placebo-Controlled Trial of Fish Oil in Psoriasis”. Lancet 1 (1988): pages 378-80.
[4] F. Grimmunger, et al., “A Double Blind, Randomized, Placebo-Controlled N-3 Fatty Acid Based Lipid Infusion in Acute, Extended Guttate Psoriasis”, Clin Invest 71 (1993): pages 634-43.
[5] P.D.L. Maurice, et al., “The Effects of Dietary Supplementation with Fish Oil in Patients with Psoriasis”, Br J Dermatol 1117 (1987): pages 599-606.
[6] S. Majewski, et al., "Decreasing Levels of Vitamin A in Serum of Patients with Psoriasis", Arch Dermatol Res 280 (1989): pages 499-501.
[7] L.J. Hinks, et al., "Trace Element Status in Eczema and Psoriasis", Clin Exp Dermatol 12 (1987): pages 93-7
[8] A. Donadini, A. Dazzaglia and G. Desirello, "Plasma Levels of Zn, Cu and Ni in Healthy Controls and in Psoriatic Patients", Acta Vitamin Enzymol 1 (1980): pages 9-16.
[9] R.H. Seville, "Psoriasis and Stress", Br J Dermatol 97 (1977): page 297.
[10] H. Urabe, K. Nishitani and H. Kodha, "Hyperthermia in the Treatment of Psoriasis", Arch Dermatol 117 (1981): pages 770-4.
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