02 Desember, 2011

Psoriasis Triggers


The cause of psoriasis isn’t fully known, but it's thought to be related to the immune system and its interaction with the environment in people who have the genetic susceptibility. More specifically, one key cell is a type of white blood cell called a T lymphocyte or T cell. Normally, T cells travel throughout the body to detect and fight off foreign substances, such as viruses or bacteria. If you have psoriasis, however, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.
Overactive T cells trigger other immune responses. The effects include dilation of blood vessels in the skin around the plaques and an increase in other white blood cells that can enter the outer layer of skin. These changes result in an increased production of both healthy skin cells and more T cells and other white blood cells. This causes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly — in days rather than weeks. Dead skin and white blood cells can't slough off quickly enough and build up in thick, scaly patches on the skin's surface. This usually doesn't stop unless treatment interrupts the cycle.
Just what causes T cells to malfunction in people with psoriasis isn't entirely clear, although researchers think genetic and environmental factors both 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 thrush
  • Injury to the skin, such as a cut or scrape, bug bite, or a severe sunburn
  • Stress
  • Cold weather
  • Smoking
  • Heavy alcohol consumption
  • Certain medications — including lithium, which is prescribed for bipolar disorder; high blood pressure medications such as beta blockers; antimalarial drugs; and iodides.

Stress

Studies have shown stress can worsen psoriasis. When you're stressed, your body reacts. And while stress is known to make psoriasis worse, psoriasis can make you more stressed out. 
Breathe deep and count to 10. Take a relaxing soak in the tub. Call up a friend to vent. Meditate. Focus on the positive and incorporate relaxation techniques into your daily routine. All are ways to bust stress and perhaps help keep psoriasis flares at bay.


Allergies

Are psoriasis and allergies linked? The immune system appears to play a key role in both.
Researchers have found that people with psoriasis are more likely to have a greater number of inflammatory mast cells (see left) -- the kind that trigger allergic reactions, such as swelling and itching -- than people without it. Although psoriasis may be a reaction of the immune system, it is not proven to be an allergic reaction. Studies have found no link between allergens and psoriasis. 


Alcohol

Many lifestyle choices can affect psoriasis. Drinking alcohol has been associated with psoriasis and its severity. While more research is needed, it's believed that heavy drinking can trigger flares in some people. Doctors say avoid alcohol altogether to help prevent psoriasis flare-ups.
Another reason to put down your drink? Some psoriasis medications and drinking don't mix.
Instead, try a nonalcoholic thirst-quencher like iced tea. Or walk around the block to unwind. Getting exercise and up to 20 minutes of sunlight a day can soothe psoriasis.


Cold or Dry Weather

Winter can be especially hard on those who live with psoriasis. Cold, dry weather can worsen psoriasis, while warm, sunny climates may help alleviate it.
Keep your skin well moisturized. Use thick, creamy lotions after showers and baths and throughout the day. Look for lotions and soaps that are fragrance-free and designed for sensitive skin to help reduce irritation.
You can also use a humidifier in your home during dry months to help keep your skin moist. Keeping the skin moist can help reduce itching and tenderness.


Tattoos

Tattoos can look cool, but to psoriatic skin the tattooing process can be a nightmare. Repeatedly piercing the skin and injecting it with dyes is a major trauma. Trauma to the skin can cause new lesions to appear, often 10 to 14 days later.
Tattoos can also lead to infection -- another psoriasis trigger.
Treat your skin with care. Avoid tattoos and acupuncture, and talk with your doctor about shots.


Medications

Some drugs used to treat high blood pressure, heart disease, arthritis, and psychiatric disorders can trigger psoriasis.
ACE inhibitors, beta-blockers, and lithium are common offenders that can cause psoriasis flare-ups as well as malaria drugs, such as Plaquenil and hydroxychloroquine, and NSAIDs. Oral steroids such as prednisone work to control flares but may cause a worsening of the condition after coming off long-term use.
Talk to your doctor if your medication is worsening your psoriasis.



Infections

Common infections are doubly difficult for people with psoriasis. Yeast infections, thrush, strep throat, respiratory infections, and staph infections are all known psoriasis triggers.
The good news? Once you treat the infection, your psoriasis flare may also calm down.
 

Cuts and Bruises

Slice your hand in the kitchen or scrape a knee and -- pow! -- new lesions may appear where you were injured. This is called Koebner's phenomenon.
Avoid skin injury and trauma when you can. 
Wear gloves while working in the garden. Prevent bug bites and sunburn. And use care when trimming nails and shaving.


Smoking

Research shows smoking is directly linked to the severity of your psoriasis. The more you smoke, the worse your flare-ups, with outbreaks most often appearing on the hands and feet. 
Kicking the habit may reduce the number of psoriasis flares and, for some, end them.  
You don't have to take on the challenge alone. Ask your doctor about ways to smooth the transition to becoming smoke-free.


Hormones

Psoriasis can start at any age in both men and women. But it seems to peak in people between the ages of 20 and 30 as well as those between the ages of 50 and 60. Both puberty and menopause also seem to trigger psoriasis patches. Hormones are often thought to be the link.
Interestingly, one study found that high levels of estrogen during pregnancy seemed to improve psoriasis in some women.




Types of psoriasis


Many forms of psoriasis
Psoriasis occurs when the life cycle of skin cells speeds up, resulting in a rapid buildup of rough, dead skin cells. These skin cells accumulate, forming thick silvery scales and itchy, dry, red patches that are sometimes painful. In some cases, pus-filled blisters appear.
Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas.
Though psoriasis signs and symptoms vary from person to person, psoriasis types are typically identified by their hallmark appearance. Here's a look at psoriasis pictures, showing classic signs and symptoms. 

Plaque psoriasis

Plaque psoriasis, the most common form of psoriasis, causes dry, raised, red skin lesions (plaques) covered with silvery scales. The plaques itch or may be painful and can occur anywhere on your body. You may have just a few plaques or many, and in severe cases, the skin around your joints may crack and bleed.
Lifestyle measures, such as using a nonprescription cortisone cream and exposing skin to small amounts of natural sunlight, may improve mild cases. Moderate or severe cases may require light therapy, prescription steroid creams, oral medications or a combination of these. 

Scalp psoriasis

Scalp psoriasis appears as red, itchy areas with silvery-white scales. You may notice flakes of dead skin in your hair or on your shoulders, especially after scratching your scalp. The scaly patches, which may bleed when removed, may extend beyond your hairline.
Treatment for scalp psoriasis includes medicated shampoo, steroid foam or lotion, and oral medications. 

Nail psoriasis

Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails may become loose and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.
Nail psoriasis often accompanies another type of psoriasis, such as plaque psoriasis. Treatment options include oral medications and light therapy. 

Guttate psoriasis

Guttate psoriasis is usually triggered by a bacterial infection such as strep throat. It's marked by small, water-drop-shaped sores on your trunk, arms, legs and scalp. The sores 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.
Guttate psoriasis typically responds to treatment, which includes light therapy, prescription steroid creams and oral medications. It may also improve with treatment of the underlying cause or infection, if identified. 

Inverse psoriasis

Inverse psoriasis causes smooth patches of red, inflamed skin primarily in the armpits, groin, under the breasts and around the genitals. Inverse psoriasis is more common in obese people and is worsened by friction and sweating.
Treatment of inverse psoriasis may include taking a prescription oral medication. 


Pustular psoriasis

Pustular psoriasis can occur in widespread patches or in smaller areas on your hands, fingertips or feet, as shown here. It can develop quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters dry within a day or two but may reappear every few days or weeks. The reaction can result from medications, an infection, severe irritation or light sensitivity.
Small patches of pustular psoriasis may be treated with a steroid cream. Larger patches usually require prescription oral medication, elimination of the underlying cause, if possible, and other topical and systemic therapies. Light therapy may be useful once the blisters resolve and the skin is less irritated. 


Erythrodermic psoriasis

Erythrodermic psoriasis, the least common type of psoriasis, can cover your entire body with a red, peeling rash that can itch or burn intensely. It may be triggered by corticosteroids or other medications, severe sunburn or sensitivity to light during phototherapy treatment, or by another type of psoriasis that's poorly controlled.
Treatment of erythrodermic psoriasis usually requires prescription oral medication, medicated wet dressings and topical steroids. Combination therapies and hospitalization may be necessary for severe cases. 

30 November, 2011

Psoriasis


Psoriasis is a common skin disease that affects the life cycle of skin cells. Psoriasis causes cells to build up rapidly on the surface of the skin, forming thick silvery scales and itchy, dry, red patches that are sometimes painful.
Psoriasis is a persistent, long-lasting (chronic) disease. You may have periods when your psoriasis symptoms improve or go into remission alternating with times your psoriasis worsens.
For some people, psoriasis is just a nuisance. For others, it's disabling, especially when associated with arthritis. There's no cure, but psoriasis treatments may offer significant relief. Lifestyle measures, such as using a nonprescription cortisone cream and exposing your skin to small amounts of natural sunlight, can improve your psoriasis symptoms.
The most common type of psoriasis is called plaque psoriasis. It causes a thick, patchy, red rash with silvery, white scales. It can appear anywhere but most often occurs on the scalp, elbows, knees, and lower back. The condition is not contagious, and it's fairly common, affecting 2% to 3% of Americans. Psoriasis is more common in adults than children.

Symptoms

Psoriasis signs and symptoms can vary from person to person but may include one or more of the following:
  • Red patches of skin covered with 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. Mild cases of psoriasis may be a nuisance; more-severe cases can be painful, disfiguring and disabling.
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. In most cases, however, the disease eventually returns. 



Several types of psoriasis exist. These include:
  • Plaque psoriasis. The most common form, plaque psoriasis causes dry, raised, red skin lesions (plaques) covered with silvery scales. The plaques itch or may be painful and can occur anywhere on your body, including your genitals and the soft tissue inside your mouth. You may have just a few plaques or many, and in severe cases, the skin around your joints may crack and bleed.
  • Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails may become loose and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.
  • Scalp psoriasis. Psoriasis on the scalp appears as red, itchy areas with silvery-white scales. You may notice flakes of dead skin in your hair or on your shoulders, especially after scratching your scalp.
  • Guttate psoriasis. This primarily affects people younger than 30 and is usually triggered by a bacterial infection such as strep throat. It's marked by small, water-drop-shaped sores on your trunk, arms, legs and scalp. The sores 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, especially if you have ongoing respiratory infections.
  • Inverse psoriasis. Mainly affecting the skin in the armpits, in the groin, under the breasts and around the genitals, inverse psoriasis causes smooth patches of red, inflamed skin. It's more common in overweight people and is worsened by friction and sweating.
  • 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 dry within a day or two, but may reappear every few days or weeks. Generalized pustular psoriasis can also cause fever, chills, severe itching and fatigue.
  • 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. It may be triggered by severe sunburn, by corticosteroids and other medications, or by another type of psoriasis that's poorly controlled.
  • Psoriatic arthritis. In addition to inflamed, scaly skin, psoriatic arthritis causes pitted, discolored nails and the swollen, painful joints that are typical of arthritis. It can also lead to inflammatory eye conditions, such as conjunctivitis. 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.

Nail Psoriasis

Up to half of people with skin plaques have psoriasis of the nails as well. This makes the nails look yellowish-red. The nails may also crumble, become pitted, or develop grooved lines. Nearly everyone with psoriasis of the nails also has psoriasis somewhere on the skin.

Psoriatic Arthritis

About 15% of people with psoriasis develop psoriatic arthritis, a painful and sometimes disabling inflammation of the joints. Psoriatic arthritis can occur at any age but is most common between the ages of 30 and 50.

Causes

The exact cause of psoriasis is unknown, but experts believe that the immune system, genes, and environmental factors play central roles. Normally, old skin cells are replaced with new ones every four weeks. In people with psoriasis, the immune system triggers inflammation, causing new cells to move to the surface every three or four days. The resulting buildup forms the rash. Psoriasis cannot be passed from person to person, but it does tend to run in families.

In psoriasis, the life cycle of your skin cells greatly accelerates, leading to a buildup of dead cells on the surface of the epidermis.

Psoriasis Triggers

People with psoriasis may find their condition flares up at certain times. Common triggers include:
  • Skin injury or infection
  • Emotional stress
  • Certain medications
  • Smoking or drinking alcohol

Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:
  • Family history. Perhaps the most significant risk factor for psoriasis is having a family history of the disease. About 40 percent of people with psoriasis have a family member with the disease, although this may be an underestimate.
  • 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 your risk of inverse psoriasis. In addition, 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
Depending on the type and location of the psoriasis and how widespread the disease is, psoriasis can cause complications. These include:
  • Thickened skin and bacterial skin infections caused by scratching in an attempt to relieve severe itching
  • Fluid and electrolyte imbalance in the case of severe pustular psoriasis
  • Low self-esteem
  • Depression
  • Stress
  • Anxiety
  • Social isolation
If you have psoriasis, you’re at greater risk of developing certain diseases, such as metabolic syndrome, a cluster of conditions that include high blood pressure and elevated insulin levels; inflammatory bowel disease; cardiovascular disease; and, possibly, cancer.
In addition, psoriatic arthritis can be debilitating and painful, making it difficult to go about your daily routine. Despite medications, psoriatic arthritis can cause joint damage.

 The Stigma of Psoriasis

For some people, psoriasis can affect their emotions and self-image. A stubborn, unsightly rash can transform a confident, outgoing person into a wallflower. People may avoid dates, social events, or job interviews. All of this can increase the risk of depression and anxiety, which can worsen the symptoms of psoriasis.


Tests and 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) that's examined under a microscope to determine the exact type of psoriasis and to rule out other disorders. A skin biopsy is usually done in a doctor's office using a local anesthetic.
Conditions that can look like psoriasis
Other conditions that may look like psoriasis include:
  • Seborrheic dermatitis. This type of dermatitis is characterized by greasy, scaly, itchy, red skin. It's often found on oily areas of the body, such as the face, upper chest and back. Seborrheic dermatitis can also appear on the scalp as stubborn, itchy dandruff.
  • Lichen planus. This is an inflammatory, itchy skin condition that appears as rows of itchy, flat-topped bumps (lesions) on the arms and legs.
  • Ringworm of the body (tinea corporis). Ringworm is caused by a fungal infection on the top layer of your skin. The infection often causes a red, scaly ring or circle of rash.
  • Pityriasis rosea. This common skin condition usually begins as one large spot (herald patch) on your chest, abdomen or back, which then spreads. The rash of pityriasis rosea often extends from the middle of the body, and its shape resembles drooping pine-tree branches. This condition usually clears within six to eight weeks.
A doctor can usually diagnose psoriasis by examining your skin, scalp, and nails. A biopsy can be done to confirm the diagnosis. If you have swelling and pain in your joints, your doctor may also order blood tests and X-rays to check for arthritis. Psoriasis cannot be cured, but treatments can relieve symptoms and control the condition.


Treatments and drugs
Psoriasis treatments aim to:
  • Interrupt the cycle that causes an increased production of skin cells, thereby reducing inflammation and plaque formation.
  • Remove scales and smooth the skin, which is particularly true of topical treatments that you apply to your skin.
Psoriasis 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 powerful anti-inflammatory drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They slow cell turnover by suppressing the immune system, which reduces inflammation and relieves associated itching. Topical corticosteroids range in strength, from mild to very strong. Low-potency corticosteroid ointments are usually recommended for sensitive areas, such as your face or skinfolds, and for treating widespread patches of damaged skin. Your doctor may prescribe stronger corticosteroid ointment for small areas of your skin, for persistent plaques on your hands or feet, or when other treatments have failed. Medicated foams and scalp solutions are available to treat psoriasis patches on the scalp. Long-term use or overuse of strong corticosteroids can cause thinning of the skin and resistance to the treatment's benefits. To minimize side effects and to increase effectiveness, topical corticosteroids are generally used on active outbreaks until they're under control.
  • Vitamin D analogues. These synthetic forms of vitamin D slow down the growth of skin cells. Calcipotriene (Dovonex) is a prescription cream or solution containing a vitamin D analogue that may be used alone to treat mild to moderate psoriasis or in combination with other topical medications or phototherapy. This treatment can irritate the skin. Calcitriol (Rocaltrol) is expensive, but may be equally effective and possibly less irritating than calcipotriene.
  • Anthralin. This medication is believed to normalize DNA activity in skin cells. Anthralin (Dritho-Scalp) can also remove scale, making the skin smoother. However, anthralin can irritate skin, and it stains virtually anything it touches, including skin, clothing, countertops and bedding. For that reason doctors often recommend short-contact treatment — allowing the cream to stay on your skin for a brief time before washing it off. Anthralin is sometimes used in combination with ultraviolet light.
  • Topical retinoids. These are commonly used to treat acne and sun-damaged skin, but tazarotene (Tazorac, Avage) was developed specifically for the treatment of psoriasis. Like other vitamin A derivatives, it normalizes DNA activity in skin cells and may decrease inflammation. The most common side effect is skin irritation. It may also increase sensitivity to sunlight, so sunscreen should be applied while using the medication. Although the risk of birth defects is far lower for topical retinoids than for oral retinoids, your doctor needs to know if you're pregnant or intend to become pregnant if you're using tazarotene.
  • Calcineurin inhibitors. Currently, calcineurin inhibitors — tacrolimus (Prograf) and pimecrolimus (Elidel) — are approved only for the treatment of atopic dermatitis, but studies have shown them to be effective at times in the treatment of psoriasis. Calcineurin inhibitors are thought to disrupt the activation of T cells, which in turn reduces inflammation and plaque buildup. The most common side effect is skin irritation. Calcineurin inhibitors are not recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma. Calcineurin inhibitors are used only with your doctor's input and approval. 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. A thick, black byproduct of the manufacture of petroleum products and coal, coal tar is probably the oldest treatment for psoriasis. It reduces scaling, itching and inflammation. Exactly how it works isn't known. Coal tar has few known side effects, but it's 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.
  • Moisturizers. By themselves, moisturizing creams won't heal psoriasis, but they can reduce itching and scaling and can help combat the dryness that results from other therapies. Moisturizers in an ointment base are usually more effective than are lighter creams and lotions.

Light therapy (phototherapy)
As the name suggests, this psoriasis 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. Ultraviolet (UV) light is a wavelength of light in a range too short for the human eye to see. When exposed to UV rays in sunlight or artificial light, the activated T cells in the skin die. This 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.
  • Narrowband UVB therapy. A newer type of psoriasis treatment, narrowband UVB therapy may be more effective than broadband UVB treatment. It's usually administered two or three times a week until the skin improves, then maintenance may require only weekly sessions. Narrowband UVB therapy 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. Once requiring a three-week hospital stay, a modification of the original treatment can be performed in a doctor's office. Another method, the Ingram regimen, combines UVB therapy with a coal tar bath and an anthralin-salicylic acid paste that's left on your skin for several hours or overnight.
  • Photochemotherapy, or psoralen plus ultraviolet A (PUVA). 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. PUVA involves two or three treatments a week for a prescribed number of weeks. Short-term side effects include nausea, headache, burning and itching. Long-term side effects include dry and wrinkled skin, freckles, and increased risk of skin cancer, including melanoma, the most serious form of skin cancer.
  • Excimer laser. This form of light therapy, used for mild to moderate psoriasis, treats only the involved skin. A controlled beam of UVB light of a specific wavelength is directed to the psoriasis plaques to control scaling and inflammation. Healthy skin surrounding the patches isn't harmed. Excimer laser therapy requires fewer sessions than does traditional phototherapy because more powerful UVB light is used. Side effects can include redness and blistering. 
  • Pulsed dye laser. Similar to the excimer laser, the pulsed dye laser uses a different form of light to destroy the tiny blood vessels that contribute to psoriasis plaques. Side effects can include bruising for up to 10 days after treatment. There is a slight risk of scarring.
  • Combination light therapy. Combining UV light with other treatments such as retinoids frequently improves phototherapy's effectiveness. Combination therapies are often used after other phototherapy options are ineffective.

~ 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. 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 reduce the production of skin cells if you have severe psoriasis that doesn't respond to other therapies. Signs and symptoms usually return once therapy is discontinued, however. Side effects may include dryness of the skin and mucous membranes, itching, 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 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 suppresses the immune system and is similar to methotrexate in effectiveness. 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.
  • Hydroxyurea. This medication isn't as effective as cyclosporine or methotrexate, but unlike the stronger drugs it can be combined with phototherapy. Possible side effects include a decrease in red blood cells (anemia) and a decrease in white blood cells and platelets. It should not be taken by women who are pregnant or planning to become pregnant.
  • Immunomodulator drugs (biologics). Several immunomodulator drugs are approved for the treatment of moderate to severe psoriasis. They include alefacept (Amevive), etanercept (Enbrel), infliximab (Remicade) and ustekinumab (Stelara). These drugs are given by intravenous infusion, intramuscular injection or subcutaneous injection and are usually used for people who have failed to respond to traditional therapy or who have associated psoriatic arthritis. Biologics work by blocking interactions between certain immune system cells and particular inflammatory pathways. Although they're derived from natural sources rather than chemical ones, they 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.
  • Thioguanine. Nearly as effective as methotrexate and cyclosporine, this drug has fewer side effects. However, this drug is more likely to cause anemia, and women who are pregnant or planning to become pregnant must avoid it because it may cause birth defects.


Treatment considerations
Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments — topical creams and ultraviolet light therapy (phototherapy) — and then progress to stronger ones only if necessary. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.
In spite of a range of options, effective treatment of psoriasis can be challenging. The disease is unpredictable, going through cycles of improvement and worsening, seemingly at random. Effects of psoriasis treatments also can be unpredictable; what works well for one person might be ineffective for someone else. Your skin also can become resistant to various treatments over time, and the most potent psoriasis treatments can have serious side effects.
Talk to your doctor about your options, especially if you're not improving after using a particular treatment or if you're having uncomfortable side effects. He or she can adjust your treatment plan or modify your approach to ensure the best possible control of your symptoms.

Lifestyle and home remedies
Although self-help measures won't cure psoriasis, they may help improve the appearance and feel of damaged skin. These measures may benefit you:
  • Take daily baths. Bathing daily helps remove scales and calm inflamed skin. Add bath oil, colloidal oatmeal, Epsom salts or Dead Sea salts to the water and soak for at least 15 minutes. Avoid hot water and harsh soaps, which can worsen symptoms; use lukewarm water and mild soaps that have added oils and fats.
  • Use moisturizer. Blot your skin after bathing, then immediately apply a heavy, ointment-based moisturizer while your skin is still moist. For very dry skin, oils may be preferable — they have more staying power than creams or lotions do and are more effective at preventing water from evaporating from your skin. During cold, dry weather, you may need to apply a moisturizer several times a day.
  • Cover the affected areas overnight. To help improve redness and scaling, apply an ointment-based moisturizer to your skin and wrap with plastic wrap overnight. In the morning, remove the covering and wash away the scales with a bath or a shower.
  • Expose your skin to small amounts of sunlight. A controlled amount of sunlight can significantly improve lesions, but too much sun can trigger or worsen outbreaks and increase the risk of skin cancer. If you sunbathe, it's best to try short sessions three or more times a week. Keep a record of when and how long you're in the sun to help avoid overexposure. And be sure to protect healthy skin with a broad-spectrum sunscreen with an SPF of at least 15. Apply sunscreen generously, and reapply every two hours — or more often if you're swimming or perspiring. Before beginning any sunbathing program, ask your doctor about the best way to use natural sunlight to treat your skin.
  • Apply medicated cream or ointment. Apply an over-the-counter cream or ointment containing hydrocortisone or salicylic acid to reduce itching and scaling. If you have scalp psoriasis, try a medicated shampoo that contains coal tar. For best results, follow label directions.
  • Avoid psoriasis triggers, if possible. Find out what triggers, if any, worsen your psoriasis and take steps to prevent or avoid them. Infections, injuries to your skin, stress, smoking and intense sun exposure can all worsen psoriasis.
  • Avoid drinking alcohol. Alcohol consumption may decrease the effectiveness of some psoriasis treatments.
  • Eat a healthy diet. Although there's no evidence that certain foods will either improve or aggravate psoriasis, it's important to eat a healthy diet, particularly when you have a chronic disease. A healthy diet includes eating a variety fruits and vegetables of all colors and whole grains. If you eat meat, focus on lean cuts and fish. If you think certain foods make your symptoms better or worse, keep a food diary to see what effect different foods have.
Alternative medicine
Many alternative therapies are available to ease the symptoms of psoriasis, including special diets, creams, dietary supplements and herbs. Some alternative therapies are deemed generally safe, and they may be helpful to some people in reducing signs and symptoms, such as itching and scaling. 

  • Aloe vera. Taken from the leaves of the aloe vera plant, aloe extract cream may reduce redness, scaling, itching and inflammation. You may need to use the cream several times a day for a month or more to see any improvements in your skin.
  • Fish oil. Omega-3 fatty acids found in fish oil supplements may reduce inflammation associated with psoriasis, although results from studies are mixed. Taking 3 grams or less of fish oil daily is generally recognized as safe, and you may find it beneficial.
If you're considering dietary supplements or other alternative therapy to ease the symptoms of psoriasis, consult your doctor. He or she can help you weigh the pros and cons of specific alternative therapies.



Coping and support
Coping with psoriasis can be a challenge, especially if the disease covers large areas of your body or is in places readily seen by other people, such as your face or hands. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden.
Here are some ways to help you cope and to feel more in control:
  • Get educated. Find out as much as you can about the disease and research your treatment options. Understand possible triggers of the disease, so you can better prevent flare-ups. Educate those around you — including family and friends — so they can recognize, acknowledge and support your efforts in dealing with the disease.
  • Follow your doctor's recommendations. If your doctor recommends certain treatments and lifestyle changes, be sure to follow them. Ask questions if anything is unclear.
  • Find a support group. Consider joining a support group with other members who have the disease and know what you're going through. You may find comfort in sharing your experience and struggles and meeting people who face similar challenges. Ask your doctor for information on psoriasis support groups in your area or online.
  • Use cover-ups when you feel it necessary. On those days when you feel particularly self-conscious, cover the psoriasis with clothing or use cosmetic cover-up products, such as body makeup or a concealer. These products can mask redness and psoriasis plaques. They can irritate the skin, however, and shouldn't be used on open sores, cuts or unhealed lesions.

Stress Reduction

Stress tends to worsen psoriasis, so relaxation techniques may help control flare-ups. Anything that helps you relax, whether it's yoga, deep breathing, or a long walk, may help ease your symptoms.




18 Oktober, 2011

Acne


Acne Vulgaris

Acne vulgaris is the medical name for common acne -- the presence of blackheads, whiteheads, and other types of pimples on the skin. The most common spots for breakouts are the face, chest, shoulders, and back. Although mild acne may improve with over-the-counter treatments, more severe forms should be treated by a dermatologist.


Comedones

A comedo, or basic acne lesion, is a hair follicle that has become clogged with oil and dead skin cells. Comedones (the plural of comedo) can develop into bumps called whiteheads and blackheads. Products that may trigger comedones are called "comedogenic." Makeup labeled "noncomedogenic" is less likely to clog pores and contribute to acne.

Blackheads

Blackheads are comedones that are open at the surface of the skin. They are filled with excess oil and dead skin cells. It's not dirt that causes the comedone to turn black. The oil's reaction to air causes the black color. Blackheads can frequently be treated with over-the-counter medications.

Whiteheads

Comedones that stay closed at the surface of the skin are called whiteheads. This happens when oil and skin cells prevent a clogged hair follicle from opening. Many of the same over-the-counter medicines that treat blackheads are also effective against whiteheads.

Papules

Papules are comedones that become inflamed, forming small red or pink bumps on the skin. This type of pimple may be sensitive to the touch. Picking or squeezing can make the inflammation worse and may lead to scarring. A large number of papules may indicate moderate to severe acne.

Pustules

Pustules are another kind of inflamed pimple. They resemble a whitehead with a red ring around the bump. The bump is typically filled with white or yellow pus. Avoid picking or squeezing pustules. Picking can cause scars or dark spots to develop on the skin.

Nodules

Nodules are large, inflamed bumps that feel firm to the touch. They develop deep within the skin and are often painful. Nodules should be treated by a dermatologist. Over-the-counter treatments may not be powerful enough to clear them up, but prescription drugs can be effective.

Cysts

Cysts are large, pus-filled lesions that look similar to boils. Like nodules, cysts can be painful and should be treated by a dermatologist. People who develop nodules and cysts are usually considered to have a more severe form of acne.

Mild Acne

Acne falls into the "mild" category if you have fewer than 20 whiteheads or blackheads, fewer than 15 inflamed bumps, or fewer than 30 total lesions. Mild acne is usually treated with over-the-counter topical medicine. It may take up to eight weeks to see a significant improvement.

Moderate Acne

If you have 20 to 100 whiteheads or blackheads, 15 to 50 inflamed bumps, or 30 to 125 total lesions, your acne is considered moderate. Dermatologists usually recommend prescription medication for moderate to severe acne. It may take several weeks to notice an improvement, and your acne may appear to get worse before it gets better.

Severe Nodulocystic Acne

People with severe nodulocystic acne have multiple inflamed cysts and nodules. The acne may turn deep red or purple. It often leaves scars. Prompt treatment by a dermatologist can minimize scarring. In some cases, a doctor may inject corticosteroids directly into nodules and cysts to reduce the size and painful inflammation.

Acne Conglobata

Acne conglobata is one of the most severe forms of acne. It involves many inflamed nodules that are connected under the skin to other nodules. It can affect the neck, chest, arms, and buttocks. It often leaves scars. This type of acne is more common in men and is sometimes caused by taking steroids or testosterone. Timely treatment by a dermatologist is essential.

Acne Mechanica

Acne mechanica is caused by heat, friction, and pressure against the skin, often the result of wearing sports gear such as a helmet or baseball cap. It is sometimes called "sports-induced acne" because it occurs frequently in athletes. Preventive measures include wearing an absorbent material under sports equipment and showering immediately after activity.

Topical Therapy

Topical therapy is acne medication that is applied directly to the skin, like gels or creams. Over-the-counter topical products can often help mild acne. They may contain ingredients like benzoyl peroxide, resorcinol, salicylic acid, or sulfur. Prescription products such as antimicrobial or retinoid creams can treat mild to moderately severe acne. These can be prescribed alone or in combination with other ingredients.

Systemic Therapy

Systemic therapy refers to acne medication that is taken by mouth. Antibiotics like tetracycline, minocycline, doxycycline, or erythromycin may treat moderate to severe acne by targeting bacteria and reducing inflammation. Other systemic therapies include oral contraceptives, which can reduce acne in some women, spironolactone, an anti-androgen hormone pill, and isotretinoin (high-dose prescription vitamin A). Isotretinoin is used only in certain severe, cystic acne cases, or in cases where other treatments don't work. A course of isotretinoin treatment requires regular appointments with your dermatologist.