May 19, 2014

Ask the Doctors

I have developed psoriasis, and I find it a nuisance. It is in my scalp and it catches my comb. Do you have any advice?

Psoriasis, unfortunately, is a common skin disorder. It causes irritation, redness, and scaly, silvery-white patches. It often occurs in families, and may well be a condition caused by autoimmune processes.

Normal skin grows from a basal layer of cells that multiply in number through division of cells—one into two, two, and so forth. As these cells come to the surface, they flatten and are called squamous cells. They lose their nuclei and are, on the surface, microscopic little scales that rub off and provide protection to the deeper layers. In psoriasis the outer, or cornified, layer is much thicker. There is an increased blood supply and greater cellular activity.

The normal growth from basal layer to external squamous scale takes about one month; in psoriasis this is a shorter period of time by reason of the “revved-up” cellular activity.

Psoriasis is not infectious and does not spread to others. It commonly shows up between the ages of 15 to 35, and sometimes it comes and goes.

Attacks or outbreaks of psoriasis may follow acute infections such as influenza or streptococcal infection. Insect bites, with resultant irritation and scratching, may play a role. Sunburn, at times, has been associated with an outbreak. People who are taking chemotherapy treatments, are infected with HIV, or have other autoimmune diseases seem to be at greater risk.

Psoriasis favors such sites as the elbows, knees, trunk, and scalp, but can appear anywhere. When the flaky skin is scratched off, a pink irritated skin can be seen to lie beneath. The appearance of psoriasis has led to a descriptive classification, but this is not overly meaningful except to those who might have one type or another.

Psoriasis can be associated with involvement of the fingernails or toenails, as well as with arthritis. This latter condition can be quite a problem.

As with many dermatological treatments, that for psoriasis is not curative but symptomatic. Your doctor may suggest various creams or lotions, often with the intent of lessening the scaliness and/or the irritation/inflammation. A further treatment may be to use medication or injectables that modify the immune response. A third approach is to use light in a treatment called phototherapy.

The lotions often contain salicylic acid, which cures the scale, or corticoid-type creams to dampen inflammation. Moisturizing lotions to soften the scale, or dandruff shampoos to remove the scale, might be employed.

Newer “biologic” drugs include specific antibodies that seem to target other antibodies. Your doctor many mention such names such as Humira, Enbrel, and Remicade.

Some people are given medications called parabens, which sensitize the skin to ultraviolet light. Such treatments seem to work very well for some patients, but concerns that there may be an increased risk of skin cancer following such exposure have tempered the enthusiasm for such treatments.

The encouraging news is that most patients, although inconvenienced by their condition, live normal and productive lives. We pray that you will, too.

Send your questions to Ask the Doctors, Adventist Review 12501 OId Columbia Pike, Silver Spring, Maryland 20904. Or e-mail them to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend you consult with your personal physician on all matters of your health.