The ways to treat Psoriasis

Eczema is complex skin affliction

2007-04-24T01:27:00.001-07:00

This week's expert: Dr. Mary Jo Fisher, associate program director with Cox Family Medicine Residency.

Q. What is eczema?

A. Eczema is a condition rather than a disease. It is a description of a skin condition that can be caused by many different things including allergic reactions, caustic chemicals and even dry skin.

There are three stages of eczema. Acute eczema is the earliest stage; it usually lasts a few days. The skin may blister and turn red, looking like early poison ivy. It often itches intensely. The next stage is sub-acute and can last weeks. There is less itching and redness and the affected areas may be covered with a fine white scale. The last stage is chronic. Not all eczema goes through this stage. In this stage there may be cracks in the thick dry skin and the scale is thicker. Many people have seen their hands or feet look like this in the winter.

Q. What can trigger eczema?

A. Eczema can be the result of dry skin, irritating chemicals and allergic reactions to substances. Some people are much more prone to eczema and can break out from stress, heat, cold and certain foods and materials.

Q. Is eczema genetic?

A. The most common eczema in this country is atopic eczema, and it is genetic. Atopic means an extra sensitivity to substances (allergens). It is a dominant trait, but the same gene may show up differently and to different degrees in different people. Asthma, eczema and allergies are all from that same gene.

Q. How does eczema differ from psoriasis?

A. There are some similarities between eczema and psoriasis, and it is not always easy to tell them apart. In general, psoriasis will be pink rather than red, will form a thick plaque and will have a medium to thick white scale over the top. Although it can occur anywhere on the skin, it tends to be found on the skin of the back of the elbow, the front of the knee, the buttocks — in other words, places where joints bend out rather than in. Like eczema, psoriasis has several forms and can be found anywhere on the body.

Q. Does eczema affect any specific age group?

A. Atopic eczema is usually worse in early childhood and improves toward adulthood but it can be present at any age. Eczema from other causes is not so age-dependent.

Q. What are the available treatments? Can it be cured?

A. There are many nonmedical measures that can treat eczema, as well as several prescription medications that a family doctor or dermatologist can recommend. Most eczema will respond to lubrication with hand cream or even petroleum jelly. Steroid creams, steroid pills or other medications may be recommended for resistant cases.

Atopic eczema is a chronic condition and cannot be cured. Eczema from a specific source, such as poison ivy, is a self-limiting illness and can be "cured" with appropriate treatment.

Q. How can the symptoms be lessened?

A. The itching associated with acute eczema can be lessened with cool soaks of the affected area several times daily. Over-the-counter antihistamines may give additional relief.

Again, lubrication of the affected areas gives relief to most people. Steroid creams may give additional relief. Using over-the-counter anti-itch, or medicated, creams and powders can make the condition worse as they may have perfume or other irritating ingredients.

Children with atopic eczema should stay cool and (preferably) wear cotton and polyester. They should avoid frequent bathing, sweating, wearing wool and eating foods or handling materials known to trigger their eczema.

Article published in www.news-leader.com

Psoriasis Linked to Diabetes

2007-04-20T00:07:00.001-07:00

Psoriasis is a chronic skin condition characterized by thick, red, scaly plaques that itch and sometimes bleed, causing considerable discomfort and emotional stress for patients. In addition to the daily chore of dealing with the physical symptoms of this condition, new research suggests an association between psoriasis and two potentially serious medical conditions – diabetes and atherosclerosis, also known as hardening of the arteries.

For the 2 percent to 4 percent of the worldwide population affected by psoriasis, these findings could have a significant impact on their overall health, including the estimated 5.8 to 7.5 million Americans affected by the condition.

In the report entitled, “The association between psoriasis, diabetes mellitus, and atherosclerosis in Israel: A case-control study,” published in the April 2007 issue of the Journal of the American Academy of Dermatology, dermatologist Michael David, MD, Dermatology Department at Rabin Medical Center, Tel Aviv, Israel, and his colleagues found a higher occurrence of diabetes and atherosclerosis in psoriasis patients compared to patients without psoriasis.

“Previous reports have demonstrated an association between psoriasis and other diseases, including heart failure and diabetes,” said Dr. David.

“Our study was designed to determine if such an association existed with psoriasis patients in Israel, if so, what subset of this patient population was most affected.”

The retrospective case-control study included 46,095 patients with psoriasis (identified as case patients) and 1,579,037 patients without psoriasis (identified as control patients) from the patient database of Maccabi Healthcare Services (MHS), the second largest managed care organization in Israel.

“When we compared the age-adjusted proportion of diabetes and atherosclerosis between patients with psoriasis and those patients in the control group, we found that the proportion of both medical conditions was significantly higher in psoriasis patients vs. the control group,” said Dr. David. “Examining the data among the psoriasis patients by age and gender, we also found several interesting associations.”

Specifically, the researchers noted that the association between diabetes and psoriasis was more prominent in women compared to men and in patients between the ages of 35 and 55.

Similarly, the association between atherosclerosis and psoriasis was highest among women as compared with men and in patients between the ages of 35 and 55, and 65 and 75.

In addition, in patients with psoriasis, data analysis showed an association between diabetes and the overuse of extremely potent topical steroids or certain systemic medications for psoriasis.

The researchers suggested that these observations could indicate that the prevalence of diabetes among psoriasis patients increases with the severity of psoriasis.

An association also was observed between the prevalence of atherosclerosis and the use of phototherapy, the medical light treatment administered by dermatologists for psoriasis.

The researchers noted that it is possible that phototherapy is a marker for psoriasis severity rather than being the cause of atherosclerosis.

Another possible explanation they offered is that phototherapy may be chosen as the treatment of choice for severe psoriasis patients who suffer from atherosclerosis rather than treating these patients with systemic medications.

“It is important to emphasize that while our study showed an association between psoriasis, diabetes and atherosclerosis, we did not determine the cause of this association or why there was a higher risk of both conditions in women and certain age groups,” added Dr. David.

“Our data raise the question as to whether treatments for psoriasis predispose patients for developing diabetes or atherosclerosis, or if previous reports of a higher prevalence of both smoking and obesity among patients with severe psoriasis can explain this association. Regardless of the cause, this association has a major impact on public health issues and should be addressed in the management of all patients with psoriasis.”

9 Facts About Psoriasis for Newbies

2007-04-18T03:25:00.001-07:00

1. What Is Psoriasis?

Psoriasis is a skin disease that causes scaling and swelling. Skin cells grow deep in the skin and slowly rise to the surface. This process is called cell turnover, and it takes about a month. With psoriasis, it can happen in just a few days because the cells rise too fast and pile up on the surface.

Most psoriasis causes patches of thick, red skin with silvery scales. These patches can itch or feel sore. They are often found on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet. But they can show up other places such as fingernails, toenails, genitals, and inside the mouth.

2. Who Gets Psoriasis?

Anyone can get psoriasis, but it occurs more often in adults. Sometimes there is a family history of psoriasis. Certain genes have been linked to the disease. Men and women get psoriasis at about the same rate.

3. What Causes Psoriasis?

Psoriasis begins in the immune system, mainly with a type of white blood cell called a T cell. T cells help protect the body against infection and disease. With psoriasis, T cells are put into action by mistake. They become so active that they set off other immune responses. This leads to swelling and fast turnover of skin cells. People with psoriasis may notice that sometimes the skin gets better and sometimes it gets worse. Things that can cause the skin to get worse include:
Infections
Stress
Changes in weather that dry the skin
Certain medicines.

4. How Is Psoriasis Diagnosed?

Psoriasis can be hard to diagnose because it can look like other skin diseases. The doctor might need to look at a small skin sample under a microscope.

5. How Is Psoriasis Treated?

Treatment depends on:
How serious the disease is
The size of the psoriasis patches
The type of psoriasis
How the patient reacts to certain treatments.

All treatments don't work the same for everyone. Doctors may switch treatments if one doesn't work, if there is a bad reaction, or if the treatment stops working.

6. Topical Treatment:

Treatments applied right on the skin (creams, ointments) may help. Treatments can:
Help reduce swelling and skin cell turnover
Suppress the immune system
Help the skin peel and unclog pores.

Bath solutions and lotions may feel good, but they rarely make the skin better. They are often used along with stronger treatments.

7. Light Therapy:

Natural ultraviolet light from the sun and artificial ultraviolet light are used to treat psoriasis. One treatment, called PUVA, uses a combination of a drug that makes skin more sensitive to light and ultraviolet A light.

8. Systemic Treatment:

If the psoriasis is severe, doctors might prescribe drugs or give medicine through a shot. This is called systemic treatment. Antibiotics are not used to treat psoriasis unless bacteria make the psoriasis worse.

9. Combination Therapy:

When you combine topical (put on the skin), light, and systemic treatments, you can often use lower doses of each. Combination therapy can also lead to better results.

Tai Chi Chuan against Shingles

2007-04-17T02:54:00.001-07:00

Shingles, a painful skin condition, may be prevented if you perform Tai Chi Chuan, an ancient Chinese martial art, say researchers from the University of California, Los Angeles. Tai Chi Chuan is commonly used in many parts of the world as a low-impact exercise for older people.

In this new study, researchers found that elderly people who performed Tai Chi Chuan enjoyed better immune responses against the shingles-causing virus, compared to people who just received health education.

Shingles affects about one million people in the USA alone - it most commonly affects people over the age of 50.

112 healthy volunteers, aged 59-86, were involved in this study. All participants had had chickenpox. Half of them had three Tai Chi classes each week for 12 weeks, while the other half had health education classes (but no Tai Chi lessons). They all had blood tests before and after their vaccinations.

Six months later, the researchers found that those who had received the Tai Chi lessons had almost twice the immunity levels against shingles, compared to the other group. In fact, the researchers found that the Tai Chi group managed to develop a level of immunity similar to what younger people would have after the vaccination.

"Augmenting Immune Responses to Varicella Zoster Virus in Older Adults: A Randomized, Controlled Trial of Tai Chi"
Michael R. Irwin, MD, Richard Olmstead, PhD, Michael N. Oxman, MD
Journal of the American Geriatrics Society
Volume 55 Issue 4 Page 511 - April 2007 - doi:10.1111/j.1532-5415.2007.01109.x