What is Psoriasis?

As I sat visiting my father in a physical therapy rehab center (following his recent, unfortunate stroke), I was delighted to find that he is able to distract his mind and enjoy some entertainment by watching all-day rerun marathons of the hit reality show, "Keeping Up With the Kardashians."

Having given up TV (not just cable) a long time ago, I was left wondering about the appeal of this show, which even my 80-something-year-old parents can’t seem to get enough of. Whatever it may be, I am simply grateful that it is keeping my dad occupied and distracted, even for a moment.                                                

For those of you who also can’t get enough of reality TV, you may have discovered (certainly before myself) that Kim Kardashian revealed her diagnosis of psoriasis on her show. And more likely than not, you may know someone in real life who suffers from psoriasis, too, given that up to 7.5 million Americans are estimated to have this diagnosis.

So what exactly is psoriasis? Is is just a cosmetic issue, or more than that? And what are its risks?  Let’s find out in today’s episode.

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What is Psoriasis?

Psoriasis is a medical condition that falls under the larger heading of “autoimmune disorder.”  These are disorders in which the immune system erroneously produces a certain protein called an “antibody,” which then attacks “normal” parts of our bodies, such as the joints or skin.

Besides psoriasis, other examples of autoimmune disorders you may have heard of include rheumatoid arthritis, lupus, Grave’s disease, Hashimoto’s disease (which is related to the thyroid), and Type I diabetes. 

Kim Kardashian’s mom also reportedly has psoriasis, which is not unusual: there’s a genetic component in the disorder, and these genes are inherited from our parents in 40% of those with psoriasis.  Symptoms often first show up sometime between the age of 15 and 30 – typically on the younger side. 

What Does Psoriasis Look Like?

A rash is the primary symptom in those with psoriasis, and just ras there are various types of psoriasis, there are varying appearances of the rash.  But the most common type of psoriasis includes a reddish, well-demarcated (meaning the border or lining is distinct and easily visible) patch, with an overlying white or silvery-scale.  It can be itchy, but for most patients the itchiness is mild. 

The rash also tends to vary in severity. Some patients may have a mild case, with a very small skin patch, on rare occasions throughout their lives, while others might have widespread disease with rashes covering everything from the scalp down to the toes.   

Besides the skin, psoriasis can sometimes affect the nails with a characteristic “pitting” appearance on the surface.  The fingernails are often more affected than the toenails.

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Consequences of Psoriasis

Unfortunately, psoriasis is not always “just a rash.”  When severe enough, or when in very visible areas of our skin, psoriasis can have a pretty significant psychosocial impact. Depression has been reported in 60% of those with psoriasis, with patients describing how the disease negatively interferes with their daily personal lives and career, not to mention self-image.  

Besides the psychological affects, psoriasis does have some other unwanted risks associated with it as well:

• Arthritis:  Studies show that up a third of those with psoriasis can develop some type of joint pain due to arthritis.
• Autoimmune disorders: Those with one type of autoimmune disorder are often at higher risk of developing another one, compared to the general population. In those with psoriasis, there are studies that show a higher risk of developing alopecia areata (distinct patches of hair loss), Celiac Disease, Crohn’s Disease, ulcerative oolitis of the colon, Vitiligo (the skin condition Michael Jackson reportedly suffered from), and multiple sclerosis.
• Metabolic Syndrome: This refers to patients with concurrent diabetes, hypertension, high cholesterol, and obesity who often develop these conditions simultaneously.  For some reason, those with psoriasis also tend to suffer from one or more of these components, and sometimes even all of the above.
• Heart Disease: An inflammatory condition like psoriasis can also affect the blood vessels, and recent studies have shown increased risk of heart attack, stroke, and heart disease in those with psoriasis.
• Cancer: Studies in those with psoriasis have also shown slightly higher risks of developing cancer than in the general population. Pancreatic cancer and Lymphoma were two of the most reported types, along with non-melanoma-type skin cancers in those previously treated with UV light therapy.

Treatment of Psoriasis

Anything Kim tries to sell you as the “cure all” for psoriasis, I would surely take with a grain of salt. The truth is, there is currently no cure for psoriasis; it is a lifelong condition, and one that can only be controlled with treatment. 

The disease course can wax and wane, but certain medications can alleviate the symptoms. These include prescription:

• Topical steroid creams
• Vitamin D topical derivatives that help slow down the growth of skin cells (calcipotriene or calcitriol)
• Vitamin A topical derivatives (tazarotene)
• Other topicals like pimecrolimus or tacrolimus
• UV light therapy
• Oral medications (methotrextrate, oral retinoids, cyclosporine, etc.)
• Injectables that target the immune system

For those with difficult to treat or widespread psoriasis, a referral to a dermatologist may be needed.

That's all for this week! Be sure to share your questions and tips with me on the House Call Doctor Facebook and Twitter pages. 

Psoriasis photo courtesy of Shutterstock.