This paper discusses the effects, treatments, and social and/or emotional problems associated with plaque psoriasis or psoriasis vulgaris. It includes the immune and genetic sides, mild and severe symptoms, triggers, topical treatments, phototherapy, and systemic treatments. It also includes social and emotional distress for children and adults in the workplace, at school, or at home, as well as a few ways to ease this distress. The disease and the people who have it are often stereotyped. This paper will try to shed some light on the subject.
Psoriasis is an immune system disorder that causes the body to produce too many T cells, which is a type of white blood cell. These T cells cause inflammation and also cause skin cells to reproduce too quickly and too much. There is a known genetic predisposition to psoriasis, but the disease has multiple factors. However, a family tendency has been identified. Scientists are still working to find the specific genes that hold a clue to psoriasis, and they hope that this can give them a tool against it.
In most mild cases of plaque psoriasis, small patches of skin turn red and thick, and they become covered with white flaky patches. Often times they itch and burn, and the skin can crack, especially at the joints. Psoriasis most often occurs on the elbows, knees, scalp, lower back, face, palms, and soles of the feet (What Is). The whitish flakes or scales covering the affected areas can be scratched or pulled off easily, which many say eases the itching (Psychosocial).
In severe cases, almost the entire skin may be affected. Skin may be inflamed, and if the feet are affected it becomes impossible to walk. Sometimes lesions on the scalp trap hairs and pull them out, which can cause pain. Some patches are so thick that entire layers of skin peel off painlessly (Wall). Often the psoriasis on the joints can lead to a form of arthritis known as psoriatic arthritis.
There are many triggers for a breakout of psoriasis, including climate, physical injury, infection, and emotional stress. Some studies prove that sunlight is beneficial in treating it, which means that cold or cloudy weather can be a trigger for a breakout. There is also a proven relationship between a skin injury and a psoriasis lesion. If a patient’s skin is injured or irritated, a lesion often appears in the same place. This is known as “Koebner’s Phenomenon.” Upper respiratory disease, strep throat, HIV, and boils are all proven triggers for psoriasis, sometimes for unknown reasons. Emotional stress is linked to increased itching in patients. Stress makes the psoriasis itch more, and the itching makes the patient’s stress level rise. It’s a continuing cycle.
Treatments for psoriasis usually occur in a three-step process. First, topical treatments are used for milder cases. Sunlight has proven to be very beneficial in moderation, which accounts for the rise of psoriasis problems in the winter. Coal tar can be used in shampoo, lotion, or alone. Cortisone, vitamin D3, anthralin, salicylic acid, and moisturizers can be applied alone or in combination with another treatment.
Another popular option is phototherapy, or ultraviolet radiation. This is used more often with moderate or severe cases because is helps treat the entire body. Forms of phototherapy use both UVA and UVB rays. UVB radiation is applied with light boxes in a doctor’s office or in a patient’s home. This form is often used together with another treatment like coal tar. A treatment called PUVA combines a topical medicine called psoralen with exposure to UVA rays. This is used only in severe cases and clears psoriasis better that UVB treatment. However, this is slower and comes with greater risks for skin cancer and other diseases. (What Is)
Finally, for severe cases, doctors prescribe medication to be taken internally. These can be pills or injections. Some doctors use retinoids, methotrexate, cyclosporine, or hydrozyuria to treat cases in which more than 10% of the body is affected. Retinoids are derived from vitamin A, but can cause birth defects. Methotrexate “slows down cell production and suppresses the immune system” (What Is), but causes infertility in men and women. Hydrozyuria is less harmful than others, so it is usually combined with retinoids or PUVA. All of these treatments can cause anemia, infertility, and birth defects, because they are all toxic. Most doctors put patients on a rotating cycle of medicines so the body doesn’t build up an immunity to them.
Recently, the FDA has approved a few biological treatments. Amevive, by Biogen, works to block and eliminate the malformed T cells that trigger psoriasis (Amevive). This is less toxic than many other forms, and looks promising. Also, some natural or herbal treatments are used, but many are not reliable. There have been radical treatments for psoriasis throughout history, when it was more commonly known as a form of leprosy.
Since psoriasis is such a visible affliction, many of its victims are ridiculed for their looks. Children in particular have a hard time reconciling themselves to the difference. Because psoriasis can strike at any age, children – and their parents – are almost never ready for it. At school, young children must cope with the taunts and laughs of unfeeling classmates. Eventually, their self-esteem is almost entirely gone, and they feel like they will never make friends, never amount to anything. This only gets worse as the children approach high school. As their classmates find boyfriends and girlfriends, they feel that no one will ever accept them with their horrible condition, and some fall into a spiral of depression.
At home, children need to understand that their outward appearance is not a reflection of their inner selves. Parents need to learn about the disease and in turn educate their children. A supportive family can be the one thing that saves a child from a complete loss of any feelings of self-worth. For a child to experience the same ridicule at home that they might at school would be terrible. The first thing the child needs to inform others of is that their condition is not contagious in any way. (Zimmerman) (Wall)
Conditions often do improve in adulthood, but for some they remain bad. Coworkers may inquire about or even make fun of the disease in ignorance. If nothing is done to stop it, it can become a horrible experience for the person suffering this torment. Steps can be taken to help this. If coworkers are informed of the disease and given a brief explanation, they can be much more considerate. Some even help when the psoriasis gets in the way of work. Adults can often find the support they need at home. An understanding spouse or even a good friend can provide comfort after a hard day. By the time they are adults, many people have come to terms with their condition and are helping others to accept it as well.
Psoriasis, while not deadly, can be a terrible disease to have. Because of its chronic nature, it can continue over an entire lifetime. The lesions are itchy and painful, and the treatments range from messy to toxic. Severe cases can leave a person unable to participate in life fully. The social and emotional stress caused by the disease can leave permanent marks on a person’s mind and self-esteem. The human stereotype that the outside is a reflection of the inside can take a toll on those who have no control over their skin condition. Hopefully, new treatments and knowledge of diseases like this can erase that feeling.