A Bright Future
For some, SUNLIGHT may relieve the itch of psoriasis

By Rick Mattoon

If you stop and think about it, we probably all know or know of someone suffering from psoriasis. For some, the disease brings periodic bouts of mild itching; for others, it's a lifetime of discomfort and unsightly skin changes that can affect their overall livelihoods. The disease affects approximately 2.6 percent of Americans which translates into more than 7 million individuals nationwide. Yet, sunlight is shedding some GOOD NEWS on the disease.

The American Academy of Dermatology lists psoriasis as a persistent skin disease that got its name from the Greek word for "itch." A chronic skin disorder, psoriasis is thought to be related to the immune system, though the cause is still unknown. However, recent medical discoveries point to the abnormality in the functioning of key white cells in the blood stream triggering inflammation in the skin.

Interestingly, reports indicate that psoriasis appears to be slightly more prevalent among women than men; however, it can strike at any age--most often between the ages of 15 and 35. Additionally, there are approximately 150,000 to 260,000 new cases of psoriasis diagnosed each year.

The most common form of the disease is called plaque psoriasis. Raised, inflamed lesions covered by a silvery buildup called scales distinguish it from other forms of skin disorders. Normal skin cells mature and are sloughed off about every 28 to 30 days. When a person has psoriasis, skin cells mature and move to the surface in three to four days, causing them to buildup and form elevated red plaques. The redness and inflammation comes from the increased blood supply necessary to feed the rapidly dividing skin cells. The white scales that cover the inflamed area are composed of flaky dead skin cells.

Additionally, psoriasis comes in several other forms. Each differs in intensity, length and location, as well as shape and pattern of the scales. Other forms of psoriasis are known as pustular, guttate, inverse (or flexural) and erythrodermic.

• Pustular psoriasis usually affects the hands, feet or both. It typically appears as blisters superimposed on plaque psoriasis.
• Guttate psoriasis usually affects children and young adults. It often shows up after a sore throat, with many small, red, drop-like, scaly spots appearing on the skin. It often clears up by itself in weeks or a few months.
• Inverse psoriasis occurs in the armpit, under the breast and in skin folds around the groin, buttocks and genitals.
• Erythrodermic psoriasis usually develops in chronic forms as a reaction to topical therapy or as a result of overexposure to ultraviolet radiation.

Let There Be Light

Although there is no cure for psoriasis, the goal for treatment is to remedy the symptoms. A number of therapies, including exposure to ultraviolet light, temporarily can clear psoriasis plaques while considerably improving the skin's appearance. The best therapies are those that prove most effective while posing the fewest side effects.

Typically, dermatologists will start with the least potent treatment and work up until one is found that provides the most relief for the individual. The American Academy of Dermatology lists many treatment options when dealing with patients diagnosed with psoriasis.

As you may know, many dermatologists have prescribed phototherapy for patients with psoriasis. Sunlight and ultraviolet light slow the rapid growth of skin cells. Although there may be risks involved, light treatment can be safe and effective under a doctor's care.

Psoriasis patients may be advised by their dermatologist to sunbathe carefully. Since indoor tanning facility operators typically are not medically trained in the role of light therapy, it is advised that a person seek the advice of a dermatologist before self-treating with natural or artificial sunlight. Additionally, discuss your condition with your tanning salon operator. He or she should be aware that you are under a doctor's care and chart your progress for their own records.

The short-term threat of using UVB for treating psoriasis is minimal. Furthermore, according to the National Psoriasis Foundation, long-term studies of a large numbers of patients treated with UVB have failed to demonstrate an increased risk of skin cancer, suggesting that this treatment may be "better than sunlight."

Therefore, UVB treatments are considered to be one of the most-effective therapies for moderate to severe psoriasis with the least amount of risk. It is important that your heath-care provider monitors your skin intermittently during phototherapy.

What is the difference between UVA and UVB? Since UVA is dispensed in both doctors' offices and indoor tanning salons, most people are curious about its function in treating individuals with skin disorders like psoriasis. UVA by itself usually is not used alone to treat psoriasis. UVA is not as effective unless used with photosensitizing medications such as psoralen. Psoralen will be discussed later as a medication used with PUVA therapy.

UVB is the treatment of choice in most cases of psoriasis because it has been proven to be the most-effective type of phototherapy with the least amount of side effects. In controlled amounts, artificial and natural sources of UVB can be used to treat many skin disorders such as psoriasis. Always ask your doctor when exposing to sunlight or indoor tanning to improve your skin condition. Other treatments include:

Steroids (Cortisone)--Cortisone creams, ointments and lotions may clear the skin temporarily and control the condition in many patients. Weaker solutions typically are used on more sensitive areas of the body such as the genitals, groin and face. Stronger solutions often are needed to control lesions on the scalp, elbow, knees, palms, soles and parts of the torso.

Scalp Treatment--The treatment for psoriasis of the scalp depends on the seriousness of the disease, hair length and the patient's lifestyle. A variety of non-prescription and prescription shampoos, oils, solutions and sprays are available. Most contain coal tar or cortisone.

Anthralin--This medication seems to work well on tough-to-treat thick patches of psoriasis. It can cause irritation and temporary staining of the skin and clothes. Newer preparations have lessened these side effects.

Vitamin D--A synthetic vitamin D, calcipotriene, now is available in prescription form. It is useful for individuals with localized psoriasis and can be used with other treatments. Limited amounts should be used to avoid side effects. Ordinary vitamin D purchased in drug stores or health food stores is of no value in the treatment of psoriasis.

Coal Tar--For more than 100 years, coal tar has been used to treat psoriasis. Today's products are greatly improved and less messy. Stronger prescriptions can be made to treat difficult areas.

Retinoids--Prescription vitamin A-related drugs may be prescribed alone or in combination with ultraviolet light for severe cases of psoriasis. Side effects include dryness of the skin, lips and eyes, elevation of fat levels in the blood, and formation of tiny bone spurs. Retinoids should not be used by women of childbearing age, as birth defects may result. Close monitoring by a dermatologist is required together with regular blood tests.

PUVA--When psoriasis has not responded to other treatments or is widespread, PUVA is effective in 85 percent to 90 percent of cases. The treatment name comes from "Psoralen + UVA," the two factors involved. Patients are given a drug called psoralen, then exposed to a carefully measured amount of a special form of ultraviolet (UVA) light. It sometimes takes up to 25 treatments, over a two- or three-month period, before clearing occurs. About 30 to 40 treatments each year usually are required to keep the psoriasis under control.

The above treatments alone or in combination greatly can clear or improve psoriasis in most cases, but no treatment permanently "cures" it. The best way to care for psoriasis is to stay informed. The American Academy of Dermatology and the National Psoriasis Foundation are excellent resources for the control and treatment of psoriasis.

What does the future hold for sufferers of this disease? With work being done at medical facilities such as the Problem Psoriasis Clinic at the University of Tennessee, Memphis, the future looks bright. The clinic currently is studying antimicrobial therapy for the treatment of psoriasis. The study is assessing its effectiveness through thousands of physical examinations and patient questionnaires.

Currently, some dermatologists are using antibiotic and/or antifungal therapy as part of their treatment programs for psoriasis; however, most rarely make antimicrobials their primary treatment for psoriasis. More thorough studies and continued research are necessary to explain the role of antigens in psoriasis and how treatments can be administered effectively in this area. Furthermore, with the intensifying growth of genetics and immunology, tremendous interest in psoriasis research is mounting.

Rick Mattoon is the Technical Training Director for the National Tanning Training Institute.

At A Glance...PSORIASIS

• Psoriasis affects more than 7 million Americans.
• The average age of onset is 28 years of age, though psoriasis is seen at birth and as late as age 90.
• Between 10 percent to 15 percent of the people who get psoriasis are under the age of 10.
• There is a form of arthritis that occurs in approximately 10 percent to 20 percent of the people who have psoriasis. It is called psoriatic arthritis.
• Between 150,000 and 260,000 new cases of psoriasis occur each year.
• Annual outpatient costs for treating psoriasis are estimated at $1.6 billion to $3.2 billion.
• Approximately 400 people die from psoriasis-related causes each year.

Source: National Psoriasis Foundation