Karen’s knees and elbows are red and scaly. Her mother helps her bathe and moisturize with her favorite cream every day after breakfast and every night before bedtime.
Susan’s skin from head to toe is itchy, red, and flaky. Every day, she soaks at least twice in the tub (and it feels so good she’d like to stay in it forever) and applies her prescription moisturizer. She has to visit her dermatologist (a physician who specializes in the skin) once a month for an ultraviolet light treatment. She resents the time her skin care takes and is afraid that it may be this way all her life.
Dave is a natural athlete and sports was the only reason he liked school. But he’s dropped out. Last August his skin condition flared so severely that he couldn’t wear his football gear for practice. He’s been in the hospital twice since then and is very depressed.
Karen, Susan, and Dave all have psoriasis, a skin disorder caused by new cells rushing to form more skin. In psoriasis, this process takes only three days instead of the 28 to 30 days it normally takes new skin to grow. This abnormal cell growth means that excessive skin cells pile up with nowhere to go except the surface, where they are pushed forward by new cells. Red, scaly “plaques,” or lesions, are formed, covered with a silvery-white scale made of dead cells, that sheds like dandruff.
Psoriasis is characterized by intense itching and painful, dry, cracking skin. Swelling and even bleeding can occur when the attempts to remove the scaly skin are too vigorous.
Psoriasis is not contagious; you will not catch it from physical contact with a person who has it. It is chronic, meaning it will always be present, but it can be controlled or even made to go into remission (where symptoms disappear permanently or temporarily). It is incurable; there is no vaccine to prevent it, and there is no procedure for stopping it.
The cause of psoriasis is not yet known. It cannot be predicted by a blood test and is only diagnosed once it appears. The usual methods to clear up more common rashes are unsuccessful. It has been suspected that a strep infection (like a strep throat) may lead to psoriasis in persons already predisposed to having it. A severe sunburn may trigger it, though the sun itself isn’t the cause and is, in fact, very helpful in reasonable doses in temporarily clearing up psoriasis. One out of three people who have psoriasis inherited it. There might be a family history, and a person might be predisposed to psoriasis, but whether the disease is present in one or more genes is not known yet.
Psoriasis strikes men and women in equal numbers. About 4 million Americans have psoriasis–between 1 percent and 2 percent of the population. It most often begins in people between the ages of 15 and 35. If children get it, it will usually happen before age 10, though infants and the elderlymay have the disorder. There does not seem to be a particular personality type more likely than another to develop psoriasis. It is seen in Caucasians and East Africans much more commonly than in Asians, West Africans, or Native Americans. African Americans rarely have it.
The severity of psoriasis is determined by how much of the body is covered: a “mild” case might cover 10 percent of the body, and a “severe” case would cover 30 percent or more. Most people with psoriasis have a controllable amount on the scalp, the elbows, the trunk, and the legs. In infants, it might look like a diaper rash that won’t clear up. Often a person’s psoriasis pattern will be the same on both sides of the body–the plaques probably will appear in the same general pattern on both forearms, both shins, or both sides of the trunk.
There are treatments that can clear up the plaques temporarily and improve the skin’s appearance. Some even show promise in slowing down skin cell production. The dermatologist will start with the mildest medication and simplest procedure, and gradually increase treatment to whatever will clear up the psoriasis. The physician tries to find the right balance between clearing up the skin and avoiding unwanted medication side effects. Most people are able to take care of their skin at home and see their dermatologist only a few times a year.
People with psoriasis have dry, itchy skin that needs lubrication to stay moist and flexible. This can be quite troublesome. Treatments must be done daily, sometimes several times a day. This is especially hard for small children, who can’t always see the long-term benefits of all the soaking and cream applications, but it’s not much easier for the teens or adults who feel as if they have been doing the same thing for centuries. There is always the constant search for the right emollient (cream). The skin condition might come and go on its own, producing periods of flare-up and remission. The vast majority of those with psoriasis function normally in their everyday lives, and no one dies of psoriasis.
Karen, Susan, and Dave (and their parents) may know about or already belong to a support group. A support group may help the person with psoriasis understand that he or she is not the only one experiencing distress. One group member may not have exactly the same feelings or skin condition as another, but to find that fears and aggravations are understood by others–that you’re in this “together”–can be a comforting revelation to the person with psoriasis.