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Disease & Conditions >>> Psoriasis Articles & News
By: Kenneth Gordon, MD & Mark Lebwohl, MD
The word "psoriasis" is derived from the Greek word for "itch," but unlike some pesky prickle, psoriasis can't be scratched away. More than seven million Americans suffer with psoriasis, a chronic skin disease characterized by an overproduction of skin cells that result in flaky and patchy raised areas on the skin's surface.
Below, two experts in psoriasis offer a full introduction to this chronic disease.
Let's start with the basics. What is psoriasis?MARK LEBWOHL, MD: Psoriasis is a disorder of the skin in which an abnormality of the immune system triggers the release of substances that cause the cells of the skin to multiply too quickly. Ordinarily, skin cells on the superficial area of the skin regenerate about every 28 days. In those with psoriasis, that same portion of the skin may be made over every two to four days, and that skin comes up as thick, scaly, red plaques.
Are there some parts of the body that are more susceptible to psoriasis than others?KENNETH GORDON, MD: Typically traumatic areas are more susceptible, like elbows and knees, and the lower part of the back. But the important thing to remember is, psoriasis can happen anywhere on the body. Anywhere there's skin you can have psoriasis.
Are there many different types?MARK LEBWOHL, MD: Classically, there are four types. The most common type is plaque psoriasis, which is characterized by large, red, scaly patches that, as you've already heard, affect the elbows and knees, but can affect any part of the body. There are severe cases in which patients are covered, 80 to 100% of their body surface, with plaques. That accounts for the majority of patients with psoriasis.
Around 10% of patients have something called guttate psoriasis, which are smaller, red, scaly lesions-1 or 2 cm-that cover large areas of the body. Typically, these patients will develop a lot of little spots all over after strep throat. That's the second most common type.
The two most dangerous types are called erythrodermic psoriasis and pustular psoriasis.
Erythrodermic psoriasis patients' entire skin surface turns bright red and scaly, and they lose all of the protective functions of their skin. They literally can't control body temperature. They lose nutrients and fluid through their skin and they're susceptible to infection. The skin barrier against infection is lost, and that is a life-threatening form of psoriasis. Patients have actually died from that form of psoriasis.
The other form, pustular psoriasis, occurs in two ways. One of them is generalized pustular psoriasis, in which, again, patients lose all of those protective functions of the skin, and this becomes a life-threatening instance where patients can die from their psoriasis. And there is a localized form which, while it is not life-threatening, is just as debilitating. It is a localized pustular psoriasis of the palms and soles. Patients simply can't use their hands or feet. They can't walk, they can't handle anything with their hands, because it's very painful.
How common are these more serious forms of psoriasis?MARK LEBWOHL, MD: Fortunately they are rare. They're most commonly triggered by systemic steroids, or withdrawal of systemic steroids.
If someone has a very chronic case of psoriasis, are other parts of the body affected by it?MARK LEBWOHL, MD: The one particular part of the body that can routinely be affected in patients with psoriasis are the joints. It turns out that roughly 7%, or a little less than one out of ten patients who have psoriasis, will have significant psoriatic arthritis, meaning inflammation of the joints. There are several different forms of that, and it can range in severity from fairly mild to quite severe and debilitating.
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