psoriasis

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Definition

Named for the Greek word psōra meaning "itch," psoriasis is a chronic, non-contagious disease characterized by inflamed lesions covered with silvery-white scabs of dead skin.

Description

Psoriasis, which affects at least four million Americans, is slightly more common in women than in men. Although the disease can develop at any time, 10–15% of all cases are diagnosed in children under 10, and the average age at the onset of symptoms is 28. Psoriasis is most common in fair-skinned people and extremely rare in dark-skinned individuals.

Normal skin cells mature and replace dead skin every 28–30 days. Psoriasis causes skin cells to mature in less than a week. Because the body can't shed old skin as rapidly as new cells are rising to the surface, raised patches of dead skin develop on the arms, back, chest, elbows, legs, nails, folds between the buttocks, and scalp.

Psoriasis is considered mild if it affects less than 5% of the surface of the body; moderate, if 5–30% of the skin is involved, and severe, if the disease affects more than 30% of the body surface.

Dermatologists distinguish different forms of psoriasis according to what part of the body is affected, how severe symptoms are, how long they last, and the pattern formed by the scales.

PLAQUE PSORIASIS. Plaque psoriasis (psoriasis vulgaris), the most common form of the disease, is characterized by small, red bumps that enlarge, become inflamed, and form scales. The top scales flake off easily and often, but those beneath the surface of the skin clump together. Removing these scales exposes tender skin, which bleeds and causes the plaques (inflamed patches) to grow.

Plaque psoriasis can develop on any part of the body, but most often occurs on the elbows, knees, scalp, and trunk.

SCALP PSORIASIS. At least 50 of every 100 people who have any form of psoriasis have scalp psoriasis. This form of the disease is characterized by scale-capped plaques on the surface of the skull.

NAIL PSORIASIS. The first sign of nail psoriasis is usually pitting of the fingernails or toenails. Size, shape, and depth of the marks vary, and affected nails may thicken, yellow, or crumble. The skin around an affected nail is sometimes inflamed, and the nail may peel away from the nail bed.

GUTTATE PSORIASIS. Named for the Latin word gutta, which means "a drop," guttate psoriasis is characterized by small, red, drop-like dots that enlarge rapidly and may be somewhat scaly. Often found on the arms, legs, and trunk and sometimes in the scalp, guttate psoriasis can clear up without treatment or disappear and resurface in the form of plaque psoriasis.

PUSTULAR PSORIASIS. Pustular psoriasis usually occurs in adults. It is characterized by blister-like lesions filled with non-infectious pus and surrounded by reddened skin. Pustular psoriasis, which can be limited to one part of the body (localized) or can be widespread, may be the first symptom of psoriasis or develop in a patient with chronic plaque psoriasis.

Generalized pustular psoriasis is also known as Von Zumbusch pustular psoriasis. Widespread, acutely painful patches of inflamed skin develop suddenly. Pustules appear within a few hours, then dry and peel within two days.

Generalized pustular psoriasis can make life-threatening demands on the heart and kidneys.

Palomar-plantar pustulosis (PPP) generally appears between the ages of 20 and 60. PPP causes large pustules to form at the base of the thumb or on the sides of the heel. In time, the pustules turn brown and peel. The disease usually becomes much less active for a while after peeling.

Acrodermatitis continua of Hallopeau is a form of PPP characterized by painful, often disabling, lesions on the fingertips or the tips of the toes. The nails may become deformed, and the disease can damage bone in the affected area.

INVERSE PSORIASIS. Inverse psoriasis occurs in the armpits and groin, under the breasts, and in other areas where skin flexes or folds. This disease is characterized by smooth, inflamed lesions and can be debilitating.

ERYTHRODERMIC PSORIASIS. Characterized by severe scaling, itching, and pain that affects most of the body, erythrodermic psoriasis disrupts the body's chemical balance and can cause severe illness. This particularly inflammatory form of psoriasis can be the first sign of the disease, but often develops in patients with a history of plaque psoriasis.

PSORIATIC ARTHRITIS. About 10% of partients with psoriasis develop a complication called psoriatic arthritis. This type of arthritis can be slow to develop and mild, or it can develop rapidly. Symptoms of psoriatic arthritis include:

• joint discomfort, swelling, stiffness, or throbbing
• swelling in the toes and ankles
• pain in the digits, lower back, wrists, knees, and ankles
• eye inflammation or pink eye (conjunctivitis).

— Maureen Haggerty

A noncontagious inflammatory skin disease characterized by recurring reddish patches covered with silvery scales.

[Greek psōriāsis, itch, mange, from psōriān, to have the itch, from psōrā, itch.]

As if having psoriasis (inflammatory skin disease) isn't hard enough; new studies show that people with the disease may run a higher risk of heart attacks.

"Findings from a new study suggest that psoriasis may be an independent risk factor for heart attack, particularly in young individuals with severe psoriasis."

Link: Psoriasis may raise risk of heart attack — Yahoo! News

Posted October 12, 2006.

See our Word Overheard blog to see interesting uses of strange words.

A papulosquamous inflammatory skin disease of unknown cause. Rare oral lesions consist of red patches with white, scaly surfaces.

Psoriasis. (Zitelli/Davis, 2002)

Definition

Psoriasis is a chronic, non-contagious disease characterized by inflamed hyperproliferative lesions covered with silvery-white scabs of dead skin.

Description

Psoriasis, which affects at least four million Americans, is slightly more common in women than in men. Although the disease can develop at any time, 10–15% of all cases are diagnosed in children under 10, and the average age at the onset of symptoms is 28 years of age. Psoriasis is most common in fair-skinned people and relatively rare in dark-skinned individuals, although the rate among African Americans appears to be slowly rising.

Normal skin cells mature and replace dead skin every 28–30 days. Psoriasis causes skin cells to mature in less than a week. Because the body can't shed the old skin as rapidly as new cells are rising to the surface, raised patches of dead skin develop on the arms, back, chest, elbows, legs, nails, folds between the buttocks, and scalp.

Psoriasis is considered mild if it affects less than 5% of the surface of the body, moderate if 5–30% of the skin is involved, and severe if the disease affects more than 30% of the body surface.

Types of Psoriasis

Dermatologists distinguish different forms of psoriasis according to what part of the body is affected, how severe symptoms are, how long they last, and the pattern formed by the scales.

PLAQUE PSORIASIS. Plaque psoriasis (psoriasis vulgaris), the most common form of the disease, is characterized by small, red bumps that enlarge, become inflamed, and form scales. The top scales flake off easily and often, but those beneath the surface of the skin clump together. Removing these scales exposes tender skin, which bleeds and causes the plaques (inflamed patches) to grow.

Plaque psoriasis can develop on any part of the body, but most often occurs on the elbows, knees, scalp, and trunk.

SCALP PSORIASIS. At least 50 of every 100 people who have any form of psoriasis have scalp psoriasis. This form of the disease is characterized by scale-capped plaques on the surface of the skull.

NAIL PSORIASIS. The first sign of nail psoriasis is usually pitting of the fingernails or toenails. Size, shape, and depth of the marks vary, and affected nails may thicken, yellow, or crumble. The skin around an affected nail is sometimes inflamed, and the nail may peel away from the nail bed.

GUTTATE PSORIASIS. Named for the Latin word gutta, which means "a drop," guttate psoriasis is characterized by small, red, drop-like dots that enlarge rapidly and may be somewhat scaly. Often found on the arms, legs, and trunk and sometimes in the scalp, guttate psoriasis can clear up without treatment or disappear and resurface in the form of plaque psoriasis.

PUSTULAR PSORIASIS. Pustular psoriasis usually occurs in adults. It is characterized by blister-like lesions filled with non-infectious pus and surrounded by reddened skin. Pustular psoriasis, which can be limited to one part of the body (localized) or can be widespread, may be the first symptom of psoriasis or develop in a patient with chronic plaque psoriasis.

Generalized pustular psoriasis is also known as Von Zumbusch pustular psoriasis. Widespread, acutely painful patches of inflamed skin develop suddenly. Pustules appear within a few hours, then dry and peel within two days.

Generalized pustular psoriasis can make life-threatening demands on the heart and kidneys.

Palomar-plantar pustulosis (PPP) generally appears between the ages of 20 and 60. PPP causes large pustules to form at the base of the thumb or on the sides of the heel. In time, the pustules turn brown and peel. The disease usually becomes much less active for a while after peeling.

Acrodermatitis continua of Hallopeau is a form of PPP characterized by painful, often disabling, lesions on the fingertips or the tips of the toes. The nails may become deformed, and the disease can damage bone in the affected area.

INVERSE PSORIASIS. Inverse psoriasis occurs in the armpits and groin, under the breasts, and in other areas where skin flexes or folds. This disease is characterized by smooth, inflamed lesions and can be debilitating.

ERYTHRODERMIC PSORIASIS. Characterized by severe scaling, itching, and pain that affects most of the body, erythrodermic psoriasis disrupts the body's chemical balance and can cause severe illness. This particularly inflammatory form of psoriasis can be the first sign of the disease, but often develops in patients with a history of plaque psoriasis.

PSORIATIC ARTHRITIS. About 10% of patients with psoriasis develop a complication called psoriatic arthritis. This type of arthritis can be slow to develop and mild, or it can develop rapidly. Symptoms of psoriatic arthritis include:

• joint discomfort, swelling, stiffness, or throbbing
• swelling in the toes and ankles
• pain in the digits, lower back, wrists, knees, and ankles
• eye inflammation

Causes & Symptoms

The cause of psoriasis is unknown, but research related to the Human Genome Project is mapping the genetic component of the disease. As of late 2001, accumulated evidence indicates that psoriasis is a multifactorial disorder, which means that it is the end result of a number of different factors. It appears to be caused by the combined action of multiple disease genes in a single individual that are triggered by irritants in the environment. Factors that increase the risk of developing psoriasis include:

• blood relatives with psoriasis
• stress
• exposure to cold temperatures
• injury, illness, or infection
• steroids and other medications
• mechanical stress (leaning on knees or skin exposure to chemicals, for example)

Trauma and certain bacteria may trigger psoriatic arthritis in patients with psoriasis.

Diagnosis

A medical history and physical examination is the basis for a diagnosis of psoriasis. In some cases, a microscopic examination of skin cells is also performed.

Blood tests can distinguish psoriatic arthritis from other types of arthritis.

Treatment

Psoriasis treatments include:

• Soaking in warm water and German chamomile (Matricaria recutita) or bathing in warm salt water.
• Drinking as many as three cups a day of hot tea made with one or a combination of the following herbs: burdock root (Arctium lappa), dandelion (Taraxacum mongolicum) root, Oregon grape root (Mahonia aquifolium), sarsaparilla (Smilax officinalis), and balsam pear (Momardica charantia).
• Taking two 500-mg capsules of evening primrose oil (Oenothera biennis) a day. Pregnant women should not use evening primrose oil, and patients with liver disease or high cholesterol should use it only under a doctor's supervision.
• Eating a diet that includes plenty of fish, turkey, celery (for cleansing the kidneys), parsley, lettuce, lemons (for cleansing the liver), limes, fiber, and fruit and vegetable juices.
• Eating a diet that eliminates animal products high in saturated and unsaturated fats, such as fried foods, dairy products, and fatty meats, that promote inflammation.
• Drinking plenty of water (at least eight glasses) each day.
• Regularly imagining clear, healthy skin.

Other helpful alternative approaches include identifying and eliminating food allergens from the diet; enhancing liver function; augmenting the supply of hydrochloric acid in the stomach; and completing a detoxification program. Constitutional homeopathic treatment, if properly prescribed, can sometimes help resolve psoriasis.

Allopathic Treatment

Age, general health, lifestyle, and the severity and location of symptoms influence the type of treatment used to reduce inflammation and decrease the rate at which new skin cells are produced. Because the course of this disease varies with each individual, doctors must experiment with or combine different treatments to find the most effective therapy for a particular patient.

Mild–moderate Psoriasis

Steroid creams and ointments are commonly used to treat mild or moderate psoriasis, and steroids are sometimes injected into the skin of patients with a limited number of lesions. In mid-1997, the United States Food and Drug Administration (FDA) approved the use of tazarotene (Tazorac) to treat mild-to-moderate plaque psoriasis. This water-based gel has chemical properties similar to Vitamin A.

Brief daily doses of natural sunlight can significantly relieve symptoms. Sunburn, however, has the opposite effect.

Certain moisturizers and bath oils can loosen scales, soften skin, and may eliminate the itch. (Often petroleum-based, coal tar-based, or other greasy ointments are used.) Adding a cup of oatmeal to a tub of bath water or using Aveeno in the bath can soothe the itch. Dilute, topical salicylic acid (an ingredient in aspirin) can be used to remove dead skin or increase the effectiveness of other therapies.

Moderate Psoriasis

Administered under medical supervision, ultraviolet light B (UVB) is used to control psoriasis that covers many areas of the body or that has not responded to other treatment. Doctors combine UVB treatments with topical medications to treat some patients and sometimes prescribe home phototherapy, in which the patient administers his own UVB treatments.

Photochemotherapy (PUVA) is a medically super-vised procedure that combines medication with exposure to ultraviolet light (UVA) to treat localized or widespread psoriasis. An individual with wide-spread psoriasis that has not responded to treatment may enroll in one of the day treatment programs conducted at special facilities throughout the United States. Psoriasis patients who participate in these intensive sessions are exposed to UVB and given other treatments for six to eight hours a day for two to four weeks.

A newer form of treatment that has several advantages over standard phototherapy is therapy with an excimer laser system. Laser treatment for psoriasis uses a carefully focused beam of ultraviolet light that not only relieves symptoms quickly but also minimizes exposure of healthy skin to the ultraviolet rays.

Severe Psoriasis

Methotrexate (MTX) can be given as a pill or as an injection to alleviate symptoms of severe psoriasis or psoriatic arthritis. Patients who take MTX must be carefully monitored by a doctor who checks blood liver enzymes to prevent liver damage.

Psoriatic arthritis can also be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), like acetaminophen (Tylenol) or aspirin. Hot compresses and warm water soaks may also provide some relief for painful joints.

Other medications used to treat severe psoriasis include etrentinate (Tegison) and isotretinoin (Accutane), whose chemical properties are similar to those of Vitamin A. Most effective in treating pustular or erythrodermic psoriasis, Tegison also relieves some symptoms of plaque psoriasis. Tegison can enhance the effectiveness of UVB or PUVA treatments and reduce the amount of exposure necessary.

Accutane is a less effective psoriasis treatment than Tegison, but can cause many of the same side effects, including nosebleeds, inflammation of the eyes and lips, bone spurs, hair loss, and birth defects. Tegison is stored in the body for an unknown length of time, and should not be taken by a woman who is pregnant or planning to become pregnant. A woman should use reliable birth control while taking Accutane and for at least one month before and after her course of treatment.

Cyclosporin emulsion (Neoral) is used to treat stubborn cases of severe psoriasis. Cyclosporin is also used to prevent rejection of transplanted organs, and Neoral, approved by the FDA in 1997, should be particularly beneficial to psoriasis patients who are young children or African Americans, or those who have diabetes. The drawback to use of cyclosporin, however, is that it has been implicated in an increased risk of skin cancer for psoriasis patients. Researchers in Boston reported toward the end of 2001 that psoriasis patients who had been given cyclosporin as part of their treatment developed three times as many squamous cell cancers as those who had not. Patients who had taken cyclosporin for longer than three months were four times as likely to develop skin cancers.

A promising new medication for psoriasis that is in the clinical testing stage as of early 2002 is a drug called Alefacept. Alefacept targets the T-cells that cause psoriasis without suppressing the patient's immune system. The new drug not only relieves the symptoms of psoriasis more rapidly than current treatments, but patients also remain symptom-free longer.

Other conventional treatments for psoriasis include:

• Capsaicin (Capsicum frutecens), an ointment that can stop production of the chemical that causes the skin to become inflamed and halts the runaway production of new skin cells. Capsaicin is available without a prescription, but should be used under a doctor's supervision to prevent burns and skin damage.
• Hydrocortisone creams, topical ointments containing a form of vitamin D called calcitriol, and coal-tar shampoos and ointments can relieve symptoms but may cause such side effects as folliculitis (inflammation of hair follicles) and heightened risk of skin cancer.

Expected Results

Most cases of psoriasis can be managed. However, some people who have psoriasis are so self-conscious and embarrassed about their appearance that they become depressed and withdrawn. The Social Security Administration grants disability benefits to about 400 psoriasis patients each year.

Prevention

A doctor should be notified if:

• Psoriasis symptoms appear or reappear after treatment.
• Pustules erupt on the skin and the patient experiences fatigue, muscle aches, and fever.
• Unfamiliar, unexplained symptoms appear.

Resources

Books

Gottlieb, Bill, ed. New Choices in Natural Healing. Emmaus, PA: Rodale Press, Inc., 1995.

The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life, Inc., 1995.

Periodicals

Elder, James T., Rajan P. Nair, Tilo Henseler, et al. "The Genetics of Psoriasis 2001: The Odyssey Continues." Archives of Dermatology 137 (November 2001): 1447-1454.

Franz, Rachel. "Trials Show Positive Results for New Psoriasis Treatment." Dermatology Nursing 13 (December 2001): 445.

"Psoriasis Patients at Increased Risk of Skin Cancer." Cancer Weekly (October 16, 2001): 4.

"Revolutionary New Laser Treatment Reaches Patients." Medical Devices & Surgical Technology Week (October 21, 2001): 30.

Zoler, Mitchel L. "Psoriasis Generally Mild in African Americans." Skin & Allergy News 32 (October 2001): 33.

Organizations

American Academy of Dermatology. P.O. Box 681069, Schaumburg, IL 60618-4014. (703) 330-0230. .

American Skin Association, Inc. 150 E. 58th Street, 3rd floor, New York, NY 10155-0002. (212) 688-6547.

National Psoriasis Foundation. 6600 S.W. 92nd Avenue, Suite 300, Portland, OR 97223. (800) 723-9166. .

[Article by: Maureen Haggerty; Rebecca J. Frey, PhD]

Definition

Named for the Greek word psōra meaning itch, psoriasis is a chronic, non-contagious disease characterized by inflamed lesions covered with silvery-white scabs of dead skin.

Description

Normal skin cells mature and replace dead skin every 28 to 30 days. In psoriasis, the immune system triggers the immune system to make T cells, a type of white blood cell, that cause skin cells to mature in two to three days. Because the body cannot shed old skin as rapidly as the new cells appear, raised patches of dead skin form on the body.

Psoriasis is considered mild if it affects less than 5 percent of the surface of the body; moderate, if 5 to 30 percent of the skin is involved, and severe, if the disease affects more than 30 percent of the body surface.

There is no cure for psoriasis. The disease is managed through treatment. Psoriasis can seriously impact children's lives when the hands and feet are affected so the children cannot take notes or walk or play, or when the disease becomes so widespread that the immune system becomes compromised. Children also experience low self-esteem and depression because of the disfiguring aspects of the disease.

Types of Psoriasis

Dermatologists distinguish different forms of psoriasis according to what part of the body is affected, how severe symptoms are, how long they last, and the pattern formed by the scales. Though children usually have only one form of the disease, some do experience two more types of psoriasis throughout their lifetimes.

PLAQUE PSORIASIS. Plaque psoriasis (psoriasis vulgaris), the most common form of the disease, is characterized by small, red bumps that enlarge, become inflamed, and form scales. The top scales flake off easily and often, but those beneath the surface of the skin clump together. Removing these scales exposes tender skin, which bleeds and causes the plaques (inflamed patches of skin) to grow.

Plaque psoriasis can develop on any part of the body, but most often occurs on the elbows, knees, scalp, and trunk. Patches of psoriasis are found in the scalp for nearly half of all psoriasis sufferers.

GUTTATE PSORIASIS. Named for the Latin word gutta, which means "a drop," guttate psoriasis is characterized by small, red, drop-like dots that enlarge rapidly and may be somewhat scaly. Often found on the arms, legs, trunk, scalp, and sometimes in the diaper area, guttate psoriasis can clear up without treatment or disappear and resurface in the form of plaque psoriasis.

Guttate psoriasis is the most common form of psoriasis in children. It usually first appears in children around four or five years old after a streptococcal infection.

PUSTULAR PSORIASIS. Pustular psoriasis usually occurs in adults but can occur in children and adolescents. It is characterized by blister-like lesions filled with non-infectious pus and surrounded by reddened skin. Pustular psoriasis, which can be limited to one part of the body or can be widespread, may be the first symptom of psoriasis or develop in a patient with chronic plaque psoriasis.

Generalized pustular psoriasis is also known as Von Zumbusch pustular psoriasis. Widespread, acutely painful patches of inflamed skin develop suddenly. Pustules appear within a few hours, then dry, and peel within two days. It can make life-threatening demands on the heart and kidneys.

Palomar-plantar pustulosis (PPP) generally appears between the ages of 20 and 60.

INVERSE PSORIASIS. Inverse psoriasis occurs in the armpits and groin, under the breasts, and in other areas where skin flexes or folds. This disease is characterized by smooth, inflamed lesions and can be debilitating.

ERYTHRODERMIC PSORIASIS. Characterized by severe scaling, itching, and pain that affects most of the body, erythrodermic psoriasis disrupts the body's chemical balance and can cause severe illness or even death when the body's immune system becomes compromised. Erythrodermic psoriasis interferes with the body's ability to control temperature and prevent infections. This particularly inflammatory form of psoriasis can be the first sign of the disease but often develops in patients with a history of plaque psoriasis.

PSORIATIC ARTHRITIS. About 10 percent of patients with psoriasis develop a complication called psoriatic arthritis. This type of arthritis can be slow to develop and mild, or it can develop rapidly. Symptoms of psoriatic arthritis include:

• joint discomfort, swelling, stiffness, or throbbing
• swelling in the toes and ankles
• pain in the digits, lower back, wrists, knees, and ankles
• eye inflammation or pink eye (conjunctivitis)

Children who have psoriatic arthritis also have nail deformations, usually pitting of the fingernails or toenails. Size, shape, and depth of the marks vary, and affected nails may thicken, yellow, or crumble. The skin around an affected nail is sometimes inflamed, and the nail may peel away from the nail bed.

Demographics

Psoriasis affects 4.5 million Americans and is slightly more common in women than in men. Although the disease can develop at any time, a third of all cases occur in childhood with 10 to 15 percent of them being diagnosed in children under ten. It appears between the ages of 15 and 35. It is rare in infants but does occur. Nearly 20,000 U.S. children are diagnosed with psoriasis every year. Psoriasis affects people of all ethnicities, but fair-skinned individuals have a slightly higher incidence.

About 1.5 million Americans have moderate to severe psoriasis. Of them, 75 percent report that their disease has a serious impact on their daily lives. One-third report sleeping problems, disruptions with their normal routine, and negative self-image because of the disease.

In adults, psoriasis can be serious enough that four hundred people are granted disability by the Social Security Administration each year, and having psoriasis disqualifies individuals from serving in the military. Annually, three hundred and fifty people die annually from psoriasis or complications of treatment.

Nearly one million people in the United States have psoriatic arthritis. Though psoriatic arthritis usually develops between the age of 30 and 50, it does occur in children. About 10 to 30 percent of psoriasis patients have psoriatic arthritis, but the condition can occur before the characteristic scaly lesions occur.

Having one parent with psoriasis increases a child's risk of developing the disease to 20 to 25 percent. If both parents have psoriasis, the risk is doubled.

Patients with psoriasis make 2.4 million visits to dermatologists each year, with costs exceeding $3 million annually.

Causes and Symptoms

Causes

The cause of psoriasis is, as of 2004, unknown, but research suggests that it is genetic and is related to the immune-system. Having both parents with the disease increases a child's risk by 50 percent.

Psoriasis is usually cyclical, with episodes flaring up for weeks or months throughout the child's life and then receding. Certain factors, however, do seem to trigger bouts of the disease. Injury to the skin seems to precipitate many episodes of plaque psoriasis, usually within seven to ten days. This is called the Koebner reaction. Streptococcal infections are associated with guttate psoriasis and some plaque psoriasis cases. Both trauma and certain bacteria may also trigger psoriatic arthritis.

Environmental factors are also implicated in reoccurrence of psoriasis. Exposure to cold temperatures can trigger episodes of the disease. Though sunlight is usually beneficial to most patients, for a few children, too much sun can cause a flare up or worsen the condition.

Some drugs have been found to aggravate psoriasis. Antimalarial drugs, beta-blockers used to treat high blood pressure, and lithium, a drug used to treat depression and bi-polar disorder, can make episodes worse in some individuals. Non-steroid anti-inflammatory (NSAID) drugs, such as ibuprofen or naproxen used to manage pain and inflammation can also aggravate psoriasis.

During puberty, adolescents report more frequent flare ups and more severe ones. The hormonal changes within their bodies seem to trigger the immune system.

Stress is also a factor in increased frequency of psoriatic episodes. Because stress pumps large amounts of adrenalin, a hormone, into the body, the immune system is overstimulated and reacts by triggering flare ups of the disease.

Symptoms

The most common symptoms of psoriasis are skin rashes or red patches covered with white scales that may itch or burn. In plaque psoriasis, the skin may crack and bleed and is susceptible to infection. When the scales are removed, the skin underneath is deep red and shiny and may bleed. Psoriasis on the scalp is distinguished from seborrheic dermatitis, or dandruff, because the scales of psoriasis are dry, not greasy. There may be a red drop-like rash (guttate psoriasis) or patches of scaly skin that crack and ooze pus (pustular psoriasis).

In young children, the scaly patches in plaque psoriasis do not appear as thick or as scaly as those of adults. Psoriasis appears often in the diaper area and affects the face more in children than adolescents or adults.

When to Call the Doctor

Many children routinely see their doctors to supervise their regime of treatment for psoriasis flare ups. Others only see their doctors at the first sign of a recurrence of the disease. There are circumstances, however, when the doctor should be notified. If a treatment does not seem to be working, episodes worsen with treatment, or the child experiences a serious side effect to medications give, the doctor should be consulted to discuss alternative treatment. If there are signs of infections, such as red streaks on the skin or pus, or if there is fever or increased pain, the doctor should be called immediately.

Diagnosis

A complete medical history and examination of the skin, nails, and scalp are the basis for a diagnosis of psoriasis. In some cases, a microscopic examination of skin cells is also performed.

Blood tests can distinguish psoriatic arthritis from other types of arthritis. Rheumatoid arthritis, in particular, is diagnosed by the presence of a particular antibody present in the blood. That antibody is not present in the blood of patients with psoriatic arthritis.

Treatment

Age, general health, lifestyle, and the severity and location of symptoms influence the type of treatment used to reduce inflammation and decrease the rate at which new skin cells are produced. Because the course of this disease varies with each individual, doctors must experiment with or combine different treatments to find the most effective therapy for a particular patient.

Treating children with this disease with drugs is problematic. Though treatment regimes have been developed that are effective on adults, research has not been conducted sufficiently on children, except in the area of psoriatic arthritis. Treatment in children is usually not aggressive because of their small, developing bodies. Long-term use can produce toxicity so potent drugs, such as methotrexate (MTX) and cyclosporine, are not used with children. Although MTX is sometimes used in extreme cases for brief amounts of time. Topical steriods are also not used on children because their bodies can absorb the steriods in the medication.

Mild Psoriasis

Typically, steroid creams and ointments are commonly used to treat mild or moderate psoriasis in adults. These topical ointments are not generally used with children for mild psoriasis. However, new creams that are used in treating eczema appear to be effective in treating psoriasis as well and do not appear to have long-term problems. In addition, tazarotene (Tazorac), a drug approved by the United States Food and Drug Administration (FDA) in 1997, is proving to be effective for mild-to-moderate plaque psoriasis. This water-based gel has chemical properties similar to vitamin A.

A more subdued approach is undertaken with children who have less severe psoriasis. Brief daily doses of natural sunlight can significantly relieve most symptoms. Sunburn, however, has the opposite effect.

Moisturizers and bath oils are used to loosen scales, soften skin, and eliminate the itch. Adding a cup of oatmeal to a tub of bath water is also helpful. Salicylic acid (an ingredient in aspirin) can be used to remove dead skin or increase the effectiveness of other therapies.

Moderate Psoriasis

Administered under medical supervision, ultraviolet light B (UVB) is used to control psoriasis that covers many areas of the body or that has not responded to topical preparations. Doctors combine UVB treatments with topical medications to treat some patients and sometimes prescribe home phototherapy, in which the parent administers the UVB treatments.

Tanning beds use ultraviolet A and produce a more intense experience. Adolescents should avoid tanning salons and should sunbathe but without tanning. Any sun exposure or UVB treatment should be coordinated with a dermatologist.

Severe Psoriasis

Methotrexate (MTX), given as a pill or as an injection, is sometimes used in extreme cases to alleviate symptoms of severe psoriasis or psoriatic arthritis. Patients who take MTX must be carefully monitored to prevent liver damage.

Enbrel is another drug dermatologists prescribe for children. It appears to be very safe when used for long periods of time.

A new self-injected medication called efalizumab (Raptiva) has the potential to be effective for severe cases of psoriasis. Since it is suppresses the immune system, its use with children or over the long-term is cautioned because it can increase the risk of infection.

Psoriatic arthritis can also be treated with NSAIDs, such as acetaminophen (Tylenol) or aspirin. Hot compresses and warm water soaks may also provide some relief for painful joints.

Photochemotherapy (PUVA) is a medically supervised procedure that combines medication with exposure to ultraviolet light (UVA) to treat localized or widespread psoriasis. An individual with widespread psoriasis that has not responded to treatment may enroll in one of the day treatment programs conducted at special facilities throughout the United States. Psoriasis patients who participate in these intensive sessions are exposed to UVA and given other treatments for six to eight hours a day for two to four weeks.

Alternative Treatment

Non-traditional psoriasis treatments include:

• soaking in warm water and German chamomile (Matricaria recutita) or bathing in warm salt water
• drinking as many as three cups a day of hot tea made with one or a combination of the following herbs: burdock (Arctium lappa) root, dandelion (Taraxacum mongolicum) root, Oregon grape (Mahonia aquifolium), sarsaparilla (Smilax officinalis), and balsam pear (Momardica charantia)
• taking two 500-mg capsules of evening primrose (Oenothera biennis) oil a day (Pregnant women should not use evening primrose oil, and patients with liver disease or high cholesterol should use it only under a doctors supervision.)
• eating a diet that includes plenty of fish, turkey, celery (for cleansing the kidneys), parsley, lettuce, lemons (for cleansing the liver), limes, fiber, and fruit and vegetable juices
• eating a diet that eliminates animal products high in saturated fats, since they promote inflammation
• drinking plenty of water (at least eight glasses) each day
• taking nutritional supplements including folic acid, lecithin, vitamin A, vitamin E, selenium, and zinc
• regularly imagining clear, healthy skin

Other helpful alternative approaches include identifying and eliminating food allergens from the diet, enhancing the function of the liver, augmenting the hydrochloric acid in the stomach, and completing a detoxification program. Constitutional homeopathic treatment, if properly prescribed, can also help resolve psoriasis.

Prognosis

Most cases of psoriasis can be controlled, and most people who have psoriasis can live normal lives. However, some people who have psoriasis are so self-conscious and embarrassed about their appearance that they become depressed and withdrawn. Others may become disabled because of psoriatic arthritis or because their psoriasis affects their hands and feet so that they cannot walk or handle objects.

Prevention

Psoriasis cannot be prevented. However, recurrences can be avoided or minimized by maintaining a healthy lifestyle by getting plenty of sleep, eating a balanced diet, participating in regular exercise, and minimizing stress. Avoiding overexposure to cold temperatures, sunburn, and skin irritants, such as drying soaps and lotions, can also minimize flare-ups. Not smoking or drinking alcohol can also prevent or minimize some episodes.

Parental Concerns

Children living with psoriasis often find the disease overwhelming. It is an emotionally charged disease that can have a child feeling anger one minute and deep depression the next. Because the disfigurement of their skin, though often temporary, is sometimes quite pronounced, children will turn inward, avoiding contact with friends or relatives. School can be particularly traumatizing due to teasing by other children. Teenagers, who already feel awkward and ugly, may feel worse during flare-ups of the disease. Complicating this already emotional situation is the discouragement of treatments that do not work as expected and the uncertainty of finding something that will work.

Parents can help their children by providing education about the psoriasis. This is the first step in managing the disease and feeling some control in their lives. Sometimes this education includes discussing the disease with the childs teachers or the parents of their friends so that these adults will understand more about the emotional state of the child.

Parents can listen to their children when they are able to talk about their feelings about the disease. Emphasizing their childrens strengths, especially when these children appear sad or depressed, and encouraging them to stay active and see their friends can help a child cope with the disease.

Sometimes, participating in a childrens psoriasis support group may be helpful. In addition, sending the child to a special camp for school age children with childhood skin diseases can help them learn tools for coping with the disease as well as establish a support system.

Children can often feel shame as well as guilt, thinking that they have somehow brought on the disease. Coupled with anger and resentment, these powerful emotions can contribute to stress, which can trigger the recurrence of the disease. Stress reduction techniques, such as exercise, yoga, and meditation, are also helpful.

Parents should be available to their child and offer as much tangible and emotional support they can. However, they should not encourage the child to become too dependent on the parent or others. Parents can also help children find creative solutions to deal with teasing, camouflage their lesions, and educate their peers about the disease. One of the most important lessons parents can teach their child, who is living with psoriasis, is not to be embarrassed because of the disease. Psoriasis can be treated matter-of-factly as people do diabetes, another chronic disorder.

See also Depressive disorders; Itching; Self-esteem.

Resources

Books

Cram, David L. Coping with Psoriasis: A Patients Guide toTreatment. Omaha, NB: Addicus Books, 2000.

Scott, Jerry G. Psoriasis: The Real Way Out: A Self-EducationGuide to Complete Natural Healing. Kenora, Ont.: Psoriasis Connection International, 2003.

Periodicals

"Generic Name: Efalizumab Injection." Drug Topics 148 (January 26, 2004): HSE21.

Harrar, Sari. "New, Inject-it-yourself." Prevention 56 (2004): 48.

Organizations

American Academy of Dermatology. 930 N. Meacham Road, PO Box 4014, Schaumburg, IL 601684014. Web site: www.aad.org.

American Skin Association Inc. 150 E. 58th St., 3rd floor, New York, NY 101550002. Web site: www.americanskin.org.

National Psoriasis Foundation. 6600 SW 92nd Ave., Suite 300, Portland, OR 97223. Web site: www.psoriasis.org.

Web Sites

"Juvenile Psoriatic Arthritis." Arthritis Foundation, 2004. Available online at www.arthritis.org/conditions/diseasecenter/juvenilepsoriaticarthritis.asp(accessed December 11, 2004).

[Article by: Janie Franz Maureen Haggerty]

For more information on psoriasis, visit Britannica.com.

A usually chronic, recurrent skin disease in humans marked by discrete macules, papules or patches covered with lamellated silvery scales resulting from an increased turnover of epidermal cells. The cause is multifactorial and poorly understood. There is no equivalent disease in animals.

Tutor's tip: This was the final winning word in the 1982 National Spelling Bee.

Psoriasis
Classification and external resources
A person whose back and arms are affected by psoriasis
ICD-10	L40.
ICD-9	696
OMIM	177900
DiseasesDB	10895
MedlinePlus	000434
eMedicine	emerg/489  Dermatology:derm/365 plaque derm/361 guttate derm/363 nails derm/366 pustular Arthritis derm/918 Radiology radio/578 Physical Medicine pmr/120
MeSH	D011565

Psoriasis (pronounced /səˈraɪəsɪs/) is a chronic, non-contagious autoimmune disease which affects the skin and joints. It commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis, called psoriatic plaques, are areas of inflammation and excessive skin production. Skin rapidly accumulates at these sites and takes on a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area including the scalp and genitals. In contrast to eczema, psoriasis is more likely to be found on the extensor aspect of the joint.

The disorder is a chronic recurring condition which varies in severity from minor localized patches to complete body coverage. Fingernails and toenails are frequently affected (psoriatic nail dystrophy) and can be seen as an isolated finding. Psoriasis can also cause inflammation of the joints, which is known as psoriatic arthritis. Ten to fifteen percent of people with psoriasis have psoriatic arthritis.

The cause of psoriasis is not known, but it is believed to have a genetic component. Factors that may aggravate psoriasis include stress, withdrawal of systemic corticosteroid, excessive alcohol consumption, and smoking.^[1] There are many treatments available, but because of its chronic recurrent nature psoriasis is a challenge to treat.

Contents 1 History 2 Types 3 Clinical classification 4 Diagnosis 5 Severity 6 Effect on the quality of life 7 Epidemiology 8 Cause 9 Treatment 10 Cognitive behaviour therapy 11 Topical treatment 12 Phototherapy 13 Photochemotherapy 14 Systemic treatment 15 Alternative therapy 16 Historical treatment 17 Future drug development 18 Prognosis 19 "The heartbreak of psoriasis" 20 See also 21 References 22 External links 22.1 Research and non-commercial 22.2 Books

History

Psoriasis is probably one of the longest known illnesses of humans and simultaneously one of the most misunderstood. Some scholars believe psoriasis to have been included among the skin conditions called tzaraat in the Bible.^[2] In more recent times psoriasis was frequently described as a variety of leprosy. The Greeks used the term lepra (λεπρα) for scaly skin conditions. They used the term psora to describe itchy skin conditions. It became known as Willan's lepra in the late 18th century when English dermatologists Robert Willan and Thomas Bateman differentiated it from other skin diseases. They assigned names to the condition based on the appearance of lesions. Willan identified two categories: leprosa graecorum and psora leprosa.

While it may have been visually, and later semantically, confused with leprosy, it was not until 1841 that the condition was finally given the name psoriasis by the Viennese dermatologist Ferdinand von Hebra. The name is derived from the Greek word psora which means to itch.^[3]

It was during the 20th century that psoriasis was further differentiated into specific types.

Types

An arm covered with plaque psoriasis

The symptoms of psoriasis can manifest in a variety of forms. Variants include plaque, pustular, guttate and flexural psoriasis. This section describes each type (with ICD-10 code [5]).^[4]

Plaque psoriasis (psoriasis vulgaris) (L40.0) is the most common form of psoriasis. It affects 80 to 90% of people with psoriasis. Plaque psoriasis typically appears as raised areas of inflamed skin covered with silvery white scaly skin. These areas are called plaques.

Flexural psoriasis (inverse psoriasis) (L40.83-4) appears as smooth inflamed patches of skin. It occurs in skin folds, particularly around the genitals (between the thigh and groin), the armpits, under an overweight stomach (pannus), and under the breasts (inframammary fold). It is aggravated by friction and sweat, and is vulnerable to fungal infections.

Guttate psoriasis (L40.4) is characterized by numerous small round spots (differential diagnosis—pityriasis rosea—oval shape lesion). These numerous spots of psoriasis appear over large areas of the body, such as the trunk, limbs, and scalp. Guttate psoriasis is associated with streptococcal throat infection.

Pustular psoriasis (L40.1-3, L40.82) appears as raised bumps that are filled with non-infectious pus (pustules). The skin under and surrounding the pustules is red and tender. Pustular psoriasis can be localised, commonly to the hands and feet (palmoplantar pustulosis), or generalised with widespread patches occurring randomly on any part of the body.

Psoriasis of a fingernail

Nail psoriasis (L40.86) produces a variety of changes in the appearance of finger and toe nails. These changes include discolouring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail, and the loosening (onycholysis) and crumbling of the nail.

Psoriatic arthritis (L40.5) involves joint and connective tissue inflammation. Psoriatic arthritis can affect any joint but is most common in the joints of the fingers and toes. This can result in a sausage-shaped swelling of the fingers and toes known as dactylitis. Psoriatic arthritis can also affect the hips, knees and spine (spondylitis). About 10-15% of people who have psoriasis also have psoriatic arthritis.^{[citation needed]}

Erythrodermic psoriasis (L40.85) involves the widespread inflammation and exfoliation of the skin over most of the body surface. It may be accompanied by severe itching, swelling and pain. It is often the result of an exacerbation of unstable plaque psoriasis, particularly following the abrupt withdrawal of systemic treatment. This form of psoriasis can be fatal, as the extreme inflammation and exfoliation disrupt the body's ability to regulate temperature and for the skin to perform barrier functions.^[5]

Clinical classification

Psoriasis is a chronic relapsing disease of the skin, which may be classified into nonpustular and pustular types as follows^[6]:414:

• Nonpustular psoriasis
  • Psoriasis vulgaris (Chronic stationary psoriasis, Plaque-like psoriasis)
  • Psoriatic erythroderma (Erythrodermic psoriasis)
• Pustular psoriasis
  • Generalized pustular psoriasis (Pustular psoriasis of von Zumbusch)
  • Pustulosis palmaris et plantaris (Persistent palmoplantar pustulosis, Pustular psoriasis of the Barber type, Pustular psoriasis of the extremities)
  • Annular pustular psoriasis
  • Acrodermatitis continua
  • Impetigo herpetiformis

Additional types of psoriasis include^[7]:191-197:

• Drug-induced psoriasis
• Inverse psoriasis
• Napkin psoriasis
• Seborrheic-like psoriasis

Diagnosis

A diagnosis of psoriasis is usually based on the appearance of the skin. There are no special blood tests or diagnostic procedures for psoriasis. Sometimes a skin biopsy, or scraping, may be needed to rule out other disorders and to confirm the diagnosis. Skin from a biopsy will show clubbed Rete pegs if positive for psoriasis. Another sign of psoriasis is that when the plaques are scraped, one can see pinpoint bleeding from the skin below (Auspitz's sign).

Pie chart showing the distribution of severity among people with psoriasis.

Severity

Psoriasis is usually graded as mild (affecting less than 3% of the body), moderate (affecting 3-10% of the body) or severe.^{[citation needed]} Several scales exist for measuring the severity of psoriasis. The degree of severity is generally based on the following factors: the proportion of body surface area affected; disease activity (degree of plaque redness, thickness and scaling); response to previous therapies; and the impact of the disease on the person.

The Psoriasis Area Severity Index (PASI) is the most widely used measurement tool for psoriasis. PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease).^[8] Nevertheless, the PASI can be too unwieldy to use outside of trials, which has led to attempts to simplify the index for clinical use.^[9]

Effect on the quality of life

This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (October 2008)

Psoriasis has been shown to affect health-related quality of life to an extent similar to the effects of other chronic diseases such as depression, myocardial infarction, hypertension, congestive heart failure or type 2 diabetes. Depending on the severity and location of outbreaks, individuals may experience significant physical discomfort and some disability. Itching and pain can interfere with basic functions, such as self-care, walking, and sleep. Plaques on hands and feet can prevent individuals from working at certain occupations, playing some sports, and caring for family members or a home. Plaques on the scalp can be particularly embarrassing as flaky plaque in the hair can be mistaken for dandruff. Medical care can be costly and time-consuming and can interfere with an employment or school schedule.

Individuals with psoriasis may also feel self-conscious about their appearance and have a poor self-image that stems from fear of public rejection and psychosexual concerns. Psychological distress can lead to significant depression and social isolation.

In a 2008 National Psoriasis Foundation survey of 426 psoriasis sufferers, 71 percent reported that the disease was a significant problem in everyday life. More than half reported significant feelings of self-consciousness (63 percent) and embarrassment (58 percent). More than one-third said they avoided social activities and limited dating or intimate interactions.^[10]

Epidemiology

Psoriasis affects both sexes equally and can occur at any age, although it most commonly appears for the first time between the ages of 15 and 25 years.

The prevalence of psoriasis in Western populations is estimated to be around 2-3%. The prevalence of psoriasis among 7.5 million patients who were registered with a general practitioner in the United Kingdom was 1.5%.^[11] A survey^[12] conducted by the National Psoriasis Foundation (a US based psoriasis education and advocacy group) found a prevalence of 2.1% among adult Americans. The study found that 35% of people with psoriasis could be classified as having moderate to severe psoriasis.

Around one-third of people with psoriasis report a family history of the disease, and researchers have identified genetic loci associated with the condition. Studies of monozygotic twins suggest a 70% chance of a twin developing psoriasis if the other twin has psoriasis. The concordance is around 20% for dizygotic twins. These findings suggest both a genetic predisposition and an environmental response in developing psoriasis.^[13]

Onset before age 40 usually indicates a greater genetic susceptibility and a more severe or recurrent course of psoriasis.

Cause

The cause of psoriasis is not fully understood. There are two main hypotheses about the process that occurs in the development of the disease. The first considers psoriasis as primarily a disorder of excessive growth and reproduction of skin cells. The problem is simply seen as a fault of the epidermis and its keratinocytes. The second hypothesis sees the disease as being an immune-mediated disorder in which the excessive reproduction of skin cells is secondary to factors produced by the immune system. T cells (which normally help protect the body against infection) become active, migrate to the dermis and trigger the release of cytokines (tumor necrosis factor-alpha TNFα, in particular) which cause inflammation and the rapid production of skin cells. It is not known what initiates the activation of the T cells.

The immune-mediated model of psoriasis has been supported by the observation that immunosuppressant medications can clear psoriasis plaques. However, the role of the immune system is not fully understood, and it has recently been reported that an animal model of psoriasis can be triggered in mice lacking T cells.^[14] Animal models, however, reveal only a few aspects resembling human psoriasis.

Compromised skin barrier function has a role in psoriasis susceptibility.^[15]

Psoriasis is a fairly idiosyncratic disease. The majority of people's experience of psoriasis is one in which it may worsen or improve for no apparent reason. Studies of the factors associated with psoriasis tend to be based on small (usually hospital based) samples of individuals. These studies tend to suffer from representative issues, and an inability to tease out causal associations in the face of other (possibly unknown) intervening factors. Conflicting findings are often reported. Nevertheless, the first outbreak is sometimes reported following stress (physical and mental), skin injury, and streptococcal infection. Conditions that have been reported as accompanying a worsening of the disease include infections, stress, and changes in season and climate. Certain medicines, including lithium salt and beta blockers, have been reported to trigger or aggravate the disease. Excessive alcohol consumption, smoking and obesity may exacerbate psoriasis or make the management of the condition difficult.^[16][17]

Individuals suffering from the advanced effects of the Human immunodeficiency virus, or HIV, often exhibit psoriasis.^[18] This presents a paradox to researchers as traditional therapies that reduce T-cell counts generally cause psoriasis to improve. Yet, as CD4-T-cell counts decrease with the progression of HIV, psoriasis worsens.^[19] In addition, HIV is typically characterized by a strong Th2 cytokine profile, whereas psoriasis vulgaris is characterized by a strong Th1 secretion pattern.^[20] It's hypothesized that the diminished CD4-T-Cell presence causes an over-activation of CD8-T-Cells, which are responsible for the exacerbation of psoriasis in HIV positive patients. It is important to remember that most individuals with psoriasis are otherwise healthy and the presence of HIV accounts for less than 1% of cases. The prevalence of psoriasis in the HIV positive population ranges from 1 to 6 percent, which is about 3 times higher than the normal population.^[21]

Schematic of psoriasis treatment ladder

Psoriasis occurs more likely in dry skin than oily or well-moisturized skin, and specifically after an external skin injury such as a scratch or cut. This is believed to be caused by an infection, in which the infecting organism thrives under dry skin conditions with minimal skin oil, which otherwise protects skin from infections. The case for psoriasis is opposite to the case of athlete's foot, which occurs because of a fungus infection under wet conditions as opposed to dry in psoriasis. This infection induces inflammation, which causes the symptoms commonly associated with psoriasis, such as itching and rapid skin turnover, and leads to drier skin as the infecting organism absorbs the moisture that would otherwise go to the skin. To prevent dry skin and reduce psoriasis symptoms, it is advised to not use shower scrubs, as they not only damage skin by leaving tiny scratches, they also scrape off the naturally occurring skin oil. It is recommended to use talc powder after washing as that helps absorb excess moisture which would otherwise go to the infecting agent. Additionally, moisturizers can be applied to moisturize the skin, and lotions used to promote skin oil gland functions.^{[citation needed]}

Treatment

There can be substantial variation between individuals in the effectiveness of specific psoriasis treatments. Because of this, dermatologists often use a trial-and-error approach to finding the most appropriate treatment for their patient. The decision to employ a particular treatment is based on the type of psoriasis, its location, extent and severity. The patient’s age, sex, quality of life, comorbidities, and attitude toward risks associated with the treatment are also taken into consideration.

In 2008, the FDA approved three new treatment options^[22] available to psoriasis patients: 1) Taclonex Scalp, a new topical ointment for treating scalp psoriasis; 2) the Xtrac Velocity excimer laser system, which emits a high-intensity beam of ultraviolet light, can treat moderate to severe psoriasis; and 3) the biologic drug adalimumab (brand name Humira) was also approved to treat moderate to severe psoriasis. Adalimumab had already been approved to treat psoriatic arthritis.

Medications with the least potential for adverse reactions are preferentially employed. If the treatment goal is not achieved then therapies with greater potential toxicity may be used. Medications with significant toxicity are reserved for severe unresponsive psoriasis. This is called the psoriasis treatment ladder.^[23] As a first step, medicated ointments or creams, called topical treatments, are applied to the skin. If topical treatment fails to achieve the desired goal then the next step would be to expose the skin to ultraviolet (UV) radiation. This type of treatment is called phototherapy. The third step involves the use of medications which are taken internally by pill or injection. This approach is called systemic treatment.

Over time, psoriasis can become resistant to a specific therapy. Treatments may be periodically changed to prevent resistance developing (tachyphylaxis) and to reduce the chance of adverse reactions occurring. This is called treatment rotation.

Antibiotics are generally not indicated in routine treatment of psoriasis. However, antibiotics may be employed when an infection, such as that caused by the bacteria Streptococcus, triggers an outbreak of psoriasis, as in certain cases of guttate psoriasis.^{[citation needed]}

Cognitive behaviour therapy

A psychological symptom management programme has been reported as being a helpful adjunct to traditional therapies in the management of psoriasis.^[24]. In the UK The Psoriasis and Psoriatic Arthritis Alliance (PAPAA) a not-for-profit charity has funded research carried out by the University of Manchester, to develop a symptom management programme called Electronic Targeted Intervention for Psoriasis (eTIPs) using a modified Cognitive Behaviour Therapy model. This research follows research by Fortune D G et al. ^[25] on psychological stress, distress and disability in patients with psoriasis.

Topical treatment

Bath solutions and moisturizers help soothe affected skin and reduce the dryness which accompanies the build-up of skin on psoriatic plaques. Medicated creams and ointments applied directly to psoriatic plaques can help reduce inflammation, remove built-up scale, reduce skin turn over, and clear affected skin of plaques. Ointment and creams containing coal tar, dithranol (anthralin), corticosteroids like desoximetasone (Topicort), fluocinonide, vitamin D₃ analogues (for example, calcipotriol), and retinoids are routinely used. Argan oil has also been used with some promising results.^[26] The mechanism of action of each is probably different but they all help to normalise skin cell production and reduce inflammation. Activated vitamin D and its analogues are highly effective inhibitors of skin cell proliferation.

The disadvantages of topical agents are variably that they can often irritate normal skin, can be time consuming and awkward to apply, cannot be used for long periods, can stain clothing or have a strong odour. As a result, it is sometimes difficult for people to maintain the regular application of these medications. Abrupt withdrawal of some topical agents, particularly corticosteroids, can cause an aggressive recurrence of the condition. This is known as a rebound of the condition.

Some topical agents are used in conjunction with other therapies, especially phototherapy.

Phototherapy

It has long been recognized that daily, short, non-burning exposure to sunlight helped to clear or improve psoriasis. Niels Finsen was the first physician to investigate the therapeutic effects of sunlight scientifically and to use sunlight in clinical practice. This became known as phototherapy.

Sunlight contains many different wavelengths of light. It was during the early part of the 20th century that it was recognised that for psoriasis the therapeutic property of sunlight was due to the wavelengths classified as ultraviolet (UV) light.

Ultraviolet wavelengths are subdivided into UVA (380–315 nm) UVB (315–280 nm), and UVC (< 280 nm). Ultraviolet B (UVB) (315–280 nm) is absorbed by the epidermis and has a beneficial effect on psoriasis. There are two types of UVB lamps: Narrowband UVB (311 to 312 nm), and Wideband UVB (290-320 nm). UVB Wideband is more effective and it requires shorter exposure time, while UVB Narrowband does not include the spectrum of less than 300 nanometer, and thus considered safer. Exposure to UVB several times per week, over several weeks can help people attain a remission from psoriasis. Sometimes it is needed to continue the treatments once a week as maintenance, or the chronic disease will return.

In hospitals, ultraviolet light treatment is frequently combined with topical (coal tar, calcipotriol) or systemic treatment (Retinoids) as there is a synergy in their combination. The Ingram regime involves UVB and the application of anthralin paste. The Goeckerman regime combines coal tar ointment with UVB. Because coal tar includes unknown ingredients that might cause cancer, the use of coal tar was stopped.

Photochemotherapy

Psoralen and ultraviolet A phototherapy (PUVA) combines the oral or topical administration of psoralen with exposure to ultraviolet A (UVA) light. Precisely how PUVA works is not known. The mechanism of action probably involves activation of psoralen by UVA light which inhibits the abnormally rapid production of the cells in psoriatic skin. There are multiple mechanisms of action associated with PUVA, including effects on the skin immune system.

PUVA is associated with nausea, headache, fatigue, burning, and itching. Long-term treatment is associated with squamous cell carcinoma (not with melanoma).

Systemic treatment

Pictures of a patient with psoriasis (and psoriatic arthritis) at baseline and 8 weeks after initiation of infliximab therapy.

Psoriasis which is resistant to topical treatment and phototherapy is treated by medications that are taken internally by pill or injection. This is called systemic treatment. Patients undergoing systemic treatment are required to have regular blood and liver function tests because of the toxicity of the medication. Pregnancy must be avoided for the majority of these treatments. Most people experience a recurrence of psoriasis after systemic treatment is discontinued.

The three main traditional systemic treatments are methotrexate, cyclosporine and retinoids. Methotrexate and cyclosporine are immunosuppressant drugs; retinoids are synthetic forms of vitamin A.

Other additional drugs, not specifically licensed for psoriasis, have been found to be effective. These include the antimetabolite tioguanine, the cytotoxic agent hydroxyurea, sulfasalazine, the immunosuppressants mycophenolate mofetil, azathioprine and oral tacrolimus. These have all been used effectively to treat psoriasis when other treatments have failed. Although not licensed in many other countries fumaric acid esters have also been used to treat severe psoriasis in Germany for over 20 years.

Biologics are manufactured proteins that interrupt the immune process involved in psoriasis. Unlike generalised immunosuppressant therapies such as methotrexate, biologics focus on specific aspects of the immune function leading to psoriasis. These drugs (interleukin antagonists) are relatively new, and their long-term impact on immune function is unknown, but they have proven effective in treating psoriasis and psoriatic arthritis. They include Amevive, Enbrel, Humira, Remicade and Raptiva. Raptiva was withdrawn by its maker from the US market in April, 2009. Biologics are usually given by self-injection or in a doctor's office. They are very expensive and only suitable for very few patients with severe psoriasis. Ustekinumab (IL-12 and IL-23 blocker) shows hopeful results for psoriasis therapy.

In the United Kingdom in 2005 the British Association of Dermatologists (BAD) published guidelines for use of biological interventions in psoriasis ^[27] .A UK national register called the BAD Biological Register (BADBIR) has been setup to collect valuable information on side effects and benefits and will be used to inform doctors on how best to use biological agents and similar drugs.

Alternative therapy

Climatotherapy involves the notion that some diseases can be successfully treated by living in a particular climate. Several psoriasis clinics are located throughout the world based on this idea. The Dead Sea is one of the most popular locations for this type of treatment.

In Turkey, Croatia (Altermedica) & Ireland, doctor fish which live in the outdoor pools of spas, are encouraged to feed on the psoriatic skin of people with psoriasis. The fish only consume the affected areas of the skin. The outdoor location of the spa may also have a beneficial effect. This treatment can provide temporary relief of symptoms. A revisit to the spas every few months is often required. Treatment in this hot spring has been examined in two small clinical trials, with positive results.^[28][29]

Oregon-grape (Mahonia Aquifolium) is said to be effective in the treatment of eczema and psoriasis.^[30][31][32]

Historical treatment

The history of psoriasis is littered with treatments of dubious effectiveness and high toxicity. These treatments received brief popularity at particular time periods or within certain geographical regions. The application of cat faeces to red lesions on the skin, for example, was one of the earliest topical treatments employed in ancient Egypt. Onions, sea salt and urine, goose oil and semen, wasp droppings in sycamore milk, and soup made from vipers have all been reported as being ancient treatments.

In the more recent past Fowler's solution, which contains a poisonous and carcinogenic arsenic compound, was used by dermatologists as a treatment for psoriasis during the 18th and 19th centuries. Grenz rays (also called ultrasoft X-rays or Bucky rays) was a popular treatment of psoriasis during the middle of the 20th century. This type of therapy was superseded by ultraviolet therapy.

Undecylenic acid was investigated and used for psoriasis some 40 years ago(cir. 1950~).^[33]

All these treatments have fallen out of favour.

Sulphur was fashionable as a treatment for psoriasis in the Victorian and Edwardian eras. It has recently re-gained some credibility as a safe alternative to steroids and coal tar.

Future drug development

Historically, agents used to treat psoriasis were discovered by experimentation or by accident. In contrast, current novel therapeutic agents are designed from a better understanding of the immune processes involved in psoriasis and by the specific targeting of molecular mediators. Examples can be seen in the use of biologics which target T cells and TNF inhibitors.

It has been suggested that cannabis might treat psoriasis, due to the anti-inflammatory properties of its cannabinoids, and the regulatory effects of THC on the immune system.^[34] The adverse effects of cannabis might be overcome by use of more specific cannabinoid receptor medications,^[35] to inhibit keratinocyte proliferation.^[36]

Future innovation should see the creation of additional drugs that refine the targeting of immune-mediators further.^[37]

Research into antisense oligonucleotides carries the potential to provide novel therapeutic strategies for treating psoriasis.^[38]

ABT-874 is a human anti-IL-12 monoclonal antibody being developed by Abbott Laboratories in conjunction with Cambridge Antibody Technology for the treatment of multiple autoimmune diseases including psoriasis. Phase II trials have been completed and showed promising results.^[39] Abbott was planning to initiate Phase III trials in 2007.^[40]

In 2004, Tas and Avci ^[41] demonstrated cyclopamine’s clinical potential for the treatment of psoriasis and basal cell carcinoma in two preliminary proof of concept studies. By treating 31 psoriatic lesions in 7 patients, these authors asserted that topical cyclopamine was more effective in the clinical and histological clearance of guttate and plaque psoriasis than the topical steroid clobetasol-17 propionate.Furthermore, they demonstrated that concurrent application of cylopamine and clobetasol-17 propionate accelerated regression and clearance of selected lesions greater than cyclopamine alone with clearance times as early as 48 hours.They assert that cyclopamine inhibits the abnormal proliferation of epithelial cells, induces terminal differentiation, and is associated with the decreased presence of inflammatory cells, including CD41 lymphocytes.

On August 27, 2006, scientists led by Jeung-Hoon Lee created in the laboratory synthetic lipids called pseudoceramides which are involved in skin cell growth and could be used in treating skin diseases such as atopic dermatitis, a form of eczema characterized by red, flaky and very itchy skin; psoriasis, and glucocorticoid-induced epidermal atrophy, in which the skin shrinks due to skin cell loss.^[42]

On November 17, 2008, scientists led by Yin-Ku Lin of Chang Gung Memorial Hospital and Chang Gung University in Taoyuan, Taiwan, told Reuters by telephone that Indigo naturalis (Qing Dai, 青黛), a dark blue plant used in traditional Chinese medicine, appears to be effective in treating psoriasis. In the latest issue of Archives of Dermatology, they wrote, "The indigo naturalis ointment-treated lesions showed an 81 percent improvement, the (non-medicated) ointment-treated lesions showed a 26 percent improvement."^[43]

Talarozole amplifies the effects of retinoic acid by inhibiting its metabolism. As of February 2009^[update], it is undergoing clinical trials.^[44]

Prognosis

Psoriasis is a lifelong condition.^[45] There is currently no cure but various treatments can help to control the symptoms. Many of the most effective agents used to treat severe psoriasis carry an increased risk of significant morbidity including skin cancers, lymphoma and liver disease. However, the majority of people's experience of psoriasis is that of minor localized patches, particularly on the elbows and knees, which can be treated with topical medication. Psoriasis can get worse over time but it is not possible to predict who will go on to develop extensive psoriasis or those in whom the disease may appear to vanish. Individuals will often experience flares and remissions throughout their lives. Controlling the signs and symptoms typically requires lifelong therapy.

According to one study,^[46] psoriasis is linked to 2.5-fold increased risk for non melanoma skin cancer in men and women, with no preponderance of any specific histologic subtype of cancer. This increased risk could also be attributed to antipsoriatic treatment.

1964 Tegrin advertisement

"The heartbreak of psoriasis"

The phrase "the heartbreak of psoriasis" is often used both seriously and ironically to describe the emotional impact of the disease. It may include both the effect of having a chronic uncomfortable disorder and the social effects of being self conscious of one's appearance. The term can be found in various advertisements for topical and other treatments; conversely, it has been used to mock the tendency of advertisers to exaggerate (or even fabricate) aspects of a malady for financial gain. While many products today reference the phrase in their advertising, it originated in a 1960s advertising campaign for Tegrin, a coal tar-based ointment.

See also

• Psoriatic nails

References

1. ^ http://www.emedicine.com/derm/topic365.htm#section~clinical see causes
2. ^ Shai A, Vardy D, Zvulunov A (2002). "[Psoriasis, biblical afflictions and patients' dignity]" (in Hebrew). Harefuah 141 (5): 479–82, 496. PMID 12073533. 
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5. ^ "Erythrodermic psoriasis", New Zealand Dermatological Society
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10. ^ "Coping With Psoriasis" Parade.com
11. ^ Gelfand JM et al. (2005). "Prevalence and Treatment of Psoriasis in the United Kingdom". Arch. Dermatol. 141 (12): 1537–1541. doi:10.1001/archderm.141.12.1537. PMID 16365254. 
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13. ^ Krueger G, Ellis CN (2005). "Psoriasis--recent advances in understanding its pathogenesis and treatment". J. Am. Acad. Dermatol. 53 (1 Suppl 1): S94–100. doi:10.1016/j.jaad.2005.04.035. PMID 15968269. 
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15. ^ PMID 19169253
16. ^ [1] Psoriasis Triggers at Psoriasis Net. SkinCarePhysicians.com 9-28-05. American Academy of Dermatology, 2008.
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18. ^ [2][3] Fife, Jeffes, Koo, Waller. Unraveling the Paradoxes of HIV-associated Psoriasis: A Review of T-cell Subsets and Cytokine Profiles. 5-18-07. Retrieved 5-13-08.
19. ^ Ortonne JP, Lebwohl M, Em Griffiths C (2003). "Alefacept-induced decreases in circulating blood lymphocyte counts correlate with clinical response in patients with chronic plaque psoriasis". Eur J Dermatol 13 (2): 117–23. PMID 12695125. http://www.john-libbey-eurotext.fr/medline.md?issn=1167-1122&vol=13&iss=2&page=117. 
20. ^ Austin LM, Ozawa M, Kikuchi T, Walters IB, Krueger JG (November 1999). "The majority of epidermal T cells in Psoriasis vulgaris lesions can produce type 1 cytokines, interferon-gamma, interleukin-2, and tumor necrosis factor-alpha, defining TC1 (cytotoxic T lymphocyte) and TH1 effector populations: a type 1 differentiation bias is also measured in circulating blood T cells in psoriatic patients". J. Invest. Dermatol. 113 (5): 752–9. doi:10.1046/j.1523-1747.1999.00749.x. PMID 10571730. 
21. ^ [4] A Case Report of Severe Psoriasis in a Patient with AIDS: The Role of the HIV Virus and the Therapeutic Challenges Involved. Vol: 13 No 2, 2002. National Skin Center. Retrieved 05-13-08.
22. ^ "Psoriasis Medical Breakthroughs" Parade.com
23. ^ Lofholm PW (2000). "The psoriasis treatment ladder: a clinical overview for pharmacists". US Pharm 25 (5): 26–47. http://www.uspharmacist.com/oldformat.asp?url=newlook/files/Feat/apr00pro.cfm&pub_id=8&article_id=511. 
24. ^ "Research Findings Register: summary number 637". http://www.refer.nhs.uk/ViewRecord.asp?ID=637&Print=1. Retrieved on 2007-07-22. 
25. ^ Fortune, D.G., Richards, H.L., Griffiths, C.E.M., & Main, C.J.(2002). Psychological stress, distress and disability in patients with psoriasis: Consensus and variation in the contribution of illness perceptions, coping and alexithymia. British Journal of Clinical Psychology, 41, 157-174.
26. ^ "Irishman hits on 'cure' for psoriasis". Belfast Telegraph. December 12, 2007. http://www.belfasttelegraph.co.uk/news/local-national/article3247531.ece. Retrieved on 2007-12-13. 
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30. ^ Donsky, Howard; Don Clarke. "Relieva, a Mahonia Aquifolium Extract for the Treatment of Adult Patients With Atopic Dermatitis". http://www.americantherapeutics.com/pt/re/ajt/abstract.00045391-200709000-00008.htm;jsessionid=HnrPMH6R3JhTFQNQphZtJqdp7608hvDvWLt5sm4Wj7pW52SdRL4W!1821113646!181195629!8091!-1. Retrieved on 4 November 2007. 
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39. ^ Heller M. (2007) Positive results for ABT-874 in the treatment of psoriasis J Drugs Dermatol
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42. ^ Science Daily, New Skin-healing Chemicals
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External links

Wikimedia Commons has media related to: Psoriasis

Research and non-commercial

• "Questions and Answers about Psoriasis" at National Institute of Arthritis and Musculoskeletal and Skin Diseases
• Psoriasis at National Institute of Arthritis and Musculoskeletal and Skin Diseases
• Psoriasis at Mayo Clinic
• The Psoriasis Association
• National Psoriasis Foundation Homepage
• Psoriasis Cure Now Homepage
• Psoriasis Support Canada
• Psoriasis Help Homepage
• DermAtlas 7
• Psoriasis in Literature
• The Psoriasis and Psoriatic Arthritis Alliance (PAPAA) - UK national charity
• International Association of Psoriasis Associations - IFPA
• Electronic Targeted Intervention for Psoriasis (eTIPs)
• The British Association or Dermatologists

Books

• From Arsenic to Biologicals: A 200 Year History of Psoriasis (Barbara S. Baker), ISBN 0-955-16032-4.

v • d • e Diseases of the skin and appendages by morphology Growths Epidermal wart · callus · seborrheic keratosis · acrochordon · molluscum contagiosum · actinic keratosis · squamous cell carcinoma · basal cell carcinoma · merkel cell carcinoma · nevus sebaceous · trichoepithelioma Pigmented Freckles · lentigo · melasma · nevus · melanoma Dermal and subcutaneous epidermal inclusion cyst · hemangioma · dermatofibroma · keloid · lipoma · neurofibroma · xanthoma · Kaposi's sarcoma · infantile digital fibromatosis · granular cell tumor · leiomyoma · lymphangioma circumscriptum · myxoid cyst Rashes With epidermal involvement Eczematous contact dermatitis · atopic dermatitis · seborrheic dermatitis · stasis dermatitis · lichen simplex chronicus · Darier's disease · glucagonoma syndrome · langerhans cell histiocytosis · lichen sclerosus · pemphigus foliaceus · Wiskott-Aldrich syndrome · Zinc deficiency Scaling psoriasis · tinea (corporis · cruris · pedis · manuum · faciei) · pityriasis rosea · secondary syphillis · mycosis fungoides · systemic lupus erythematosus · pityriasis rubra pilaris · parapsoriasis · ichthyosis Blistering herpes simplex · herpes zoster · varicella · bullous impetigo · acute contact dermatitis · pemphigus vulgaris · bullous pemphigoid · dermatitis herpetiformis · porphyria cutanea tarda · epidermolysis bullosa simplex Papular scabies · insect bite reactions · lichen planus · miliaria · keratosis pilaris · lichen spinulosus · transient acantholytic dermatosis · lichen nitidus · pityriasis lichenoides et varioliformis acuta Pustular acne vulgaris · acne rosacea · folliculitis · impetigo · candidiasis · gonococcemia · dermatophyte · coccidioidomycosis · subcorneal pustular dermatosis Hypopigmented tinea versicolor · vitiligo · pityriasis alba · postinflammatory hyperpigmentation · tuberous sclerosis · idiopathic guttate hypomelanosis · leprosy · hypopigmented mycosis fungoides Without epidermal involvement Red Blanchable Erythema Generalized drug eruptions · viral exanthems · toxic erythema · systemic lupus erythematosus Localized cellulitis · abscess · boil · erythema nodosum · carcinoid syndrome · fixed drug eruption Specialized urticaria · erythema (multiforme · migrans · gyratum repens · annulare centrifugum · ab igne) Nonblanchable Purpura Macular thrombocytopenic purpura · actinic purpura Papular disseminated intravascular coagulation · vasculitis Indurated scleroderma/morphea · granuloma annulare · lichen sclerosis et atrophicus · necrobiosis lipoidica Miscellaneous disorders Ulcers Hair telogen effluvium · androgenic alopecia · trichotillomania · alopecia areata · systemic lupus erythematosus · tinea capitis · loose anagen syndrome · lichen planopilaris · folliculitis decalvans · acne keloidalis nuchae Nail onychomycosis · psoriasis · paronychia · ingrown nail Mucous membrane aphthous stomatitis · oral candidiasis · lichen planus · leukoplakia · pemphigus vulgaris · mucous membrane pemphigoid · cicatricial pemphigoid · herpesvirus · coxsackievirus · syphilis · systemic histoplasmosis · squamous cell carcinoma

v • d • e Diseases of the skin and subcutaneous tissue (integumentary system) (L, 680-709) Infections Bacterial skin disease Staphylococcus (Staphylococcal scalded skin syndrome, Impetigo, Boil, Carbuncle) · Strep (Impetigo) · Corynebacterium (Erythrasma) Viral skin disease Wart · Molluscum contagiosum · Erythema infectiosum · Exanthema subitum · Herpes simplex (Herpetic whitlow) General Cellulitis (Paronychia) · Acute lymphadenitis · Pilonidal cyst · Pimple (Pustule) Bullous disorders acantholysis (Pemphigus, Transient acantholytic dermatosis) · Pemphigoid (Bullous, Cicatricial, Gestational) · Dermatitis herpetiformis Inflammatory Dermatitis and eczema Atopic dermatitis · Seborrhoeic dermatitis (Dandruff, Cradle cap) · Contact dermatitis (Diaper rash, Urushiol-induced contact dermatitis) · Erythroderma · Lichen simplex chronicus/Prurigo nodularis · Itch (Pruritus ani, Pruritus scroti, Pruritus vulvae) · Nummular dermatitis · Dyshidrosis · Pityriasis alba Papulosquamous disorders Psoriasis (Psoriatic arthritis) · Parapsoriasis (Pityriasis lichenoides et varioliformis acuta, Pityriasis lichenoides chronica, Lymphomatoid papulosis) · other pityriasis (Pityriasis rosea, Pityriasis rubra pilaris) · other lichenoid (Lichen planus, Lichen nitidus) Urticaria Dermatographic urticaria · Cold urticaria · Cholinergic urticaria · Solar urticaria Erythema Erythema multiforme/drug eruptions: Stevens-Johnson syndrome · Toxic epidermal necrolysis · Erythema nodosum Other erythema: Erythema annulare centrifugum · Erythema marginatum · Keratolytic winter erythema · Necrolytic migratory erythema · Erythema toxicum Radiation-related disorders Sunburn · actinic rays (Actinic keratosis, Actinic cheilitis) · Polymorphous light eruption (Acne aestivalis) · Radiodermatitis · Erythema ab igne Pigmentation/ Dyschromia hypopigmentation (Albinism, Vitiligo) · hyperpigmentation (Melasma, Freckle, Café au lait spot, Lentigo/Liver spot, Acanthosis nigricans, Acral acanthotic anomaly) Other skin keratosis/hyperkeratosis (Seborrheic keratosis, Callus) · other epidermal thickening (Ichthyosis acquisita, Palmoplantar keratoderma) skin ulcer (Pyoderma gangrenosum, Bedsore) Cutaneous Markers of Internal Malignancy (Florid cutaneous papillomatosis, acanthosis nigricans, sign of Leser-Trelat) atrophic (Lichen sclerosus, Acrodermatitis chronica atrophicans) necrobiosis (Granuloma annulare, Necrobiosis lipoidica) · other granuloma (Granuloma faciale, Pyogenic granuloma) cutaneous vasculitis (Livedoid vasculitis, Erythema elevatum diutinum) Connective tissues collagen disease: Keloid localized connective tissue disorders: Lupus erythematosus (Discoid lupus erythematosus, Subacute cutaneous lupus erythematosus) · Scleroderma/Morphea · Linear scleroderma · Calcinosis cutis · Sclerodactyly · Ainhum see also congenital, neoplasia

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Dansk (Danish)
n. - psoriasis

Nederlands (Dutch)
schurft

Français (French)
n. - psoriasis

Deutsch (German)
n. - Psoriasis, Schuppenflechte

Ελληνική (Greek)
n. - (παθολ.) ψωρίαση

Italiano (Italian)
psoriasi

Português (Portuguese)
n. - psoríase (f) (Med.)

Русский (Russian)
псориаз

Español (Spanish)
n. - psoriasis

Svenska (Swedish)
n. - psoriasis (läk.)

中文（简体）(Chinese (Simplified))
牛皮癣

中文（繁體）(Chinese (Traditional))
n. - 牛皮癬

한국어 (Korean)
n. - 마른버짐

日本語 (Japanese)
n. - 乾癬

العربيه (Arabic)
‏(الاسم) مرض جلدي‏

עברית (Hebrew)
n. - ‮ספחת, מחלת עור‬

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