Moisturize, Moisturize, Moisturize: Psoriasis' First Line of Treatment

Psoriasis, which presents itself as dry skin mottled with red patches covered with off-white scales, is a condition that does not have any cure yet. That's the saddest thing about having, and the most common reason why we become frustrated over time when dealing with, this condition. Treatment for psoriasis varies differently among patients, but there is only one common goal: to rid our skin of the psoriasis lesions.

Often, doctors begin psoriasis treatment with a therapy which does not expose us to many side effects. If our response to the treatment using the least potent therapy is not promising, that's the time when doctors move up the scale, hoping to find the therapy that will clear the lesions. No matter what type of treatment (topical, light, systemic, or biologic) we use, we should not forget to moisturize our skin, including the lesions.

Aim of Emollient Therapy
While emollient therapy, or the use of moisturizers, does not make our psoriasis go away, it is an essential component in psoriasis care. Because it moisturizes and lubricates the skin, as well as helps remove scales from the psoriasis-affected patches, overall skin condition is enhanced. It is very useful in preparing our skin for application of active topical (e.g. creams or ointments containing steroids) or light therapies (natural sunlight, or UVB). Once the psoriatic skin is moisturized regularly, we feel more comfortable as we go about our everyday life because skin becomes less itchy, inflamed and scaly.

How to Apply Moisturizer on Skin
Moisturizers may come in the form of soap substitutes, lotions, steroid-free creams or ointments, and oil. Make sure you use the moisturizer that you are most comfortable with and have no qualms about using regularly, day in day out. Moisturizing the skin starts not after but during the bath or shower itself. If you are taking a shower, it is best to use a soap substitute (e.g. Cetaphil) to avoid drying the skin. For those who prefer using the bath tub, it helps to put some bath oil in the water; a thin film of oil will deposit on your skin, keeping moisture in.

Once you finish bath or shower, you can proceed to apply the lotion, or the steroid-free cream/ointment. You would not want to develop an infection on your hair follicles (called folliculitis), hence, make sure that in applying moisturizer you use long strokes in line with the natural direction of the hair. Avoid rubbing in too aggressive a fashion, as the friction provokes more plaque-formation. Instead, use a gentle, circular motion to work the liquid into the skin.

While it is best to apply moisturizers as often as possible during the day, it may not be practical in your work and lifestyle. You may want to make it a routine to apply the moisturizer before you go to work and then apply again before you sleep. Any application in between should be a great plus.

One final point about moisturizers: actually, they don't add water to your skin; instead, they minimize the amount of water lost via evaporation. If there is little water in your skin in the first place, then moisturizers will not help at all.

Make sure you do not become dehydrated by drinking plenty of fluids during the day. Then, moisturizers can do their job.

Photo credit: shawncampbell (flickr.com)

Resources:
Hughes, E. and Van Onselen, J. (2000). Dermatology Nursing. (New York: Churchill Livingstone).

Mitchell, T. and Penzer, R. (2005). Psoriasis At Your Fingertips Guide. (London: Class Publishing).

Rees, A. (1997). Consumer Health USA. (Phoenix: Oryx Press).

Suffering from Sore Throat? Guttate Psoriasis May Be Erupting Soon

If you have been suffering from sore throat recently, then watch out for any signs of psoriasis flare-ups in the next few weeks. Almost 80 percent of guttate psoriasis onset is triggered by streptococcal (or strep) bacteria, which causes sore throats.

Guttate Psoriasis' Clinical Apperance
In its clinical manifestation, guttate psoriasis may make you look like you had red polka dots of varying sizes all over your body. The Latin word, gutta, means ‘drop,’ hence, the description of droplike, or raindrop-like papules can often be found in books.

If you are more familiar with plaque psoriasis, you would most likely not recognize this condition as psoriasis from a distance. The red-colored spots may be mistaken for chicken pox, because the diameter of the lesions usually ranges between 0.1 and 1.0 centimeter. While the identifiable flakes are also present in guttate psoriasis, it is not as scaly as those in plaque psoriasis.

Guttate psoriasis is usually common among children and young adults. It could be the early manifestation of psoriasis or it could signify a looming acute flare-up of a pre-existing psoriatic condition, usually the plaque-type. If you have plaque psoriasis, then it is easier to diagnose guttate psoriasis. However, if it is the first time that this disease manifested, it may not be immediately diagnosed as psoriasis. Other conditions, such as pityriasis rosea and secondary syphilis, may be suspected. Family history and lab tests to confirm strep infection will be helpful in early diagnosis of guttate psoriasis.

Association of Strep Infection with Psoriasis
The immune system becomes overactive when there is streptococcal throat infection. It was in 1916 when Winfield made an observation that streptococcal infection is associated with psoriasis. The infection activates T-cells at various spots in the skin. These T-cells, which can penetrate into the skin, may mistakenly recognize certain foreign substances in the skin as part of the infection and proceed to attack them.

Some carbohydrates or keratins possess chemical identifiers similar to bacterial antigens. In a sense, the body is confused and over-reacts, believing the strep invasion is bigger than it actually is. As a result, some patients go on to develop the chronic condition of plaque psoriasis.

Guttate Psoriasis Treatment
In most cases, guttate psoriasis is resolved if the underlying infection is treated. It may take a few weeks, or months, for guttate psoriasis to be completely gone. In some patients, the condition does not recur. But in others, it temporarily worsens a preexisting psoriasis (which eventually recedes to its previous state) or it opens the possibility of minor recurrences of psoriasis.

To address strep infection, doctors often recommend a 10- to 14-day antibiotic therapy. Natural sunlight or ultraviolet B therapy may also be prescribed if there is no improvement after a month since the outbreak of guttate psoriasis, or if you have preexisting plaque psoriasis. If the doctor does not prescribe antibiotics, you may want to make sure it is not needed — since you do have the strep infection — or ask for a second opinion.

Photo credit: Foxtongue (flickr.com)

Resources:

Bergstrom, K. and Kimball, A. (2005). 100 Questions & Answers about Psoriasis. (Sudbury, MA: Jones and Bartlett Publishers).

Bos, J. (2004). Skin Immune System, Third Ed. (Boca Raton: CRC Press).

Camisa, C. (2004). Handbook of Psoriasis, Second Ed. (Malden: Blackwell Publishing).

Accepting Life with Psoriasis

The thought of living with psoriasis for the rest of your life is not an easy thing to accept. Although we have witnessed medical advances in recent decades, we are still being told to face the fact that there is no available cure for psoriasis yet. The most we can do is to manage the symptoms and try the best we can to avoid the triggers that cause psoriasis flare-ups.

Psoriasis Causes
We often ask our dermatologists what things cause the disease, and sometimes, even the specialists do not know how to explain or would rather not go into those details. Others simply prescribe different medications, whether topical, oral, or biologics, to treat the disease. The truth really is that the main cause of psoriasis is, up to this date, still unknown.

Researchers currently believe this hereditary disease is mediated by a set of T-cells whose autoimmune profile is highly susceptible to certain triggers. Some factors that could provoke the adverse reactions include stress, both physical and emotional; particular skin injuries or traumas (associated with Koebner’s phenomenon); bacterial infections (which triggers guttate psoriasis); and, various drugs (such as beta-blockers and anti-malarial medications).

Social and Psychological Implications
We often find it difficult to make the necessary adjustments in our lives when we are told that we have psoriasis. The disease does not only affect our physical appearance, but it also gives discomforts due to its itchiness and pain. People who do not understand psoriasis often think that we have a contagious disease. Sometimes, we find ourselves discriminated against in public places. It leads us to isolate ourselves from the public because of embarrassment and the stigma brought about by the disease. Depression, which only aggravates the condition, can also be found in some psoriasis patients.

Unlike vitiligo (another skin disorder) which can be disguised by cosmetic concealment, we cannot hide our skin lesions using that method. (Paging cosmetic companies, can you please manufacture one for us?) Our choices of clothing are constrained. We may want to wear the latest fashion styles, but we are restricted by our disease. Indeed, psoriasis has brought a significant impact in our quality of life.

Basic Things We Can Do
Managing the disease is a challenging task for us. Accepting psoriasis as a part and parcel of our lives will surely divert our emotional energy from depressing thoughts to more productive activities; this acceptance should relieve us of unnecessary stress associated with the condition. While fear and ignorance about the disease is still common these days, we can choose to have a positive attitude despite living with psoriasis. At least, society no longer ostracizes people with psoriasis unlike in biblical times.

Photo credit: tomswift46 (flickr.com)

Resource:
Buxton, P. and Morris-Jones, R. (2007). ABC of Dermatology. (Chichester, UK: Wiley-Blackwell).

Got Plaque Psoriasis? Aloe Vera May Help

Do you have plaque psoriasis (psoriasis vulgaris)? Treating plaque psoriasis with a topical form of aloe vera tends to reduce flare-ups. This is according to a research report presented during the International Congress of Dermatology (ICD) held in Prague last May. When compared with patients who use topical steroid, those who underwent aloe vera treatment showed greater improvement of their plaque psoriasis after eight weeks.

How to Identify Plaque Psoriasis
Plaque psoriasis is easier to identify than the other manifestations of this condition. Raised lesions, made vivid by bright red inflammation, form on your skin. Eventually the dead skin cells bunch up into off-white scales covering the lesions. Psoriasis vulgaris, or plaque psoriasis, is commonly found on your scalp, elbows, knees and trunk.

As the inflammation spreads, plaques may spread over larger patches of skin and merge into one another. The lesions may also appear in mirror-like locations on opposite sides of your body. Psoriasis occurs anywhere on the body, but plaque lesions seem to have a special affinity for your scalp, knees and elbows.

If you want to see some photographs of plaque psoriasis, you may want to click on this link of PsoriasisInternational.org. (Warning: You might find some of the pictures gross!)

The Aloe Vera Effect
The latest study reported at the ICD was not the first of its kind. Another clinical study was conducted in 1998 which found that applying aloe vera cream on affected skin three times daily for at least 28 days helped to control the psoriasis inflammation. In certain cases, skin outbreaks did not recur for about one year.

It is of no surprise that studies have found aloe vera to be beneficial to psoriasis patients. Legend has it that Cleopatra and Nefertiti used aloe vera as part of their beauty treatment regimen. The moisturizing characteristic of aloe vera, in fact, is the attribute that has encouraged me to use aloe vera as part of my psoriasis treatment. That's why I was ecstatic when I read about this latest report from the ICD.

Instead of using aloe vera cream, I use aloe vera gel. I usually apply the aloe gel after shower. I have been practicing this ritual for about two months now. It has an amazing effect on my skin. I still use corticosteroid cream, of course, but I keep it to the minimum, say, twice a week application.

You may want to try applying aloe vera cream, or aloe vera gel, on the affected parts. It is believed that the moisturizing and anti-inflammatory characteristics of aloe vera improve plaque psoriasis. Aloe vera has always been considered an alternative treatment without the detrimental local and systemic effects associated with chronic use of topical steroids.

Photo credit: Biology Big Brother (flickr.com)

Resources:

Balch, P. (2002). Prescription for Herbal Healing. (New York: Avery).

LeVan, L. (1999). The Psoriasis Cure. (New York: Avery).

Want to Increase Psoriasis Risk? Let's Have Some Beer

Women who are fond of drinking at least 30 grams (two drinks) of beer per week are likely to increase the risk of developing psoriasis according to a study presented during the annual Society for Investigative Dermatology meeting.

Consumption of red wine, white wine, and other forms of spirits were also included in the study for comparison. It was, however, the consumption of at least two drinks of beer every week which showed significant indication of higher psoriasis risk. It is believed that gluten, an active ingredient of beer, seems to be the trigger in the women who developed psoriasis.

Gluten — What Is It?
Do you ever wonder what holds the pasta and baked goods made from wheat, rye and barley together? Yep, the answer is gluten. Gluten provides the elasticity to the bread dough, which then helps the dough to rise when you mix it with yeast. The function of gluten is akin to glue; in fact, their Latin root is the same.

Majority of processed foods we have in the market contain gluten. And beer is not an exemption to these foods. While it is not common to see labels of packaged foods mentioning any gluten content, be aware that there are many disguises for gluten. Hydrolyzed vegetable protein, natural flavors and modified food starch are just some of these disguises.

Gluten-Free Diet
In one study, it was found that getting rid of gluten from the diet significantly improved the condition of some psoriatic patients. Do you think you can live with a gluten-free diet? Sure, it would be a sacrifice to follow a gluten-free diet especially when we consider the available foods we have here in the Philippines. And how about eliminating beer? Hmmm… The mere thought of quitting beer has already given me stress.

Photo credit: ooOJasonOoo (flickr.com)

Resource:
Ahern, S. (2009). Gluten-Free Girl. (New York: John Wiley and Sons.

Stressed Out? Be Ready for Psoriasis Flare-Ups

Do you still remember the time when you first noticed that you had psoriasis flare-ups? Were you not living stressful days at that time? While there is still some controversy about the role that the stress of daily living contributes to the flare-up of psoriasis, most, if not all, of us (psoriasis patients) agree that whenever a series of stressful events occurs in our lives, or even a single but particularly intense event, we would notice our psoriasis start to flare-up.

A Vicious Cycle
If stress is not the primary trigger, it can surely get psoriasis in a much worse condition. There can be a vicious cycle when we have a flare-up. The mere fact that we have the condition can be the cause of our stress. Because we worry about our condition, it aggravates the flare-up, which again causes another bout of stress. If we do not do anything about it, the cycle keeps on repeating over and over again. To stop this vicious cycle, effective psoriasis treatment is very important.

Reducing the Levels of Stress
There are many ways of reducing the levels of stress. What applies to me may not necessarily be applicable in your situation, but we can surely find a common ground. Some of the strategies that are generally applicable to psoriasis patients include:

• Rest. No matter how busy we are in our daily lives, it is of utmost importance that we find time to rest to keep psoriasis under control. Rest may be in the form of having sufficient sleep, or asking someone else to apply those topical creams and ointments to our skin.

•Engaging in activities that make us feel good. These activities may include playing your favorite sport, having a relaxing massage, doing a sunbath, attending yoga and meditation classes, and sharing your experiences with a support group, such as the Psoriasis Philippines Online Support Group.

These are just some ways that help minimize the levels of stress. You may want to share what works on you, too.

Photo credit: kortini (flickr.com)

Welcome Morning Sun! Take My Psoriasis Away

The next time you are under the morning sun, take the opportunity to expose the part of your body which is affected with psoriasis. While you may find it embarrassing, keep in mind that sunshine has long been known to help improve psoriasis. You may even find that regular exposure to mild sunlight is better than following a systemic immunosuppressive drug regimen.

The UVB Factor
There are three components of natural sunlight: visible light, ultraviolet A (UVA), and ultraviolet B (UVB). If once in a while you get sunburn after a few hours of sun exposure, it is actually UVB which is causing that. And it is the same UVB which is very beneficial to us, psoriatic patients.

Doctors usually prescribe narrow-band UVB treatment, especially in the West where natural sunlight is not all-year round. It can be an effective treatment, albeit temporary. Others may have a longer period of remission, some may not. To prolong the remission, doctors recommend that you undergo UVB treatment regularly. If you can afford it, you may want to own a home UVB apparatus to avoid the hassles of going to the doctor over and over again.

The Cheap Alternative
But if you live in a country where the sun shines almost every day, then welcome the morning sun with a smile. Mild sunlight, usually between 7am to 9am, is the cheapest psoriasis treatment. Whenever I have a flare-up I usually expose my affected skin to the morning sun for about 10 to 30 minutes a day, and it would greatly improve my psoriasis. If you intend to follow this regimen, it is highly recommended that you consult a healthcare professional first. While sunlight has beneficial effects, it may not necessarily be applicable in your case.

Photo credit: kiri :D (flickr.com)

Resources:
Habermann, T. (2006). Mayo Clinic Internal Medicine Board Review. (Boca Raton: CRC Press).

Rees, A. (1997). Consumer Health USA. (Westport: Greenwood Publishing Group).

Watch Your Weight, Minimize the Risk of Psoriatic Arthritis

If your age ranges from 35 to 50, then you may want to watch out for any onset of psoriatic arthritis. The risk of developing this type of arthritis becomes higher as your weight increases, according to the study conducted by the Utah Psoriasis Initiative (UPI). Psoriatic arthritis is sometimes mistaken to be the same as rheumatoid arthritis. In rheumatoid arthritis, however, there are nodules which could not be found in psoriatic arthritis.

The UPI data implies that obesity comes after the onset of psoriasis. This implication may controvert other studies which indicate that obesity is secondary only to psoriasis. While these studies seem contradictory, what is important to us (psoriasis sufferers) is the findings that obesity can be a risk factor in developing psoriatic arthritis.

To keep an eye on your weight, calculate your body mass index (BMI). This BMI calculator helps you do the chore. If your BMI is over 24.9, then it is time to lose weight. Maintaining a normal weight is not only helpful in avoiding the odds of developing psoriatic arthritis, it also lessens our likelihood of developing diabetes and hypertension.

You may want to check this video about 14-year-old Jacob talking about what it's like living with psoriatic arthritis.



Photo credit: cutup (flickr.com)

Resource:
West, S. (2002). Rheumatology Secrets. (New York: Elsevier Health Sciences).

Have Psoriasis? Monitor Blood Glucose, Pressure

If you think that psoriasis is only a skin disorder, then you may have to think again. Dermatologists may not tell you that the condition is more than skin deep, as what happened in my case, keep in mind that you are missing a very important piece of information. Numerous studies have already been conducted pointing to psoriasis as an autoimmune disease which is linked to many other health conditions.

The latest study conducted by researchers from Harvard Medical School found that women sufferers have higher probability of developing type 2 diabetes and hypertension (high blood pressure). This is not the first time that psoriasis has been linked to diabetes and hypertension, however. While the cause as to why psoriasis patients have higher chances of developing diabetes has not been definitively known, what is clear is that having psoriasis makes us more vulnerable to developing diabetes than women who are not suffering from this chronic disease.

While this study is very interesting on our part, it should not cause any panic. For as long as you are living a healthy lifestyle, your chances of acquiring diabetes and hypertension are low. Many women with psoriasis did not develop these conditions at the time the study was conducted. All the women included in the study were also white, hence, it is not clear whether the findings would be applicable to other races, such as Asians.

Nonetheless, it pays to be on top of the situation. Go and have your blood glucose level and blood pressure checked by your doctor as soon as possible. I had mine checked already.

Photo credit: robertdx (flickr.com)

Be Glad You Were Born Today

While you may be one of the 2% of the world population, or one of the 800,000 Filipinos (according to the latest estimate of the Department of Health from this news video) who have psoriasis, be happy that you were not born during biblical times.

According to medical experts, the Hebrew term zaraath which can be found in the Old Testament, particularly Leviticus 13, is so broad that it may not only refer to leprosy (Hansen's disease) but also to other skin disorders including psoriasis. As you may have known, if you were found to be suffering from leprosy during olden times, you would be considered as an unclean person. The consequence would be costly: officials could either declare you as a dead person, or burn you at the stake.

Psoriasis is from the Greek word "psora" which means itch. (Very itchy, indeed!) While Hippocrates (460-377 BC) applied the the term psora to scaly facial and genital eruptions, psoriasis, as it is known today, was believed to be first used by Aurelius Cornelius Celsus (25 BCE-45 CE). However, it took centuries before an Englishman, Robert Willan (1757-1813) described psoriasis accurately. The complete clinical separation between psoriasis and leprosy was done by Hebra and Kaposi in 1876.

Although advances in medical science have been seen during the twentieth century, many of us (psoriasis sufferers) are still feeling the embarrassment brought about by the disease. If we compare ourselves with those of the patients during ancient times, isn't it a comfort to know that we belong to this generation?

Photo credit: Eleventh Earl of Mar (flickr.com)

Resources:
Bos, J. (2004). Skin Immune System. (London: Informa Healthcare).

Roenigk, H. and Maibach, H. (1998). Psoriasis. (London:Informa Healthcare).

van de Kerkhof, P. (2003). Textbook of Psoriasis. (New Jersey:Wiley-Blackwell).

Diagnosis Day

I was diagnosed with psoriasis in the third quarter of 2001. When I looked at my face on the mirror then, I noticed a red patch on my forehead. I initially thought that the redness would eventually go away. But as days and weeks went by, I noticed that the red patch became bigger and I knew then that it was something I had to consult with a dermatologist.

Upon arriving at the dermatologist's clinic, the doctor's assistant asked me about my problem. I showed her (the assistant) the red patch on my forehead. She did not hesitate to tell me that it was psoriasis. It was the first time I had heard of that disease.

When I went inside the clinic, the dermatologist took a long time to say categorically that I had a psoriasis indeed. When I told her that her assistant mentioned about the disease, she was a bit hesitant to tell me that I would be living with psoriasis for the rest of my life.

I was clueless about psoriasis the first time I went to the dermatologist. But upon leaving the doctor's clinic, I hurriedly surfed the net to find out more about this disease. With the use of the "psoriasis" as a keyword, I was able to find the website of the National Psoriasis Foundation.

From that moment onwards, I began to understand this commonly misunderstood condition in the Philippines. And it has not been a smooth journey since then.

Here's a video explaining psoriasis:



Photo credit: a.drian (flickr.com)