All That Scales Is Not Flaky - Is It Psoriasis?

By Dr. Charles Lynde

Scaly skin is not to be taken lightly. It is a very real disease that often impacts a person’s self-confidence and self-esteem. Some people -- including some doctors -- tend to think that skin disease is trivial.

Not so according to research, which shows that the physical and emotional impact of psoriasis can be as great as cardiac failure or depression. For information on the impact on psoriasis, have a look at the rest of this site.

What is it?

Scaling, often painful, is called psoriasis, and while it may cause anxiety or nervous conditions, it is not triggered by these circumstances. It can manifest in a variety of ways, all of which can be extremely frustrating. For example:

• Your scalp is so itchy that it is driving you crazy.
• Shaking hands is embarrassing because of the rough scale on your skin.
• The cracks on your fingertips sting
• Simple activities such as buttoning your shirt are painful.
• You know all too well that others notice your brown, uneven nails.
• You need to vacuum when you take off your clothes because of the snow storm of scale when you undress.
• You are told to not use the hot tub at the local pool because you are at risk of infection others (psoriasis is not infectious).

Psoriasis:

• Does not occur because of anxiety or any nervous condition
• Occurs as small patches, or can cover most of the body
• Can vary in intensity over time
• In some people, may disappear for months or years
• Tends to run in families

Why does the skin “behave like this?”

Waterproofing is one of the important functions of the skin – it does this by producing a layer of fat mixed with protein on the surface. The skin is also the site where many of the immunological battles of the body take place. White cells called lymphocytes attack an as yet unknown immunological abnormality. These lymphocytes become activated in psoriasis causing inflammation in the skin. This not only makes the skin red, but drives the epidermis -- the outer layer -- to grow faster, thus becoming thicker and scalier.

At this time we do not know what exactly the lymphocytes are attacking in the skin. We do know that these lymphocytes produce an ongoing cascade of chemical messengers that induce changes in the skin, making it red, thick and scaly. In some people with psoriasis, these lymphocytes can also produce inflammation in joints, called psoriatic arthritis. Click on PsoriaticArthritisGuide for more information.

Is there any hope for severe psoriasis?

The good news is that this neglected disease is now getting some of the therapeutic attention it deserves.

Treatments in the past have been:

• Creams and ointments containing cortisone, Vitamin D, Tazarotene
• Ultraviolet lights
• Oral drugs including Vitamin A-like pills, methotrexate (anti-cancer drug) that slows down the abnormal inflammation

New treatments – New Hope

• A greater understanding through research has identified some of the cellular factors that play an important role in the development of psoriasis.
• The new generation of drugs called the “Biologics” is much more specific in blocking the activated lymphocytes or neutralizing some of the important chemicals that they produce that encourages psoriasis.
• In Canada a drug called Alefacept (Amevive) has recently been approved for psoriasis. This drug blocks the activation of the lymphocytes that are specific in psoriasis.
• Another drug called Entaneracept (Enbrel) has been approved recently for psoriatic arthritis. It blocks the action of a chemical called tumor necrosis factor.

There are numerous treatment options for this skin condition; visit the rest of this site and PsoriaticArthritisGuide for more in-depth information. And of course, always ask your doctor or dermatologist for help.

About the author:
Dr. Charles Lynde is an Assistant Clinical Professor, University of Toronto and a Consultant with the University Health Network (Toronto Western Division), Markham-Stouffville Hospital and Scarborough Grace Hospital. His special interests include: Paediatric Dermatology, Cosmetic Procedures, Contact Dermatitis, Skin Cancer, Laser Procedures, Psoriasis Clinic, and clinical trials in acne, eczema, psoriasis.