Psoriasis

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The appearance of psoriasis varies from person to person, however, the condition is mostly characterised by patches of silvery scale overlaying a red, inflamed looking skin. The scalp may be irritated and itchy in some cases, but not in others. Psoriasis can affect any part of the body, but the scalp, knees and elbows are the most common sites.

Psoriasis is thought to be an inherited, 'auto-immune' condition which means the body is 'doing it to itself'. You may find that it will be worse when you are stressed and generally run down and during the winter months if you don't get any sun. So one of the things that can help is ultra violet.

Don't feel shy or embarrassed of your hairdresser though, this condition is really quite common and definitely not infectious, so they will not treat you like a leper. Your hairdresser may recommend that you try using permanent colour as a temporary cure, and whilst this may remove any scale, it generally stings very badly and can worsen the condition.

Psoriasis can be triggered by stress, damage to the skin or exposure to a substance not previously encountered. There is presently no cure for psoriasis, so treatment is aimed at control. See a trichologist or your family doctor for an accurate diagnosis.

About Psoriasis - Facts and Tips

Reproduced with kind permission of Tony Pearce RN., RPN.
Consulting Trichologist.

Psoriasis is reputedly the most common scaling problem seen by health professionals. The condition is a genetically determined autoimmune disorder believed to affect 2-5% of the world's population.

With psoriasis the skin cells (epidermis) shed about seven times faster than the usual 28 days. Furthermore, the skin cells in unaffected people shed easily. By contrast, psoriatic skin cells are immature, sticky, and resist shedding. This results in scale formation on the skin surface.

The appearance of psoriasis varies from person to person; there may be heavy scale and redness in some whereas others have little of either. However the classic feature of psoriasis is a palpable bright pink plaque covered in silvery scale.

Although people who experience psoriasis have a genetic predisposition to develop it, it's believed that it still takes something to trigger the problem. That could be a bacterial or viral infection, a vaccination/injection, stress, trauma to the skin or exposure to a substance not previously encountered.

Stress influences psoriasis through its effects on the Sympathetic Nervous System. Stress causes sympathetic nerves to increase their production of chemicals in the skin called neuropeptides. These neuropeptides can increase the autoimmune reaction in the skin.

Psoriasis is extremely variable in its duration and course. A single lesion may persist for a lifetime, or many lesions may be present. Some sufferers are never free of the problem whereas others may have long remissions. This same variation occurs in people's response to treatment; what helps one person may not help another.

As psoriasis is believed to be an autoimmune condition, it can be suppressed but not presently cured. Remission may be spontaneous or induced, and last for weeks, months or years. Treatments are many, and help to control the condition in different ways:

  • one therapy trichologists use for psoriasis involves the oral intake of the amino acid Tyrosine. Tyrosine decreases neuropeptides in the skin which, in turn, decreases the skin's immune response. By doing this, the scaling and redness with psoriasis diminishes. Psoriasis should respond to this therapy within a month.
  • Zinc sulphate 5% with 3% salicylic acid is a preparation used by some trichologists to relieve the symptoms of itch, redness and scaling.
  • tar preparations are keratolytic, anti-inflammatory, and thought to be antimitotic. Coal tars can be compounded into ointments, creams, oils or shampoos. Often used in combination with salicylic acid for mild to moderate psoriasis.
  • Anthralin(Dithranol) is extracted from coal tar and inhibits epidermal mitosis. Applied topically; anthralin irritates the skin and increases the immune response to that area. Anthralin should be applied to the scalp in "quarters". Look for a reaction in first quarter before moving on. *Daivonex (calcipotriol) is a non-steroidal vitamin D derivative.
  • Roaccutane and Tigason are vitamin A derivatives
  • severe chronic psoriasis may require treatment with potent oncological drugs such as methotrexate or cyclosporin. Oral or intravenously, these drugs can only be prescribed by a medical specialist and are generally only used when other treatments have failed. Regular monitoring of the patient's white cell count and liver function are essential.
  • ultraviolet light, PUVA, or judicious exposure to sunlight has proven beneficial to many psoriatics.

Topical Corticosteroids: topical steroids are anti-inflammatory and immunosuppressive. They can be very effective in controlling mild to moderate psoriatic lesions. Steroids are easy to use and offer a relatively quick response. Topical steroids are not considered adequate treatment when used as the only therapy for severe psoriasis. However they may augment other treatments that are used to treat severe psoriasis.

  • There are several topical steroid medications specifically for use on the scalp. Some of these prescription products are: Cormax scalp application, Derma-Soothe/FS topical oil, Kenolog spray, and Temovate scalp application.
  • Topical steroid medications don't necessarily produce long remissions. Thus the early return of psoriasis can contribute to sufferers using steroids for long periods of time, or using a steroid that is too potent for a particular body area. This often heralds the appearance of common side effects associated with topical steroid use:
  • Skin damage: skin atrophy, thinning of the skin, stretch marks (stirrer), steroid redness, and dilated inflamed surface blood vessels are possible side effects with the careless use of topical steroids.
  • Rebound effect: as topical corticosteroids are essentially immunosuppressive, psoriasis tends to worsen if the steroids are discontinued suddenly. This is termed a psoriasis "rebound" or "flare". This rebound effect may be stalled by slowly reducing or tapering the use of steroids as the psoriasis starts to remit. Some medicos prefer to gradually lower the strength of steroid medications to avoid rebound.
  • Lack of Response (Tachyphylaxis) in long-term topical steroid use: changing from one steroid to another may delay this effect, but the only way to prevent it is to temporarily cease using topical steroids. The substitution to non-steroidals such as Daivonex, Anthralin, tars or retinoids can be a useful interim alternative.

Psoriasis of the Scalp:
Psoriasis can affect any area of the skin but the scalp is a common site, where psoriasis tends to stay within the hairline. The crease of the ear is also often involved, and, sometimes scaling can be seen in the ears.

Where there are plaquey lesions, the scalp hair appears lustreless. The hair is dry and tends to break easily. There is an increased shedding of telogen (falling phase) hairs, and a decreased hair density. There may be extensive hair loss in the erythrodermic forms of psoriasis.

Heavy scale may cause hairs to be 'funneled' together to form the distinguishing "tepee sign" of scalp psoriasis. Other characteristic features of psoriasis are 'Auspitz' sign', where bleeding points are revealed beneath removed scale. 'Koebner Phenomenon' is where injury to the skin can induce the development of psoriatic lesions at the site of injury. It is believed the presence of large numbers of the yeast micro-organism, Pityrosporum ovale, may be adequate to provoke a Koebner reaction in susceptible persons. Shampoos that are antipityrosporum-specific (e.g.: Nizoral 2%) have been advocated as an adjunct to therapy for scalp psoriasis.

You can go to our trichology section if you would like to find out how to get treatment for this condition. 

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