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PSORIASIS: WHAT IS IT?
Prepared By: The Psoriasis Association of Victoria Inc.

WHAT IS PSORIASIS
Psoriasis is a skin condition in which red scaly patches develop and show on the skin. These areas are most common on the scalp, elbows and knees, but they can occur on any area of the body. When the patches are on the scalp and in body fold areas, the skin is often itchy, but many people with psoriasis do not feel itchy at all.

The main problems caused by these patches are by shedding scales and by showing on the skin where they can be seen. Fortunately, psoriasis is unlikely to affect the face, and usually occurs on areas covered by clothes.

WHAT CAUSES PSORIASIS?
It is known that the skin in psoriasis patches is growing much quicker than normal skin. In all of us, the epidermis (the outer layer of the skin) grows continuously from its outer surface, and a new layer is reformed each month. In psoriasis, the skin reforms a complete layer each 3-4 days - so that extra skin must shed in scales. This process is similar to healing of the epidermis after an injury - except that normal skin 'knows when to slow down and psoriasis skin does not'. However the actual chemical cause of psoriasis is not known. There have been many scientific experiments performed looking for the cause, but so far changes found seem to result from the rapid growth, and not to cause it.

Sometimes (but not certainly always) psoriasis can run in families, and so it is likely that there are inherited properties causing a "tendency" to the condition.

If a person has this tendency, an accident or nervous shock, or some germ infections, can set off the condition and make it appear on the skin.

IS PSORIASIS INFECTIOUS?
No - it is not infectious in any way at all. It does not spread on the person who has it by infecting other areas, and it cannot be transferred to other people by any form of contact. Of course this does not stop people worrying about psoriasis if they see it, and fearing that it may infect them.

HOW SEVERE IS PSORIAISIS?
The extent and activity of psoriasis vary greatly - just as with any other disease. Many people of patches on the scalp or elsewhere, but they are not bothered by it and lead normal lives. There are people who have wider areas of skin involved, and a few who do not have it in a severe form.

HOW MANY PEOPLE HAVE PSORIASIS?
Studies in European communities show that 2 per cent of people are affected, and a preliminary survey in Brusselton (Western Australia) has shown that 2.3% of people have psoriasis. This means that in Melbourne 60,000 people have psoriasis, and in Australia 300,000 people are affected.

DOES PSORIASIS AFFECT GENERAL HEALTH?
Usually the answer can be NO to this question. However about one person in 20 can get joint troubles - with a degree of arthritis affecting the back, or large or small joints of the body. This arthritis is very rare.

If psoriasis is severe and covers very large areas of the body, there may be other problems. Psoriasis does not cause cancer or affect the blood or the circulation.

DO NERVES AFFECT PSORIASIS?
Yes. A sudden or severe shock can start off psoriasis for the first time, and also considerable continuing strain can sometimes make psoriasis worse, and make the person with psoriasis more aware and concerned about the skin problem. Of course the skin trouble itself can also make people nervous and upset.

WHAT ABOUT DIET?
Although many things are said about diet, it generally seems no special diet helps psoriasis improve. However, a "moderate" diet would be best, without excess of rich, fatty or starchy or spicy foods or alcohol. If you hear of a special diet for your psoriasis, by all means try it - but make sure you do not go short of any essential vitamins or other food ingredients for too long.

DOES IT AFFECT LIFE AND WORK?
Most people with psoriasis find it a burden and a nuisance, but they are not stopped from enjoying life and doing their usual work. However, the condition may involve an important area of the body such as the hands - and this does affect the person's life, and their ability to work with their hands.

It is hard to accept psoriasis in a society which stresses and advertises physical beauty; in young people this difficulty may be considerable, and may interfere with sport and social life. As well, there may be adults who find living with psoriasis very disturbing.

The cost of caring for psoriasis can be considerable - and this is ignored by health benefits and pharmaceutical benefit schemes.

CAN PSORIASIS DISAPPEAR?
Yes, it can settle or disappear, especially after a rapid onset which sometimes occurs in young people. If their skin tans well, people can be free from psoriasis every summer, even though it comes back in winter again.

HOW IS PSORIASIS DIAGNOSED?
The appearance of the skin rash is enough for a trained doctor to make the diagnosis of psoriasis, without any tests. If there is any problem of general health, blood tests can be performed or X-rays can be taken, but these do not help the diagnosis of the condition itself. Sometimes a piece of skin can be cut out (biopsy) and sent for pathology testing to be quite sure of the diagnosis.

IS HOSPITAL TREATMENT NEEDED?
In Europe, there have always been beds in hospitals and "sanitoria" allocated for skin disease, but in Australia there are few hospital beds for any patients with skin diseases.

In some countries, "day care centres" have been established to give most of the benefits of a hospital without the need for full-time care.

If this type of treatment is to be introduced here, it will require community activity to demonstrate that it is needed and will be accepted and used.

HOW CAN PSORIASIS BE TREATED?
There are many different treatments, and the correct treatment depends on the activity and extent of the psoriasis, wether the person has fair or dark skin, and whether there are any other problems present as well.

In general, treatment can be discussed under the headings of tar, ultra violet light, cortisone, calcipotriol, general health and stronger treatments. Psoriasis can always be helped, even though it is true that there is no cure for psoriasis at present. In this way, psoriasis is very similar to other diseases, such as diabetes and blood pressure.

TAR
It has been known for a long time that coal tar helps psoriasis and it is available as crude coal tar coal, tar lotion, and in refined forms incorporated into ready made creams, lotions and shampoos. In general, the more messy and smelly the tar preparation is, the better it is likely to work - so please be prepared to persevere with it.

A chemical similar to those found in tar may be used on its own - known as Dithranol or Anthralin. This must be used cautiously as it can irritate, but a strength and base can usually be found to suit and help the individual person's psoriasis. Tar treatments can lead to steady and effective control.

ULTRA-VIOLET LIGHT
Summer is the best source of ultra-violet light, and many people find psoriasis settles very well in summer.

Treatment in winter can be aided by artificial lamps: smaller lamps are usually not strong enough, but impulse type lamps, wall mounted "fluorescent lamp type" lamps, and larger "solarium" lamps are suitable.

It is usually best to apply a tar or drithanol preparation daily, to be followed later by ultra-violet light treatment.

Unfortunately, some psoriasis sufferers are rather sensitive to sun light, and may not be improved with this treatment.

CORTISONE
External cortisone in various different bases can help psoriasis, but this helps usually only 1-2 days at the most. There are certain areas such as ears and the backs of hands where tar treatments are not very helpful, and in these areas cortisone applications are usually best. However in general, it can be said that tar applications provide some help.

Internal cortisone tablets are best avoided in psoriasis unless every other treatment has not helped. The main problem with these tablets is that they may help, but when they are stopped psoriasis can suddenly flare it and become worse than it originally was.

DAIVONEX (Calcipotriol)
Daivonex is the trade name in Australia of calcipotriol ointment. Calcipotriol is a synthetic form of vitamin D. Vitamin D has been recognised for many years to improve some of the important abnormalities present in psoriasis skin, but ingestion of even only slightly above the daily recommended amount of Vitamin D can lead to problems with calcium metabolism in the body (possible kidney stones and irregular heart beats).

Calcipotriol has been found to also have the ability to improve psoriasis, but with minimum effects on internal calcium metabolism. It is available in a very greasy, ointment base for twice daily application. There is a risk of facial dermatitis if the ointment is used on the face or neck, so application is only recommended for the trunk and limbs, and it is important that the hands are thoroughly washed after application to avoid inadvertent transfer to the skin of the face. Comparative studies from overseas have shown that calcipotriol ointment is at least as effective as topical cortisones and dithranol in the treatment of stable plaque psoriasis.

GENERAL HEALTH
This means that each aspect of health should be treated for its own sake. If nerves are bad - treatment may be needed; if sleeping is affected - a sedative may be required. In children, psoriasis of sudden onset by be helped by taking penicillin by mouth for a time, but with accumulation in the body it can lead to serious problems after a number of years.

The Psoriasis Association of Victoria Inc.
P.O. Box 1151 Glen Waverly 3150
Telephone: (03) 9530 4454