Psoriasis comes from the Greek term “psora,” which means itch. This common skin condition speeds up the cellular turnover cycle causing a rapid buildup on the skin’s surface, forming scales and itchy, red patches that are sometimes painful. Psoriasis is a chronic disease. Most forms of psoriasis go through cycles, flaring for a few weeks or months, then subsiding or even going into complete remission. The treatment goal is to stop the skin cells from reproducing and turning over so rapidly. While researchers continue to search for a cure, the client must learn to manage their symptoms. Lifestyle considerations such as moisturizing their skin, smoking cessation, and stress management can help.
There are several types of psoriasis, including plaque, guttate, inverse, pustular, erythrodermic, nail, and psoriatic arthritis.
This article will discuss plaque psoriasis because it is the most common form and can be easily recognized by the aesthetician. It causes dry, raised, red, scaly plaques. The client may have just a couple of plaques or multiple affected areas on any part of the body. It is estimated that half the people with plaque psoriasis also have the condition in their nails, causing them to look yellowish-red. The skin can separate from the finger and toe nailbeds (onycholysis); with severe cases, the nails can actually crumble.
Each client’s symptoms are different, and a client can have more than one type of psoriasis.
Common presentations include:
- Red patches
- Scales of cellular buildup
- Cracked, dry skin
- Itching, burning, or soreness
- Thickened, pitted, or ridged nails
- Swollen and stiff joints
The cause is thought to be a malfunctioning immune system, specifically the t-cells and other white blood cells, called neutrophils. It is yet to be discovered what causes t-cells to malfunction in those with psoriasis. Both genetics and environmental factors can play a role.
The primary function of the t-cells is to defend against antigens (foreign substances); with psoriasis, the t-cells mistakenly attack healthy skin cells. These overactive t-cells also trigger the excess proliferation of healthy cells at a rapid pace, causing cellular buildup. They also cause an increase of another white blood cell called a neutrophil, which travels to the affected area contributing to the redness and occasionally pus-filled lesions.
Dilated blood vessels create heat and redness in the affected areas. The cycle is relentless, with rapid skin turnover being three to five days instead of 28 to 32. The skin cells continue to build on the surface forming scaly plaques until the treatment can break the cycle.
- Heavy drinking
- Deficiency of vitamin D
- Medications – including lithium, iodides, beta-blockers, and antimalarial drugs
- Injury to the skin
- Heredity – one parent with the disease increases chances of having it and two parents raise them significantly
- Viral and bacterial infections
- High levels of stress impact the immune system
- Obesity – excess weight increases the risk of psoriasis
- Smoking increases the risk of developing psoriasis and may increase its severity
Psoriatic clients are at higher risk of developing certain diseases including:
- Eye disorders such as conjunctivitis (pink eye) and blepharitis
- Obesity- it is not clear how these diseases are linked; however, weight gain may be contributed to decreased physical activity due to psoriasis
- Type two diabetes
- High blood pressure and heart disease
- Other autoimmune diseases including celiac, sclerosis, and crohn’s disease
- Parkinson’s disease
- Kidney disease – there is a higher risk of development if the client has moderate to severe psoriasis
- Emotional problems, especially low self-esteem and depression
Topical creams can be a consideration for mild to moderate psoriasis, as they will reduce inflammation, dryness, decrease the redness, and decrease cellular buildup. They include:
- Corticosteroids like hydrocortisone
- Vitamin D analogs (other compounds similar to vitamin D)
- Anthralin (used for long-term treatment a synthetic substance that is free of corticosteroids and coal tar)
- Retinoids (vitamin A creams)
- Calcineurin inhibitors (autoimmune suppressors) tacrolimus and pimecrolimus are anti-inflammatory and reduce plaque buildup
- Salicylic acid
- Coal tar
Light therapy treatments use ultraviolet light. The most accessible form of phototherapy is to enjoy brief periods of natural sunlight; both kinds of light therapy slow cell turnover rates. Be sure to follow doctors’ recommendations.
Phototherapy may also include the use of ultraviolet A or ultraviolet B light, alone or in combination with prescription drugs.
- Broadband UVB phototherapy is often used for mild to moderate psoriasis.
- Narrowband UVB phototherapy is a newer treatment form and may be more effective; it requires two to three treatments a week and has the potential to cause more severe burns than broad-spectrum ultraviolet B therapy.
- The combination of UVB treatment and coal tar treatment, as coal tar makes skin more receptive to UVB light.
- Psoralen combined with UVA (PUVA). This treatment combines light-sensitizing medication (psoralen) before exposure to UVA light. UVA light (the aging rays) penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.
- Excimer laser. This form of light therapy treats only damaged skin in the affected areas without harming healthy skin. A controlled beam of UVB light is directed to the psoriasis plaques to control scaling and inflammation. Side effects can include redness and blistering.
SYSTEMIC – ORAL OR INJECTED MEDICATIONS
A doctor may suggest oral or injected drugs for severe or resistant forms of psoriasis.
- Retinoids – vitamin A derivatives help normalize cell turnover.
- Methotrexate works by suppressing inflammation and by decreasing the production of skin cells.
- Cyclosporine suppresses the immune system.
- Biologics – these medications alter the immune system. Enbrel, Humira, Stelara, Otezla, and Cosentyx are a few of the more commonly prescribed biologics.
- When other drugs do not work or cannot be prescribed due to allergies or other factors, thioguanine (tabloid) and hydroxyurea (droxia and hydrea) can be considered as options.
The following anti-inflammatories are beneficial to the psoriatic client: aloe vera, fish oil, (omega-3 fatty acids), and oregon grape (barberry)
Psoriasis can be a very challenging condition for the client. A knowledgeable aesthetician can help educate the client as to the many options available aesthetically and additionally work in conjunction with medical therapies provided by the physician with doctor approval.