Summer is the highlight of the year for many Americans, a time for swimming, sunning, and wearing shorts and T-shirts. On the other hand, millions of people with psoriasis associate summertime with being turned away from swimming pools, hair salons, and restaurants. Those with psoriasis often face discrimination and embarrassment in public places simply because others fear that it is contagious, when in fact, it is not.
Psoriasis, a chronic (life-long) disease, affects the immune system and manifests itself on the skin or in the joints. There is no known cause for the disease, but researchers believe that the immune system, somehow mistakenly triggered, speeds up the growth cycle of skin cells. Instead of taking the normal 28 to 30 days for skin cells to mature and slough off the skin, psoriasis completes this process in three to four days. Instead of the cells falling off, they pile up, forming lesions that become inflamed and are covered with a silvery white scale. Psoriasis varies from person to person and can be limited to a few lesions or affect large areas of the skin. Although the lesions look bad, they are not contagious, neither are they infected nor an open wound.
According to the National Institute of Health, as many as 7.5 million Americans have psoriasis. Although it can develop at any age, psoriasis most often appears between the ages of 15 and 35, with 10% to 15% being diagnosed before the age of 10. This skin disorder affects both men and women, as well as all racial, ethnic, and socio-economic groups.
Although psoriasis can develop on any area of the body, it most commonly involves the elbows, knees, scalp, and torso, causing inflammation and damage to the affected tissue. There are five different forms of psoriasis:
• Plaque Psoriasis accounts for about 80% of cases. Patches of skin, often on the elbows, knees, scalp, and lower back, are raised, red, and covered with silvery scales that shed; they are usually very dry, and may itch, burn, or crack.
• Guttate Psoriasis, which occurs in less than 2% of patients, often starts in childhood and can be triggered by a bacterial or viral infection, such as strep throat, chicken pox, tonsillitis, or even a cold. Patients develop spots of red skin on the abdomen, chest, back, arms, legs, and scalp.
• Pustular Psoriasis occurs in less than 3% of patients. It appears as blisters on the skin, which become reddened and may appear in specific spots, mainly on the hands, feet, or widespread patches on the body.
• Erythrodermic Psoriasis, which also occurs in less than 3% of patients and usually covers most of the body’s surface. The skin becomes fiery red and may be extremely itchy and painful. This form can be very serious and may occur suddenly.
• Inverse Psoriasis, another rare form, produces smooth, dry areas of skin, mainly in the armpits, groin, under the breasts, and in skin folds around the genitals and buttocks. Affected areas become very red and inflamed. Rubbing and sweating can irritate these patches, which can become painful and itchy.
Because the skin is the largest organ of the body, controlling temperature and serving as a barrier to infection, large areas of psoriasis can often lead to infection, fluid loss, and poor circulation. In addition, 10% to 30% of people with psoriasis will develop psoriatic arthritis, which is similar to rheumatoid arthritis but generally milder. In psoriatic arthritis, the joints and the soft tissue around them become inflamed and stiff. Psoriatic arthritis can affect the fingers, toes, ankles, lower back, knees, and the neck. In severe cases, it can be disabling and cause irreversible damage to joints.
Once diagnosed, most people with psoriasis need ongoing treatments by a doctor for the rest of their lives. It is estimated that 56 million hours of work are lost each year by people who suffer from psoriasis. In addition, between $1.6 billion and $3.2 billion is spent every year to treat this disease.
Although researchers are studying psoriasis, its genetic causes, and how it involves the immune system, there is no cure at this time.
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