Content deleted Content added
m +map |
No edit summary |
||
Line 1:
{{Infobox_Disease
| Name = Psoriasis
| Image = Psoriasis_on_back.jpg
| Caption = A young man whose back and arms are affected by psoriasis.
| DiseasesDB = 10895
| ICD10 = {{ICD10|L|40||l|40}}
| ICD9 = {{ICD9|696}}
| ICDO =
| OMIM = 177900
| MedlinePlus = 000434
| eMedicineSubj = emerg
| eMedicineTopic = 489
| eMedicine_mult = Dermatology:{{eMedicine2|derm|365}} plaque<br>{{eMedicine2|derm|361}} guttate<br>{{eMedicine2|derm|363}} nails<br> {{eMedicine2|derm|366}} pustular<br>Arthritis {{eMedicine2|derm|918}}<br>Radiology {{eMedicine2|radio|578}}<br>Physical Medicine {{eMedicine2|pmr|120}}
| MeshID =
}}
'''Psoriasis''' ([[International Phonetic Alphabet|IPA pronunciation]]: {{IPA|[sə'raɪ.əsɪs]}}) is a disease which affects the [[skin]] and [[joint]]s. It is [[hypothesized]] to be [[immune-mediated disease|immune-mediated]].<ref name=Hunziker>Hunziker T, Schmidli J. Psoriasis, an autoimmune disease? ''Ther Umsch''. 1993 Feb;50(2):110-3. PMID 8456414</ref> It commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis, called psoriatic plaques, are areas of [[inflammation]] and excessive skin production. Skin rapidly accumulates at these sites and takes a silvery-white appearance. Plaques frequently occur on the skin of the [[Elbow-joint|elbows]] and [[knee]]s, but can affect any area including the [[scalp]] and [[sex organ|genitals]]. Psoriasis is not contagious.
The [[disease|disorder]] is a [[chronic (medicine)|chronic]] recurring condition which varies in severity from minor localised patches to complete body coverage. [[Nail (anatomy)|Fingernails]] and toenails are frequently affected (psoriatic nail dystrophy). Psoriasis can also cause inflammation of the joints, which is known as [[psoriatic arthritis]]. Ten to fifteen [[percentage|percent]] of people with psoriasis have psoriatic arthritis.
The cause of psoriasis is not known, but it is believed to have a [[genetics|genetic]] component. Several factors are thought to aggravate psoriasis. These include [[stress (medicine)|stress]], [[alcohol consumption and health|excessive alcohol consumption]], and [[Tobacco smoking|smoking]]. Individuals with psoriasis may suffer from [[clinical depression|depression]] and loss of [[self-esteem]]. As such, [[quality of life]] is an important factor in evaluating the severity of the disease. There are many treatments available but because of its chronic recurrent nature psoriasis is a challenge to treat.
==History==
Psoriasis is probably one of the longest known illnesses of humans and simultaneously one of the most misunderstood. Some scholars believe psoriasis to have been included among the skin conditions called [[tzaraath|tzaraat]] in the [[Bible]].<ref name=Shai>{{cite journal |author=Shai A, Vardy D, Zvulunov A |title=[Psoriasis, biblical afflictions and patients' dignity] |language=Hebrew |journal=Harefuah |volume=141 |issue=5 |pages=479-82, 496 |year=2002 |pmid=12073533 |doi=}}</ref> In more recent times psoriasis was frequently described as a variety of [[leprosy]]. The Greeks used the term lepra (λεπρα) for scaly skin conditions. They used term psora for itchy conditions. It became known as ''Willan's lepra'' in the late 18th century when English [[dermatologist]]s [[Robert Willan]] and Thomas Bateman differentiated it from other skin diseases. They assigned names to the condition based on the appearance of lesions. Willan identified two categories: ''leprosa graecorum'' and ''psora leprosa''.
While it may have been visually, and later [[semantics|semantically]], confused with [[leprosy]] it was not until [[1841]] that the condition was finally given the name ''psoriasis'' by the [[Vienna|Viennese]] dermatologist [[Ferdinand Ritter von Hebra|Ferdinand von Hebra]]. The name is derived from the [[Greek language|Greek]] word ''psora'' which means ''to itch''.<!--
--><ref name=Glickman>{{cite journal |author=Glickman FS |title=Lepra, psora, psoriasis |journal=J. Am. Acad. Dermatol. |volume=14 |issue=5 Pt 1 |pages=863-6 |year=1986 |pmid=3519699 |doi=}}</ref>
It was during the 20th century that psoriasis was further differentiated into specific types.
==Types of psoriasis==
The symptoms of psoriasis can manifest in a variety of forms. Variants include plaque, pustular, guttate and flexural psoriasis. This section describes each type (with [[ICD|ICD-10]] code [http://web.ilds.org/icd10_list.php?VIEW=1&START_CODE=L40.0&START_EXT=00]).
[[Image:Psoriasis.jpg|framed|right|146px|Photograph of an arm covered with plaque psoriasis.]]
'''Plaque psoriasis (psoriasis vulgaris) (L40.0)''' is the most common form of psoriasis. It affects 80 to 90% of people with psoriasis. Plaque psoriasis typically appears as raised areas of inflamed skin covered with silvery white scaly skin. These areas are called plaques.
'''Flexural psoriasis (inverse psoriasis) (L40.83-4)''' appears as smooth inflamed patches of skin. It occurs in [[skin fold]]s, particularly around the [[genitals]] (between the thigh and groin), the [[armpits]], under an overweight stomach ([[pannus]]), and under the [[breasts]] ([[inframammary fold]]). It is aggravated by [[friction]] and [[sweat]], and is vulnerable to [[fungal infection]]s.
'''Guttate psoriasis (L40.4)''' is characterized by numerous small oval (teardrop-shaped) spots. These numerous spots of psoriasis appear over large areas of the body, such as the trunk, limbs, and [[scalp]]. Guttate psoriasis is associated with [[Strep throat|streptococcal throat]] infection.
'''Pustular psoriasis (L40.1-3, L40.82)''' appears as raised bumps that are filled with non-infectious pus (pustules). The skin under and surrounding pustules is red and tender. Pustular psoriasis can be localised, commonly to the hands and feet ([[palmoplantar pustulosis]]), or generalised with widespread patches occurring randomly on any part of the body.
'''Nail psoriasis (L40.86)''' produces a variety of changes in the appearance of finger and toe nails. These changes include discolouring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail, and the loosening ([[onycholysis]]) and crumbling of the nail.
'''[[Psoriatic arthritis]] (L40.5)''' involves joint and [[connective tissue]] [[inflammation]]. Psoriatic arthritis can affect any joint but is most common in the joints of the fingers and toes. This can result in a sausage-shaped swelling of the fingers and toes known as [[dactylitis]]. Psoriatic arthritis can also affect the hips, knees and spine ([[spondylitis]]). About 10-15% of people who have psoriasis also have psoriatic arthritis.
'''Erythrodermic psoriasis (L40.85)''' involves the widespread inflammation and exfoliation of the skin over most of the body surface. It may be accompanied by severe itching, swelling and pain. It is often the result of an exacerbation of unstable plaque psoriasis, particularly following the abrupt withdrawal of systemic treatment. This form of psoriasis can be fatal, as the extreme inflammation and exfoliation disrupt the body's ability to regulate temperature and for the skin to perform barrier functions.
==Diagnosis==
A [[diagnosis]] of psoriasis is usually based on the appearance of the skin. There are no special blood tests or diagnostic procedures for psoriasis. Sometimes a skin [[biopsy]], or scraping, may be needed to rule out other disorders and to confirm the diagnosis. Skin from a biopsy will show clubbed [[Rete peg]]s if positive for psoriasis.
[[Image:Psoriasis severity.jpg|thumb|right|400px|Pie chart showing the distribution of severity among people with psoriasis.]]
==Severity==
Psoriasis is usually graded as mild (affecting less than 3% of the body), moderate (affecting 3-10% of the body) or severe. Several scales exist for measuring the severity of psoriasis. The degree of severity is generally based on the following factors: the proportion of body surface area affected; disease activity (degree of plaque redness, thickness and scaling); response to previous therapies; and the impact of the disease on the person.
The Psoriasis Area Severity Index (PASI) is the most widely used measurement tool for psoriasis. PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease).
==Effect on the quality of life==
Psoriasis has been shown to affect health-related quality of life to an extent similar to the effects of other chronic diseases such as [[clinical depression|depression]], [[myocardial infarction]], [[hypertension]], [[congestive heart failure]] or [[type 2 diabetes]]. Depending on the severity and ___location of outbreaks, individuals may experience significant physical discomfort and some disability. Itching and pain can interfere with basic functions, such as self-care, [[walking]], and [[sleep]]. Plaques on [[hands]] and [[foot|feet]] can prevent individuals from working at certain occupations, playing some [[sports]], and caring for family members or a home. The frequency of medical care is costly and can interfere with an employment or school schedule.
Individuals with psoriasis may also feel self-conscious about their appearance and have a poor self-image that stems from fear of public rejection and psychosexual concerns. Psychological distress can lead to significant [[clinical depression|depression]] and social isolation.
==Epidemiology==
Psoriasis affects both [[sex]]es equally and can occur at any [[ageing|age]], although it most commonly appears for the first time between the ages of 15 and 25 years.
The [[prevalence]] of psoriasis in Western populations is estimated to be around 2-3%. A [[statistical survey|survey]] [http://www.psoriasis.org/files/pdfs/press/npfsurvey.pdf] conducted by the [[National Psoriasis Foundation]] (a [[United States|US]] based psoriasis [[education]] and [[Interest group|advocacy group]], which is partly funded by [[pharmaceutical company|pharmaceutical companies]]) found a prevalence of 2.1% among [[adult]] [[United States|Americans]]. The study also found that 35% of people with psoriasis could be classified as having moderate to severe psoriasis.
Around one-third of people with psoriasis report a [[family history (medicine)|family history]] of the disease, and researchers have identified genetic [[locus (genetics)|loci]] associated with the condition. Studies of [[twin|monozygotic twins]] suggest a 70% chance of a twin developing psoriasis if the other twin has psoriasis. The [[concordance (genetics)|concordance]] is around 20% for [[twin|dizygotic twins]]. These findings suggest both a genetic predisposition and an environmental response in developing psoriasis.<!--
--><ref name=Krueger>{{cite journal |author=Krueger G, Ellis CN |title=Psoriasis--recent advances in understanding its pathogenesis and treatment |journal=J. Am. Acad. Dermatol. |volume=53 |issue=1 Suppl 1 |pages=S94-100 |year=2005 |pmid=15968269 |doi=10.1016/j.jaad.2005.04.035}}</ref>
Onset before age 40 usually indicates a greater genetic susceptibility and a more severe or recurrent course of psoriasis.
==Cause==
The cause of psoriasis is not fully understood. There are two main hypotheses about the process that occurs in the development of the disease. The first considers psoriasis as primarily a disorder of excessive growth and reproduction of skin cells. The problem is simply seen as a fault of the [[epidermis (skin)|epidermis]] and its [[keratinocytes]]. An alternate viewpoint sees the disease as being an [[immune-mediated disease|immune-mediated disorder]] in which the excessive reproduction of skin cells is secondary to factors produced by the [[immune system]]. It is thought that [[T cell]]s (which normally help protect the body against infection) become active, migrate to the [[dermis]] and trigger the release of [[cytokines]] ([[tumor necrosis factor|tumor necrosis factor-alpha TNFα]], in particular) which cause inflammation and the rapid production of skin cells. It is not known what initiates the activation of the T cells.
The immune-mediated model of psoriasis has been supported by the observation that [[immunosuppressant]] medications can clear psoriasis plaques. However, the role of the immune system is not fully understood, and it has recently been reported that an [[animal model]] of psoriasis can be triggered in mice lacking T cells.<!--
--><ref name=Zenz>{{cite journal |author=Zenz R, Eferl R, Kenner L, ''et al'' |title=Psoriasis-like skin disease and arthritis caused by inducible epidermal deletion of Jun proteins |journal=Nature |volume=437 |issue=7057 |pages=369-75 |year=2005 |pmid=16163348 |doi=10.1038/nature03963}}</ref> [[Animal model]]s, however, reveal only a few aspects resembling human psoriasis.
Psoriasis is a fairly [[idiosyncratic]] disease. The majority of people's experience of psoriasis is one in which it may worsen or improve for no apparent reason. Studies of the factors associated with psoriasis tend to be based on small (usually hospital based) samples of individuals. These studies tend to suffer from representative issues, and an inability to tease out [[causal]] associations in the face of other (possibly unknown) intervening factors. Conflicting findings are often reported. Nevertheless, the first outbreak is sometimes reported following [[stress (medicine)|stress]] (physical and mental), skin injury, and [[streptococcal infection]]. Conditions that have been reported as accompanying a worsening of the disease include infections, stress, and changes in season and [[climate]]. Certain medicines, including [[lithium salt]] and [[beta blocker]]s, have been reported to trigger or aggravate the disease. Excessive alcohol consumption, smoking and obesity may exacerbate psoriasis or make the management of the condition difficult.
[[Image:Treatment ladder.png|thumb|450px|right|Schematic of psoriasis treatment ladder]]
==Treatment==
There can be substantial variation between individuals in the effectiveness of specific psoriasis treatments. Because of this, [[Dermatology|dermatologists]] often use a trial-and-error approach to finding the most appropriate treatment for their patient. The decision to employ a particular treatment is based on the type of psoriasis, its ___location, extent and severity. The patient’s age, gender, quality of life, [[comorbidities]], and attitude toward risks associated with the treatment are also taken into consideration.
Medications with the least potential for adverse reactions are preferentially employed. If the treatment goal is not achieved then therapies with greater potential [[toxicity]] may be used. Medications with significant toxicity are reserved for severe unresponsive psoriasis. This is called the psoriasis treatment ladder.<!--
--><ref name=Lofholm>{{cite journal |author=Lofholm PW |title=The psoriasis treatment ladder: a clinical overview for pharmacists. |journal=US Pharm |year=2000 |volume=25 |issue=5 |pages=26-47 |url=http://www.uspharmacist.com/oldformat.asp?url=newlook/files/Feat/apr00pro.cfm&pub_id=8&article_id=511}}</ref> As a first step, medicated [[ointment]]s or creams are applied to the skin. This is called topical treatment. If topical treatment fails to achieve the desired goal then the next step would be to expose the skin to [[ultraviolet]] (UV) radiation. This type of treatment is called [[phototherapy]]. The third step involves the use of medications which are ingested orally or by [[Injection (medicine)|injection]]. This approach is called systemic treatment.
Over time, psoriasis can become resistant to a specific therapy. Treatments may be periodically changed to prevent resistance developing ([[tachyphylaxis]]) and to reduce the chance of adverse reactions occurring. This is called treatment rotation.
===Topical treatment===
Bath solutions and [[moisturizer]]s help sooth affected skin and reduce the dryness which accompanies the build-up of skin on psoriatic plaques. Medicated creams and ointments applied directly to psoriatic plaques can help reduce inflammation, remove built-up scale, reduce skin turn over, and clear affected skin of plaques. Ointment and creams containing [[coal tar]], [[dithranol]] (anthralin), [[corticosteroid]]s, [[vitamin D]]<sub>3</sub> analogues (for example, [[calcipotriol]]), and [[retinoid]]s are routinely used. The [[mechanism of action]] of each is probably different but they all help to normalise skin cell production and reduce inflammation. Activated vitamin D and its analogues are highly effective inhibitors of skin cell proliferation.
The disadvantages of topical agents are variably that they can often [[irritation|irritate]] normal skin, can be time consuming and awkward to apply, cannot be used for long periods, can [[stain]] [[clothing]] or have a strong [[odor|odour]]. As a result, it is sometimes difficult for [[people]] to maintain the regular application of these medications. Abrupt withdrawal of some topical agents, particularly corticosteroids, can cause an aggressive recurrence of the condition. This is known as a [[withdrawal|rebound]] of the condition.
Some topical agents are used in conjunction with other therapies, especially phototherapy.
===Phototherapy===
It has long been recognised that daily, short, non-burning exposure to [[sunlight]] helped to clear or improve psoriasis. [[Niels Ryberg Finsen|Niels Finsen]] was the first [[physician]] to investigate the therapeutic effects of sunlight scientifically and to use sunlight in clinical practice. This became known as [[phototherapy]].
[[Sunlight]] contains many different [[wavelength]]s of light. It was during the early part of the 20th century that it was recognised that for psoriasis the therapeutic property of sunlight was due to the wavelengths classified as [[ultraviolet|ultraviolet (UV)]] light.
Ultraviolet wavelengths are subdivided into UVA (380–315 nm), UVB (315–280 nm), and UVC (< 280 nm). Ultraviolet B (UVB) (315–280 nm) is absorbed by the [[epidermis (skin)|epidermis]] and has a beneficial effect on psoriasis. Narrowband UVB (311 to 312 nm), is that part of the UVB spectrum that is most helpful for psoriasis. Exposure to UVB several times per week, over several weeks can help people attain a remission from psoriasis.
Ultraviolet light treatment is frequently combined with topical (coal tar, calcipotriol) or systemic treatment (retinoids) as there is a [[synergy]] in their combination. The Ingram regime, involves UVB and the application of [[anthralin]] paste. The Goeckerman regime combines coal tar ointment with UVB.
===Photochemotherapy===
[[Psoralen]] and ultraviolet A phototherapy ([[PUVA]]) combines the oral or topical administration of psoralen with exposure to ultraviolet A (UVA) light. Precisely how PUVA works is not known. The [[mechanism of action]] probably involves activation of psoralen by UVA light which inhibits the abnormally rapid production of the cells in psoriatic skin. There are multiple mechanisms of action associated with PUVA, including effects on the skin immune system.
Dark glasses must be worn during PUVA treatment because there is a risk of [[cataracts]] developing from exposure to sunlight{{Fact|date=February 2007}}. PUVA is associated with [[nausea]], [[headache]], [[Fatigue (physical)|fatigue]], burning, and itching. Long-term treatment is associated with [[Squamous cell carcinoma|squamous-cell]] and [[melanoma]] [[skin cancer]]s.
===Systemic treatment===
Psoriasis which is resistant to [[topical|topical treatment]] and [[light therapy|phototherapy]] is treated by [[medication]]s that are taken internally by [[pill]] or [[Injection (medicine)|injection]]. This is called systemic treatment. Patients undergoing systemic treatment are required to have regular [[Blood test|blood]] and [[liver function tests]] because of the [[toxicity]] of the [[medication]]. [[Pregnancy]] must be avoided for the majority of these treatments. Most people experience a recurrence of psoriasis after systemic treatment is discontinued.
The three main traditional systemic treatments are the [[immunosuppressive drug|immunosupressant]] drugs [[methotrexate]] and [[ciclosporin]], and [[retinoids]], which are synthetic forms of [[vitamin A]]. Other additional drugs, not specifically licensed for psoriasis, have been found to be [[effectiveness|effective]]. These include the [[antimetabolite]] [[tioguanine]], the [[cytotoxic]] agent [[hydroxyurea]], [[sulfasalazine]], the [[immunosuppressive drug|immunosupressants]] [[mycophenolate mofetil]], [[azathioprine]] and oral [[tacrolimus]]. These have all been used [[effectiveness|effectively]] to treat psoriasis when other treatments have failed. Although not licensed in many other countries [[fumaric acid|fumaric acid esters]] have also been used to treat severe psoriasis in [[Germany]] for over 20 years.
[[Biologics]] are manufactured proteins that interrupt the immune process involved in psoriasis. Unlike generalised [[immunosuppressive drug|immunosuppressant]] therapies such as methotrexate, biologics focus on specific aspects of the immune function leading to psoriasis. These drugs are relatively new, and their long-term impact on immune function is unknown. They are very expensive and only suitable for very few patients with psoriasis.
===Alternative therapy===
*[[Antibiotics]] are not indicated in routine treatment of psoriasis. However, antibiotics may be employed when an infection, such as that caused by the bacteria [[Streptococcus]], triggers an outbreak of psoriasis, as in certain cases of guttate psoriasis.
*Climatotherapy involves the notion that some diseases can be successfully treated by living in particular [[climate]]. Several psoriasis clinics are located throughout the world based on this idea. The [[Dead Sea]] is one of the most popular locations for this type of treatment.
*A new natural option for mild to moderate psoriasis relief with clinically proven efficacity and safety is XP-828L, which is extracted through a patented process from whey and has an immuno-regulatory effect.<ref>{{cite journal |author=Poulin Y, Bissonnette R, Juneau C, Cantin K, Drouin R, Poubelle PE |title=XP-828l in the treatment of mild to moderate psoriasis: randomized, double-blind, placebo-controlled study |journal=Journal of cutaneous medicine and surgery |volume=10 |issue=5 |pages=241-8 |year=2006 |pmid=17234108 |doi=}}</ref><ref>{{cite journal |author=Poulin Y, Pouliot Y, Lamiot E, Aattouri N, Gauthier SF |title=Safety and efficacy of a milk-derived extract in the treatment of plaque psoriasis: an open-label study |journal=Journal of cutaneous medicine and surgery |volume=9 |issue=6 |pages=271-5 |year=2005 |pmid=16699908 |doi=10.1007/s10227-005-0103-6}}</ref><ref>Further commercial details from [http://www.naturalpsoriasisinfo.com Natural Psoriasisi Info] and [http://www.dermylex.com Dermylex]</ref>
*In [[Turkey]], [[doctor fish]] which live in the outdoor pools of spas, are encouraged to feed on the psoriatic skin of people with psoriasis. The fish only consume the affected areas of the skin. The outdoor ___location of the spa may also have a beneficial effect. This treatment can provide temporary relief of symptoms. A revisit to the spas every few months is often required.
*Some people subscribe to the view that psoriasis can be effectively managed through a healthy lifestyle. This view is based on [[anecdote]], and has not been subjected to formal scientific evaluation. Nevertheless, some people report that minimizing stress and consuming a healthy diet, combined with rest, sunshine and swimming in saltwater keep lesions to a minimum. This type of "lifestyle" treatment is suggested as a long-term management strategy, rather than an initial treatment of severe psoriasis.
*A number of patients have reported significant improvements from sun and sea water: unfortunately, salt alone does not have any effect. Sea water contains so many minerals and different life forms (thousands of species of bacteria alone [http://www.abc.net.au/science/news/stories/2006/1702359.htm]) that it will be hard to determine which of these is causing the observed effects. Interestingly, people in the tropics differentiate between "live" and "dead" sea water: "live" sea water is water that has never been covered.
*Some psoriasis patients use [[herbology]] as a holistic approach that aims to treat the underlying causes of psoriasis.
*A psychological symptom management programme has been reported as being a helpful adjunct to traditional therapies in the management of psoriasis.[http://www.refer.nhs.uk/ViewRecord.asp?ID=637&Print=1]
*It is claimed that [[Magnesium sulfate|Epsom salt]] may have a positive effect in reducing the effects of psoriasis.{{Fact|date=February 2007}}
*The use of [[Neem oil]] in [[India]] has been in documented use for 6000 years.{{Fact|date=February 2007}} There are claims that this "documented use" is fraudulent claims by sellers of Neem oil.[http://www.pinch.com/skin/pshame.html#neem]
*It is claimed that yoga and meditative practices help psoriasis patients by 'detoxifying' the body and by the reduction of stress.{{Fact|date=February 2007}}
* Sulphur has been used for many years as a safe treatment in the alleviation of Psoriasis.
==Historical treatment==
The history of psoriasis is littered with treatments of dubious effectiveness and high toxicity. These treatments received brief popularity at particular time periods or within certain geographical regions. The application of [[cat]] [[faeces]] to red lesions on the skin, for example, was one of the earliest topical treatments employed in ancient [[Egypt]]. Onions, sea salt and [[urine]], goose oil and [[semen]], wasp droppings in [[sycamore]] milk, and soup made from [[Viperidae|viper]]s have all been reported as being ancient treatments.
In the more recent past [[Fowler's solution]], which contains a [[poisonous]] and [[carcinogenic]] [[arsenic]] compound, was used by dermatologists as a treatment for psoriasis during the 18th and 19th centuries. [[Grenz Rays]] (also called ultrasoft X-rays or Bucky rays) was a popular treatment of psoriasis during the middle of the 20th century. This type of therapy was superseded by ultraviolet therapy.
[[Undecylenic acid]] was investigated and used for psoriasis some 40 years ago.<ref>{{cite journal | author=Ereaux L, Craig G | title=The Oral Administration Of Undecylenic Acid In The Treatment Of Psoriasis | journal=Canad. M. A. J. | year=1949 | month=Oct | volume=61 | pages=361-4 | url=http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1591667&blobtype=pdf | format=PDF | accessdate=2007-01-05}} - see page 4/364 of link</ref>
All these treatments have fallen out of favour.
One alternative treatment, fashionable in the Victorian and Edwardian eras, was Sulphur. Recently Sulphur has re-gained some credibilty as a safe alternative to steroids and coal tar.
==Future drug development==
Historically, agents used to treat psoriasis were discovered by experimentation or by accident. In contrast, current novel therapeutic agents are designed from a better understanding of the immune processes involved in psoriasis and by the specific targeting of molecular mediators. Examples can be seen in the use of biologics which target T cells and TNF inhibitors.
Future innovation should see the creation of additional drugs that refine the targeting of immune-mediators further.<!--
--><ref name=Nickoloff>{{cite journal |author=Nickoloff BJ, Nestle FO |title=Recent insights into the immunopathogenesis of psoriasis provide new therapeutic opportunities |journal=J. Clin. Invest. |volume=113 |issue=12 |pages=1664-75 |year=2004 |pmid=15199399 |doi=10.1172/JCI200422147}}</ref>
Research into [[oligonucleotide|antisense oligonucleotide]]s carries the potential to provide novel therapeutic strategies for treating psoriasis.<!--
--><ref name=White>{{cite journal |author=White PJ, Atley LM, Wraight CJ |title=Antisense oligonucleotide treatments for psoriasis |journal=Expert opinion on biological therapy |volume=4 |issue=1 |pages=75-81 |year=2004 |pmid=14680470 |doi=10.1517/14712598.4.1.75}}</ref>
==Prognosis==
Psoriasis is a lifelong condition.<ref>{{cite journal|author=Jobling R|title=A patient's journey:Psoriasis|journal=Br Med J|year=2007|volume=334|pages=953–4|doi=10.1136/bmj.39184.615150.802}}</ref> There is currently no cure but various treatments can help to control the symptoms. Many of the most effective agents used to treat severe psoriasis carry an increased risk of significant morbidity including skin cancers, [[lymphoma]] and liver disease. However, the majority of people's experience of psoriasis is that of minor localized patches, particularly on the elbows and knees, which can be treated with topical medication. Psoriasis does get worse over time but it is not possible to predict who will go on to develop extensive psoriasis or those in whom the disease may appear to vanish. Individuals will often experience flares and remissions throughout their life. Controlling the signs and symptoms typically requires lifelong therapy.
According to one study,<ref>{{cite journal |author=Olsen JH, Frentz G, Møller H |title=[Psoriasis and cancer] |language=Danish |journal=Ugeskr. Laeg. |volume=155 |issue=35 |pages=2687-91 |year=1993 |pmid=8212383 |doi=}}</ref> psoriasis is linked to 2,5-fold increased risk for nonmelanoma skin cancer in men and women, with no preponderance of any specific histologic subtype of cancer. This, however could be linked to antipsoriatic treatment.
[[Image:Tegrin1964.jpg|right|thumb|100px|1964 Tegrin advertisement]]
=="The heartbreak of psoriasis"==
The phrase "the heartbreak of psoriasis" is often used both seriously and [[Irony|ironically]] to describe the emotional impact of the disease. It may include both the effect of having a chronic uncomfortable disorder and the social effects of being self conscious of one's appearance. The term can be found in various advertisements for topical and other treatments; conversely, it has been used to mock the tendency of advertisers to exaggerate (or even fabricate) aspects of a malady for financial gain. While many products today use the phrase in their advertising, it originated in a 1960s advertising campaign for Tegrin, a [[coal tar]]-based ointment.
== See also ==
* [[Anti-itch drug]]
==References==
*[http://web.ilds.org/icd10_list.php?VIEW=1&START_CODE=L40.0&START_EXT=00 "Application to dermatology of International Classification of Disease (ICD-10) - ICD sorted by code: L40.000 - L41.000"], The International League of Dermatological Societies
*[http://www.psoriasis.org/files/pdfs/press/npfsurvey.pdf "Benchmark survey on psoriasis and psoriatic arthritis - summary of top-line results"], National Psoriasis Foundation
*[http://www.refer.nhs.uk/ViewRecord.asp?ID=637&Print=1 "The efficacy of a psychological symptom management programme for the treatment of psoriasis"], The Department of Health Research Findings electronic Register (ReFeR)
''Some of the information on this page was taken from the following public-___domain resource:''
*[http://www.niams.nih.gov/hi/topics/psoriasis/psoriasis.htm "Questions and Answers about Psoriasis"], National Institute of Arthritis and Musculoskeletal and Skin Diseases
''Information for children:''
*[http://www.psoriasis.org/about/youth/kids/ "NPF page for parents and children"] National Psoriasis Foundation
*[http://psoriasis-cure-now.org/psoriasiskids.php "PCN Psoriasis kids page"] Psoriasis Cure Now
''For descriptions of psoriasis and psoriasis treatments:''
*{{cite journal | author=Luba KM, Stulberg DL. | title=Chronic plaque psoriasis| journal=American Family Physician | volume=73 | issue=4 | year=2006 | pages=636-44 | pmid=16506705}}
*{{cite journal | author=Lebwohl M, Ting PT, Koo JYM. | title=Psoriasis treatment: traditional therapy| journal=Ann Rheum Dis. | volume=64 | issue=Suppl 2 | year=2005 | pages=ii83-6 | pmid=15708945}}
*[http://www.signalsmag.com/signalsmag.nsf/0/59D864E70A7D28DB88256B020013FA6B "The heartbreak of psoriasis"], Signals Magazine 2001 - the online magazine of biotechnology industry analysis
*[http://www.psoriasis.org/treatment/psoriasis/biologics/about.php "About biologics."], National Psoriasis Foundation
''For descriptions of immune processes involved in psoriasis:''
*{{cite journal | author=Griffiths CE, Voorhees JJ.| title=Psoriasis, T cells and autoimmunity| journal=J R Soc Med.| volume=89 | issue=6| year=1996 | pages=315-9 | pmid=8758188 }}
==
<!--This article uses the Cite.php citation mechanism. For more information, please see http://meta.wikimedia.org/wiki/Cite/Cite.php -->
<div class="references-small">
<references
</div>
==
<!-- Please read http://en.wikipedia.org/wiki/WP:EL before adding links. Specifically, links to commercial sites and forums are strongly discouraged. Wikipedia is not a collection of links, no matter how useful/helpful. -->
=== Research and non-commercial ===
* [http://www.niams.nih.gov/hi/topics/psoriasis/ffpsoriasis.htm National Institute of Arthritis and Musculoskeletal and Skin Diseases' Homepage]
* [http://www.psoriasis.org/home/ National Psoriasis Foundation Homepage]
* [http://www.psoriasis-cure-now.org/ Psoriasis Cure Now Homepage]
* [http://www.psoriasis-association.org.uk The Psoriasis Association]
* [http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=7 Dermatlas: Psoriasis Images]
* [http://www.psoriasis-help.org.uk Psoriasis Help Organisation], a private patient information and discussion site
[[Category:
{{Diseases of the skin and subcutaneous tissue}}
[[ar:صدفية]]
[[ca:Psoriasi]]
[[cs:Psoriáza]]
[[da:Psoriasis]]
[[de:Schuppenflechte]]
[[es:Psoriasis]]
[[eo:Psoriazo]]
[[fr:Psoriasis]]
[[hr:Psorijaza]]
[[it:Psoriasi]]
[[he:פסוריאזיס]]
[[lt:Žvynelinė]]
[[nl:Psoriasis]]
[[ja:乾癬]]
[[no:Psoriasis]]
[[pl:Łuszczyca]]
[[pt:Psoríase]]
[[ru:Псориаз]]
[[simple:Psoriasis]]
[[fi:Psoriasis]]
[[sv:Psoriasis]]
[[vi:Bệnh vẩy nến]]
[[tr:Sedef hastalığı]]
[[zh:牛皮癬]]
| |||