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November 2004, Volume 34 Number 11 , p 18 - 19





  • First-line treatment options

  • Stepping up therapy

  • Easing the heartbreak

  • The many faces of psoriasis




  • Figure. Scaling lesi...

    AN IMMUNE-MEDIATED, noncontagious chronic disease of the skin or joints, psoriasis affects an estimated 5.5 million people in the United States. Although usually mild and manageable with treatment, psoriasis can also be severe and disabling. Patients may be embarrassed by visible lesions and withdraw from social contacts.

    Plaque psoriasis, the most familiar form, produces thick, raised erythematous lesions covered with silvery white scales. The well-defined lesions, which may be itchy, can appear anywhere, but the most common areas are the scalp, knees, elbows, and torso. Facial lesions are rare.

    Lesions result from abnormal skin proliferation. Normally, keratinocytes migrate from the basal cell layer to the stratum corneum of the epidermis in 26 to 30 days. In psoriasis, this cycle takes only 3 to 4 days. Some experts think psoriasis is a primary immunologic disorder that leads to epidermal hyperproliferation.

    Psoriasis occurs in various forms (see The Many Faces of Psoriasis ), and a person may have more than one form of psoriasis at the same time. The clinical course can wax and wane, with outbreaks triggered by such events as skin injury, psychological stress, drugs, vaccines, or infection.

    First-line treatment options

    Topical treatment, the first line of defense, includes a psoriasis skin-care regimen of emollients and soap substitutes to moisturize the skin. Creams work well on the face and in skin folds; ointments are a better choice for the trunk and limbs because they conserve moisture and can contain fewer preservatives than creams.

    Topical drugs include:

    * coal tar preparations, ...

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