What is psoriasis

What is psoriasis?

Psoriasis is a distressing and chronic skin condition that is characterised by patches of thickened red, scaly patches of skin called plaques.1

The skin is made of three main layers:

Cross-section of the skin
Cross-section of the skin          © 2008 A.D.A.M., Inc


Every 28-30 days, the skin renews itself with new cells being formed at the bottom layer which then mature and rise to the top layer over the 30 day period. With psoriasis, the renewal process is accelerated and psoriatic cells can develop and reach the skin surface in just three to five days.2 While normal skin cells are shed unnoticed, psoriasis skin cells build up and form the characteristic raised, scaly lesions or plaques.2 Psoriasis can occur on any part of the body, although the elbows, knees and scalp are the most common sites.2

Psoriasis can be limited to small areas of the body or cover moderate to large areas of skin and is classed from mild to severe. 3,4


What causes psoriasis?

The cause of psoriasis is not fully understood. However, there is substantial evidence that the process of accelerated cell renewal is driven by the over-production of a substance known as tumour-necrosis-factor alpha or TNF-alpha.1,2 TNF-alpha is involved in controlling the inflammation process and in normal amounts, it can help our bodies fight infection and repair itself. 

It is believed that people with psoriasis may have a genetic pre-disposition for the disease1,5,6 and can also have their condition triggered by environmental factors. The triggers may include stress, infection with certain viruses and bacteria, skin injury or reactions to certain medications.2

Psoriasis affects more than five million men and women in Europe.7 Symptoms can first appear at any time in life, but more than a third of patients report psoriasis beginning before the age of 16.8

The unseen impact of psoriasis

It’s easy to see the physical effects of psoriasis.  What most people do not realise is that the disease has a serious emotional and psychological impact as well.  People with psoriasis report feeling embarrassed and stigmatised because of their skin and experience anxiety and stress as a result of reactions from the public.6  This embarrassment makes people with psoriasis want to cover-up: some change their entire wardrobes and buy only clothes that will hide their skin from others.  At the extreme, psoriasis can cause people to give up their favourite hobbies or even withdraw from society to avoid the hurtful stares, insensitive comments and the constant need to explain the appearance of their skin.9

Psoriasis has been linked to an increased risk of developing a number of other conditions such as obesity,7,10 type 2 diabetes7,10 and depression.6,8

In addition, results from a recent European survey have shown that moderate to severe psoriasis patients tend to make poor health choices in their daily lives: they are more likely to smoke, less likely to exercise regularly and less likely to maintain a healthy diet.11

Psoriasis may also be an independent risk factor for heart attack, particularly in younger people with severe psoriasis. Patients in their 40s with severe psoriasis are more likely to suffer a heart attack as people without the skin disease.12

References:

  1. Gottlieb, A. Psoriasis: Emerging Therapeutic Therapies, Nature Reviews volume 4, January 2005
  2. Schön MP, Boehncke WH. Psoriasis. N Engl J Med. 2005;352: 1899-912
  3. The National Psoriasis Foundation. About Psoriasis: Frequently Asked Questions http://www.psoriasis.org/about/faq/ Accessed February 2009
  4. The Psoriasis Association. What is Psoriasis? http://www.psoriasis-association.org.uk/what-is.html. Accessed February 2009
  5. Lebwohl M. Psoriasis. The Lancet. 2003; 361: 1197–204
  6. Richards HL et al. The contribution of perceptions of stigmatization to disability in patients with psoriasis. J Psychosom Res. 2001; 50:11-15
  7. Christophers E. Psoriasis - Epidemiology and Clinical Spectrum. Clin Exp Dermatol. 2001; 26:314–320
  8. Paller, AS et al. Etanercept treatment for children and adolescents with plaque psoriasis. N Engl J Med 2008; 358:241-51
  9. Wyeth data on file
  10. Mrowietz U et al. The importance of disease associations and concomitant therapy for the long-term management of psoriasis patients. Arch Dermatol Res. 2006; 298:309-319
  11. Dauden E. et al. Moderate to sever psoriasis patients are more likely to smoke, less likely to exercise regularly and less likely to maintain a healthy diet than normal controls. Abstract FP 1233 from the European Association for Dermatology and Venereology Congress, September 2008
  12. Gefland J et al. Risk of myocardial infarction in patients with psoriasis. J Am Med Assoc. 2006; 296:1735-1741

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