Psoriasis Report
Tyler Orosz
April 18, 2011
Mrs. Ulrey; Santiago High School
How would you feel to be covered in bleeding, itchy, and silvery scales? The autoimmune disease, Psoriasis, is a chronic skin disorder in which there is currently no cure. There are four main types of Psoriasis: Plaque Psoriasis, Pustular Psoriasis, Inverse Psoriasis and Guttate Psoriasis. These types of Psoriasis are caused by hereditary factors and can be triggered through environmental elements. Psoriasis symptoms include: itchy scales, bleeding from the skin, pustules, and inflamed red skin. Even though there is currently no known cure for Psoriasis, there are treatments available to relieve the symptoms of Psoriasis. These treatments include: TNF-blocking drug pills, corticosteroid ointments, biologic infusion therapy, sunlight treatment and coal tar applications directly onto the affected areas Psoriasis also has a rich history. The earliest record of Psoriasis was taken between 460 and 377 BC during the time of a well-known Greek physician, Hippocrates. About 1% to 3% of the world's population has Psoriasis. Of those 3%, is my dad, Michael Orosz. He was diagnosed when he was in sixth grade, he was twelve years old. He has had Plaque Psoriasis for about forty years. When he first was diagnosed with Psoriasis, it covered fifty percent of his body. That is very uncommon. My dad has taken about every known treatment to get rid of his Psoriasis, from simple steroid topical ointments to injecting himself with liquid biologic treatments. Unfortunately, nothing has worked to reduce the severity or mass of the lesions over his body. He is my inspiration for writing this report.
Psoriasis is caused by mutations occurring in the genes. Scientists have found nine gene mutations contributing to the cause of Psoriasis (Brannon 2010, 47). One of these nine gene mutations, occur on chromosome six. This gene mutation on chromosome six is called PSORS-1. PSORS-1 seems to be the biggest factor in developing Psoriasis. These mutations have a big affect on Helper T-cells, which is why this disease is an autoimmune disease (Brannon 2010, 49). In an autoimmune disease, the immune system attacks its self. In Psoriasis, gene mutations affect a white-blood cell called a T-cell (Brannon 2010, 48). The T-cell attacks the skin and forces it to multiply rapidly. This causes an abnormally large amount of skin cells to stack on top of each other. In normal skin cells, it takes about thirty days for a skin cell to develop, mature, and shed off from the skin itself. In Psoriasis, this process takes place in about 3-6 days (Brannon 2010, 50). Also, normal T-cells secrete a type of chemical that heals skin. In Psoriasis, this chemical is produced in huge quantities. This causes the skin to become inflamed in the joints and on the skin (Brannon 2010, 51). There are also environmental factors to trigger Psoriasis but you have to be genetically susceptible. A flare up of Psoriasis is when you come in contact with a environmental trigger (Brannon 2010, 53) These triggers, can cause a small patch of Psoriasis which typically take about 2-6 weeks to develop (Brannon 2010, 52). The patch of Psoriasis in not chronic. The patch might go away or could stay forever. Some of these triggers are: skin injuries, stress, weather, drugs, low vitamins, and infection (Brannon 2010, 54-59). This also means that Psoriasis in not contagious. It can only be spread through genetics. These environmental triggers and hereditary mutations are the causes for Psoriasis.
Psoriasis has had a long and rich history. In 460 BC, the Greek Physician Hippocrates was born. He was the first person to mention Psoriasis, even though the name "Psoriasis" was not used. Hippocrates talked about Psoriasis between 460 and 377 B.C (Sinclair 2010, 49). Then, in the first century, Roman author Cornelious Celsus described Psoriasis. He described it as "The fourth variant of impetigo, a condition caused by staphylococcus pyogenesis". Impetigo looks like red patches and has watery blisters (Sinclair 2010, 50). In 1776, Joseph Jacob Plenck wrote about Psoriasis. Joseph wrote that Psoriasis is amongst the desquamative diseases (scaly or scale like) (Sinclair 2010, 51). Then the English dermatologist, Robert Willan (1757~1812), separated Psoriasis from other diseases and classified it as a independent disease. Robert then divided it into two categories: Leprosa Graecorum and Psora Leprosa. Leprosa Graecorum was used to describe the disease when it had scales; Psora Leprosa was used to describe the disease when it became eruptive (Sinclair 2010, 52). In 1841 Ferdinand Hebra, a Vinennese dermatologist, studied Robert Willan's notes. He changed Psoriasis' name from Dartre squameuse centrifuge of Alibert to Psoriasis (author of name is unknown) (Goodless 2008, 26) . Hippocrates, Cornelious Celsus, Joseph Jacob Plenck, Robert Willan, Ferdinand Hebra, and many other anonymous authors have contributed to Psoriasis' history and to the disease today as we know it.
One of the five main types of Psoriasis is Plaque Psoriasis. Plaque Psoriasis is the most common type of Psoriasis. About eighty percent of people with Psoriasis, have Plaque Psoriasis. In fact, Plaque Psoriasis' scientific name, Psoriasis Vulgaris, means "common Psoriasis" (Edward 2009, 40). Plaque Psoriasis is caused by the accumulation of excess skin which forms plaques. These plaques, are large flat patches of skin. These usually start off as small red bumps. The red bumps then gradually enlarge to forms well-defined plaques (Edward 2009, 42). The plaques also have the typical silvery Psoriatic scales. Sometimes these plaques join together and form huge plaques that cover extensive areas of skin. These usually cover the torso, knees, elbows, and limbs. The skin affected with Plaque Psoriasis becomes very dry, painful, red and itchy. Also, In many cases, Plaque Psoriasis leads to scalp and nail Psoriasis (Edward 2009, 43). Some other symptoms of Plaque Psoriasis are red spots and patches covered with silvery scales that fall off in huge quantities which then reveal bleeding points (Edward 2009, 44). Plaque Psoriasis affects a variety of people. This disease affects children and adults, both male and female, and affects all races. But, Plaque Psoriasis usually affects females rather than males. Plaque Psoriasis usually occurs first when the individual is between sixteen and twenty-two. This condition then peaks again when the individual is between fifty-seven and sixty (Edward 2009, 45). Plaque Psoriasis is usually persistent or chronic. Even though Plaque Psoriasis has no known cure, there are treatments available to relieve the symptoms of the disease . The most popular treatment are topical ointments, but these don't cure the disease. All in all, Plaque Psoriasis is both ugly and irritating.
The second type of Psoriasis is Guttate Psoriasis. Guttate Psoriasis is not that common. It only occurs in about two percent of all of the population with Psoriasis (Chisholm 2010, 25). Guttate Psoriasis is a type of Psoriasis in which there are small salmon colored drops that appear on the skin (Chisholm 2010, 18). In fact, Guttate is derived from the Latin word, gutta, which means drop (Chisholm 2010, 19). Guttate Psoriasis is most likely believed to result when a immune reaction occurs because of a previous streptococcal infection in a genetically susceptible individual. The streptococcus seem to make a reaction with the natural killer T-cells (Chisholm 2010, 20). The environmental triggers for Guttate Psoriasis are: too much alcohol, sunburns, stress, other bacterial or viral infections, cuts on the skin including burns and insect bites, and some medications (Brannon 2010, 54). Guttate Psoriasis is nonfatal and can be chronic or acute. Guttate Psoriasis usually occurs on the torso. It can develop on any part of the body but it is most commonly developed on the torso. Guttate Psoriasis usually affects people who are under the age of thirty. It is the second most common type of Psoriasis amongst children (Chisholm 2010, 24). This condition affects both males and females equally (Chisholm 2010, 23). It also affects all races (Chisholm 2010, 22). Guttate Psoriasis may be super severe in patients with AIDS, autoimmune disorders, or are taking Chemotherapy for Cancer. Guttate Psoriasis may also cause pain, itching and skin infections. Guttate Psoriasis can be treated temporarily with medications, topical treatments being the most successful. This type of Psoriasis is not common, nonfatal, but can be extremely annoying.
The third variation of Psoriasis is Pustular Psoriasis. Pustular Psoriasis is one that is very uncommon. The presence of Pustular Psoriasis in Japan is 7.46 cases out of one million (Ricotti 2011, 63). Pustular Psoriasis is where there are numerous pustules on the skin (Ricotti 2011, 60). The skin around the pustules are reddish. Usually the pustules, pus filled lesions, are caused by infection; in Pustular Psoriasis, the pustules are caused by inflammation (Goodless 2008, 10). There are both generalized (throughout the body) and localized (specific location) types of Pustular Psoriasis. There are four patterns of Generalized Pustular Psoriasis or GPP. The patterns of GPP are the von Zumbusch pattern, Annular pattern, Exanthematic type, and the "localized" pattern (Goodless 2008, 11). In the von Zumbusch pattern a number of pustules appear all over the body. The von Zumbusch pattern can be either sub acute or chronic. This can also bring systematic symptoms with it. Sometimes the pustules combine together to form "Lakes of Pus" (Goodless 2008, 12). Annular patterns are circular rings with pustules on the outside of them. The rings continue to grow for hours to days. This pattern can also bring systematic symptoms with it. Annular patterns are usually acute (Goodless 2008, 13). Exanthematic types are tiny eruptions of pustules which have a rapid clearing. This type usually doesn't bring any symptoms and is acute (Goodless 2008, 14). The "localized" pattern occurs with patients who have wide-spread Plaque Psoriasis. Pustules form on the outskirts of or on top of the plaques. This is because of a sudden removal of a certain medicine (Goodless 2008, 15). Localized Pustular Psoriasis are confined to a specific location. The locations are usually the palms, soles of feet, fingertips, and tips of toes. When Pustular Psoriasis is just on the palms or soles of feet, it is sometimes called Palmoplantar pustulosis. When Pustular Psoriasis is located on the fingertips, it is called Acrodermatitis continua of Hallopeau. This can lead to the complete shedding of the nails (Goodless 2008, 16). These conditions can cause systematic symptoms. The systematic symptoms include fever, pain, and malaise. Some factors that can cause you to get Pustular Psoriasis are: certain medical drugs, infection, sunlight or phototherapy, strong and irritating topical ointments, tar, steroids, and much more (Ricotti 2011, 62). Pustular Psoriasis affects all races and also affects male and female adults equally. Male children are usually more affected than female children. The ratio for Pustular Psoriasis, males-females, is 1-1 in adults and 3-2 in children (Ricotti 2011, 65). The average age for people with Pustular Psoriasis is fifty (Ricotti 2011, 66). Children can get the disease, but it is extremely rare. Pustular Psoriasis is one of the variations of Psoriasis that is painful and filled with pus.
The fourth type of Psoriasis is Inverse Psoriasis. Inverse Psoriasis is the inverse or opposite of Psoriasis. These types of Psoriasis occur on the knees, elbows, torso, and other exterior parts of the body. With Inverse Psoriasis, the Psoriasis occurs on the folds of the body. Places like the armpits, the groin, underneath the breasts, the genitals and the folds of the buttocks are common places this type of Psoriasis occurs (Lee-Frye 2009, 17). The environmental factors that can trigger Inverse Psoriasis are friction, sweating and dampness (Lee-Frye 2009, 19). Inverse Psoriasis is fairly uncommon. It only affects around two to six percent of the Psoriatic population. Of those two to six percent, most of them are middle aged or older (Thompson 2010, 69). Children are less likely to get Inverse Psoriasis but it is still possible. Also, people with deep skin folds, are obese, or are overweight, are more likely to get Inverse Psoriasis. Another reason this is the inverse of normal Psoriasis is because of the symptoms it produces. With normal Psoriasis there are usually dry scales on the red skin. With Inverse Psoriasis the areas this Psoriasis occurs are too moist and damp to form scales. Instead the area is mostly red and looks shiny and smooth (Thompson 2010, 70). Inverse Psoriasis is one of the most painful variations of all the types of Psoriasis. This is because the areas of the Psoriasis are very itchy and rub up against one another. This also creates pain and sometimes creases. These creases can crack and bleed. The cracks can then lead to an infection (Thompson 2010, 71). This can be very painful and annoying. Inverse Psoriasis affects both males and females . It is also a chronic disease. Even though there is no cure, there are treatments available to relieve the symptoms. These treatments include: Corticosteroids, Calcipotriene, coal tar, Light therapy, topical ointments, and oral pills (Thompson 2010, 72). Inverse Psoriasis is a painful variation of Psoriasis; in other words it is a chronic pain.
The new research regarding Psoriasis has been beneficial and an eye opener to the disease. One example of this is a research conducted by Shanu Kohli Kurd and colleges from the University of Pennsylvania. Shanu and his colleges studied earlier medical records from the U.K. The analysis of the records showed a test for a connection of Depretion, Anxiety, or suicidal tendencies with 146,042 patients with mild Psoriasis, 3,956 with severe Psoriasis, and 766,950 without Psoriasis (Troxel 2010, 73). Five patients without Psoriasis to every one person with. The results showed that people with severe to mild Psoriasis that have Depression are 25.9 out of 1,000 patients, that have anxiety are 20.9 out of 1,000 and 0.9 out of 1,000 are to be suicidal (Troxel 2010, 74). This was an major increase from a previous 11.8 out of 1,000 people with Depression, 8.1 out of 1,000 with Anxiety, and 0.4 out of 1,000 with suicidal tendencies (Troxel 2010, 76).
Another research experiment was on the oral pill, ISA247. ISA247 is a calcineurin inhibitor (Calcineurin is a protein that helps regulate inflammation) (Unknown 2008, 77). This study was preformed by lead researcher Dr. Kim Papp from Probity Medical Research in Waterloo, Ontario (Unknown 2008, 78). The purpose of this experiment was to see if ISA247 was an effective drug, if so what dosage? Papp's team selected 451 with 10 percent of body affected with Plaque Psoriasis (Unknown 2008, 79). The researchers gave the patients either ISA247 or placebo. There were three groups which received the drug in different dosages. The researchers were looking for a seventy five percent reduction of Psoriasis mass. The researchers called this PASI 75 (Unknown 2008, 80). After 12 weeks of treatment, 47% of the group which received the highest dosage of ISA247 achieved PASI 75 (Unknown 2008, 81). The two groups which received the lowest amount of the drug got either 25% or 16% PASI 75 (Unknown 2008, 83). In the placebo group, only four of the one hundred and fifteen patients achieved PASI 75 (Unknown 2008, 84). "ISA247 is a reasonable oral medication for the treatment of psoriasis," Papp said. "It is reasonable because of reasonable efficacy, high tolerability and minimal metabolic effects. (Unknown 2008, 82)" All in all, ISA247 is a reasonable and effective oral drug.
In conclusion, Psoriasis is a complicated and irritating skin disease. Psoriasis is caused by a genetic mutation and can be triggered by a number of environmental factors. This condition has a number of variations, four of them being Plaque, Pustular, Inverse and Guttate Psoriasis. These types produce a wide range of symptoms from simple scales to full-blown pustules. People are affected all over the world, regardless of race, gender and age. Psoriasis has affected people for centuries, all the way back to the time of Hippocrates. Even though Psoriasis has been around this long, we still do not have a cure for the disease, only treatment to temporarily relieve the symptoms. Through scientific and technological advances, researchers have discovered new treatments and drugs that provide more relief for the many people who suffer from this disease. It is clear that this autoimmune disease has and will continue to affect the lives of the affected both physically and mentally. How do you think Psoriasis would change your life?