Some Types of Phototherapy

Different types of phototherapy include:

Psoralen UVA (PUVA) therapy. A more aggressive treatment, psoralen UVA (PUVA) therapy involves taking a light-sensitizing medication (psoralen) before exposure to ultraviolet A (UVA) light. You usually have two or three treatments a week for a prescribed number of weeks. PUVA is effective in suppressing the growth of skin cells in severe psoriasis, but long-term treatment may increase your risk of skin cancer, including melanoma, the most serious form of skin cancer. The risk of skin cancer depends on a number of factors, among them skin pigmentation, family history, total dosage of UVA over time, the concurrent use of therapies that suppress the immune system, and the amount of protection given to your face and genital areas while undergoing PUVA therapy. There may be a delay of up to 15 years after the first treatment before any cancer is detected.

Narrow-band UVB (NBUVB) therapy. This form of phototherapy doesn’t require oral medications before each treatment and so may be less likely to cause cancer. Yet much about NBUVB remains unknown because it has been in widespread use for only a few years. It’s usually administered two or three times a week. Many people who would have been treated with PUVA are now being treated with NBUVB. Sometimes your doctor may also use phototherapy and oral medications such as retinoids, methotrexate or the newer immune-modulating drugs in rotation to minimize the side effects of both.

Combination light therapy. Combining ultraviolet light with other treatments such as retinoids improves phototherapy’s effectiveness. Some doctors give UVB treatment in conjunction with coal tar, an approach called the Goeckerman treatment. The two therapies together are more effective than either alone because coal tar makes skin more receptive to UVB light. Another method, the Ingram regimen, combines UVB therapy with a coal tar bath and an anthralin-salicylic acid paste that’s left on your skin for several hours or overnight.

Types of Psoriasis (continued)

Guttate psoriasis- This primarily affects people younger than 30 and is usually triggered by a bacterial infection such as strep throat. It’s marked by small, waterdrop-shaped sores on your trunk, arms, legs and scalp. The sores are covered by a fine scale and aren’t as thick as plaque sores are. You may have a single outbreak that goes away on its own, or you may have repeated episodes, especially if you have ongoing respiratory infections.

Pustular psoriasis- This rare form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips. It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters dry within a day or two but may reappear every few days or weeks. Generalized pustular psoriasis can also cause fever, chills, severe itching, weight loss and fatigue.

Inverse psoriasis- Mainly affecting the skin in the armpits, groin, under the breasts and around the genitals, inverse psoriasis causes smooth patches of red, inflamed skin. It’s more common in overweight people and is exacerbated by friction and sweating.

Erythrodermic psoriasis- The least common type of psoriasis, this can cover your entire body with a red, peeling rash that may itch or burn intensely. Eythrodermic psoriasis may be triggered by severe sunburn, by corticosteroids and other medications, or by another type of psoriasis that’s poorly controlled.

Psoriatic arthritis- In addition to inflamed, scaly skin, psoriatic arthritis causes pitted, discolored nails and the swollen, painful joints that are typical of arthritis. It can also lead to inflammatory eye conditions such as conjunctivitis. Symptoms range from mild to severe. Although the disease usually isn’t as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity. Adults in their 30s, 40s and 50s are most often affected, but children also can develop a form of the disease.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission, although in most cases, the disease eventually returns.

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Types of Psoriasis

Several types of psoriasis exist, but the most common form, plaque psoriasis, causes dry, red skin lesions (plaques) covered with silvery scales. These usually itch or feel sore and may occur anywhere on your body, including your genitals, the soft tissue inside your mouth, and your fingernails and toenails. But plaques are most common on your knees, elbows, trunk, palms, soles and scalp. You may have just a few plaques or many, and in severe cases, the skin around your joints may crack and bleed.

Other types of psoriasis have different characteristics. They include:

• Guttate psoriasis
• Pustular psoriasis
• Inverse psoriasis
• Erythrodermic psoriasis
• Psoriatic arthritis

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Psoriasis Treatment

Psoriasis can be challenging to treat in spite of a wide range of therapeutic options. The disease is unpredictable, going through cycles of improvement and exacerbation seemingly at whim. And treatments themselves can be unpredictable; what works well for one person might be ineffective for someone else. Your skin can also become resistant to various therapies over time and the most potent treatments can have serious side effects.

Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments — topical creams and light therapy (phototherapy) — and then progress to stronger ones if necessary. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.

Topical treatments

Used alone, creams and ointments can effectively treat mild to moderate psoriasis. When skin disease is more severe, creams are likely to be combined with systemic drugs or phototherapy.

Psoriasis Affects Your Quality of Life

Psoriasis has a significant negative impact on patients’ health related quality of life. In a survey by the National Psoriasis Foundation almost 75% of patients believed that psoriasis had moderate to large negative impact on their quality of life, with alterations in their daily activities. Another study reported that at least 20% of psoriasis patients had contemplated suicide. Furthermore, physical and emotional effects of psoriasis were found to have a significant negative impact at patients’ workplace as measured by the validated scales including Work Productivity Assessment Index (WPAI), SF-8, Hospital Anxiety and Depression (HADS) and past medical/psoriasis history. Absenteeism is a greater concern for people suffering from psoriasis than their co-workers without psoriasis with nearly 60% patients reporting missing an average of 26 days a year directly related to their psoriasis. Patients with psoriasis have a higher financial burden due to absenteeism in addition to the cost of caring for their disease.

Psoriasis patients often experience difficulties like maladaptive coping responses, problems in body image, self esteem, self concept and also have feelings of stigma, shame and embarrassment regarding their appearance. This is often times accompanied by a perception of being evaluated by others based on their disfigurement. Individuals with psoriasis commonly engage in coping strategies to avoid unwanted and unpleasant social consequences. However, most of these strategies fail to improve patients’ quality of life. Discussing their skin condition, covering their lesions, and avoiding contact with people are significantly associated with negative impact on life. Studies have indicated that talking to others regarding the non-contagious nature of psoriasis lessens the negative impact on the quality of life and thereby reduces social discomfort.

Studies that have probed the link between psoriasis and depression hint towards a reciprocal relation between them. Psoriasis patients were more likely to be depressed than the general population with patients’ age, education and disease severity being important predictors of psychological distress in the patient cohort. Gupta et al. in their study of 127 psoriasis patients found that 9.7% of patients reported their wish to be dead, and 5.5% reported active suicidal ideation at the time of the study. These studies have highlighted the need for psychosocial strategies in treating patients with psoriasis and helping them to improve their overall quality of life.

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Psoriatic Arthritis

Psoriatic Arthritis is associated with psoriasis on the skin with approximately 10-30% of people with psoriasis developing psoriatic arthritis. Often Psoriatic Arthritis goes undiagnosed for long periods of time, particularly in its milder forms. It can develop at any time, but for most people it appears between the ages of 30 and 50. Psoriatic arthritis tends to affect men at a slightly higher rate than women.

Read the full article here Psoriatic Arthritis

Psoriasis and the Sun

One of the forms of ultraviolet light given off by the sun, UVB light, can help your psoriasis! UVB does encourage skin cancers in part by reducing your immune activity in the skin. It’s the UVB light that causes your skin to burn, and it’s this reddening effect that occurs right after sun exposure that can help to heal your psoriasis. Keep in mind, though, that too much UVB can burn your skin and that can cause your psoriasis to flare. The sun also produces UVA light which can cause wrinkles, making you look older than your really are, and can also increase your risk of skin cancer. So you really need to take care even if you do find that sunshine helps your skin. You are at highest risk if you have fair or red hair and your skin does not tan easily. There’s more information about psoriasis and sunscreens.