DR. G. G. noaz

Psoriasis
Psoriasis is a chronic, recurring disease recognizable by silvery scaling bumps and various-sized plaques (raised patches).
An abnormally high rate of growth and turnover of skin cells causes the scaling. The reason for the rapid cell growth is unknown, but immune mechanisms are thought to play a role. The condition often runs in families. Psoriasis is common affecting 2 to 4 percent of whites; blacks are less likely to get the disease. Psoriasis begins most often in people ages 10 to 40, although people in II age groups are susceptible.
Symptoms
Psoriasis usually starts as one or more small psoriatic plaques that become excessively flaky. Small bumps may develop around the area. Although the first plaques may clear up by themselves, others may soon follow. Some plaques nay remain thumbnailsized, but others may grow to cover large areas of the body, sometimes in striking ring-shaped or spiral patterns.
Psoriasis typically involves the scalp, elbows. knees, back, and buttocks. The flaking may be mistaken for severe dandruff, but the patchy nature of psoriasis, with flaking areas interspersed among completely normal ones, distinguishes the disease from dandruff. Psoriasis can also break out around and under the nails, making them thick and deformed. The eyebrows, armpits, navel, and groin may also be affected.
Usually, psoriasis produces only flaking. Even itching is uncommon. When flaking areas heal, the skin takes on a completely normal appearance, and hair growth is unchanged. Most people with limited psoriasis suffer few problems beyond the flaking, although the skin s embarrassing.
Some people, however, have extensive psoriasis or experience serious effects from psoriasis. Psoriatic arthritis produces symptoms very, similar to those of rheumatoid arthritis.
Very rarely psoriasis covers the entire body and produces exfoliative psoriatic dermatitis, in which the entire skin becomes inflamed.
This form of psoriasis is serious because, like a burn, it keeps the skin from serving as a protective barrier against injury and infection. In another uncommon form of psoriasis, pustular psoriasis, large and small pus-filled pimples (pustules) form on the palms of the hands and soles of the feet. Sometimes, these pustules are scattered on the body.
Psoriasis may flare up for no apparent reason, or a flare-up may result from severe sunburn, skin irritation, anti-malaria drugs, lithium, beta-blocker drugs (such as propranolol and metoprolol), or almost any medicated ointment or cream. Strep-tococcal infections (especially in children), bruises, and scratches can also stimulate the formation of new plaques.
Diagnosis
Psoriasis may be misdiagnosed at first because many other disorders can produce similar plaques and flaking. As psoriasis develops, the characteristic scaling pattern is usually easy for doctors to recognize, so diagnostic tests usually aren't needed. However, to confirm a diagnosis, a doctor may perform a skin biopsy (removal of a skin specimen and examination under a micro-scope).
Treatment
When a person has only a few small plaques, psoriasis responds quickly to treatment. Using ointments and creams that lubricate the skin (emollients). once or twice a day can keep the skin moist. Ointments containing corticosteroids are effective, and their effectiveness can be enhanced by applying them and then wrapping the area in cellophane. Vitamin 0 cream is also effective in many patients.
Ointments and creams containing salicylic acid or coal tar are also used to treat psoriasis. Most of these medications are applied twice a day to the affected area. Stronger medications like an-thralin are used sometimes, but they can irritate the skin and stain sheets and clothing. When the scalp is affected, shampoos containing these active Ingredients are often used.
Ultraviolet light also can help clear up psoriasis. In fact, during summer months, exposed regions of affected skin may clear up spontaneously. Sunbathing often helps to clear up the plaques on larger areas of the body; exposure to ultraviolet light under controlled conditions is another common therapy. For extensive psoriasis, such light therapy may be supplemented by psoralens, drugs that make the skin extra sensitive to the effects of ultraviolet light.
The combination of psoralens and ultraviolet light (PUVA) is usually effective and may clear up the skin for several months. However, PUVA treatment can increase the risk of skin cancer from ultraviolet light; therefore, the treatment must be closely supervised by a doctor.
For serious forms of psoriasis and widespread psoriasis, a doctor may give methotrexate. Used to treat some forms of cancer, this drug interferes with the growth and multiplication of skin cells. Doctors use methotrexate for people who don't respond to other forms of therapy. It can be effective in extreme cases but may cause adverse effects on the bone marrow, kidneys and liver. Another effective medication, cyclosporine, also has serious side effects.
The two most effective medications for treating pustular psoriasis are etretinate and isotretinoin, which are also used to treat severe acne.
Pityriasis Rosea
Pityriasis Rosea is a mild disease that causes scaly, rose-colored inflamed skin.
Pityriasis Rosea is possibly caused by an infectious agent, although none has been identified. It can develop at any age but is most common in young adults. It usually appears during spring and autumn.
Symptoms
Pityriasis Rosea begins as a rose red or light tan area that doctors call a herald or mother patch. This round or oval area usually develops on the torso. In 5 to 10 days, many similar but smaller patches appear on other parts of the body. These secondary patches are most common on the torso, especially along and radiating from the spine. Most people with pityriasis rosea have few symptoms, and the rash usually isn't very itchy. However, fatigue, headaches, and troublesome itching may occur.
Treatment
Usually the rash goes away in 4 to 5 weeks with-out treatment, although sometimes it lasts for -2 months or more. Both artificial and natural sunlight may clear up pityriasis rosea faster and relieve the itching. A cream containing menthol can relieve the itching. Rarely oral corticosteroids are prescribed for severe itching.
Lichen Planus
Lichen planus, a recurring itchy disease, starts as c. rash of small discrete bumps that then combine and become rough, scaly plaques (raised patches).
About half of those who get lichen planus also develop mouth sores.
The cause of lichen planus isn't known. An identical rash sometimes breaks out in people exposed to drugs containing gold bismuth, arsenic, quinine, quinidine, or quinacrine and to certain chemicals used to develop color photographs. Thus lichen planus may be the body's response to some external chemical or other agent.
Symptoms
The first episode may begin gradually or suddenly and persist for weeks or months. Although lichen planus usually clears up by itself, patches often come back, and the episodes may recur for years. The rash almost always itches-some-times severely. The bumps are usually violet and have angular borders; when light is directed at them from the side, the bumps display a distinctive sheen. New bumps may form wherever scratching or a mild skin injury occurs. Some-times a dark discoloration remains after the rash heals.
Usually, the rash is distributed symmetrically- most commonly in the mouth, on the torso, on the inner surfaces of the wrists, on the legs, or the head of the penis, and in the vagina. The face is seldom affected. On the legs, the rash may become especially large and scaly. The rash sometimes results in patchy baldness on tile scalp.
Lichen planus mouth sores are particularly vexing; they are usually bluish-white and may form in a line. Often mouth sores appear before the skin rash, and although mouth sores usually don't hurt, they sometimes cause deeper sores that may be painful. Cycles of outbreaks followed by healing are common. Though unusual, long-standing sores may result in mouth cancer.
Diagnosis
Diagnosis may be difficult because many conditions resemble lichen planus. A dermatologist can usually recognize it by its appearance and pattern of recurrence, but a skin biopsy (removal of a specimen and examination under a microscope) may be needed to confirm the diagnosis.
Treatment
Drugs or chemicals that may be causing lichen planus should be avoided. For people who suffer from itching, an antihistamine such as anthistamine such as diphen-hydramine, hidroxyzine, or chlorphentramine may be prescribed, although it may cause sleepiness.
Conicosteroids may be injected into the bumps, applied to the skin, or given orally, sometimes with other medications, such as tretinoin.
For painful mouth sores, a mouthwash containing lidocaine may be used before meals to form pain-killing coating.
Lichen planus may disappear and then recur after several years. Prolonged treatment may be needed during outbreaks of the disease; between outbreaks, no' treatment is needed.
The author is a practioner at New Jursey, USA.