a chronic skin disorder that causes red, scaly patches on the limbs, trunk, scalp, and other parts of the body. It is not
The rash of psoriasis goes through cycles of improving
and worsening. A period of worsening is called a "flare". At times, psoriasis can be disfiguring, uncomfortable,
and even painful.
The scaling and unpleasant appearance
of psoriasis lesions (especially if left untreated) can cause embarrassment and be a significant source of anxiety or depression.
Psoriasis can also interfere with sleep and make everyday tasks difficult.
Types of psoriasis
There are five types of psoriasis, each defined by the type of skin lesions that appear.
Plaque psoriasis appears as thickened, red scaly lesions called plaques. This
is the most common type of psoriasis.
Guttate psoriasis appears as small, drop-shaped spots on the trunk, limbs, and scalp. This is
often triggered by bacterial infections, such as strep throat.
Inverse psoriasis appears as smooth, red patches in the folds of skin near the genitals, breasts, or armpits.
Erythrodermic psoriasis appears as a scaly, red, peeling rash that
afflicts the entire body. This is an uncommon form.
psoriasis appears as pus-filled blisters that can be widespread or localized to the hands or feet. Also uncommon.
Most people have just one type of psoriasis at a time, but it is possible
to have two types simultaneously. And a person with one type of psoriasis (typically plaque psoriasis) may later develop a
See a larger image
Psoriasis can occur anywhere on the body. However, people tend to have areas that
are more prone to developing lesions than others. Some places are particularly challenging to treat, including the scalp,
face, hands, feet, and nails.
Each psoriasis outbreak can vary
in severity. A mild outbreak, with small dandruff-like scales limited to one spot, could be followed by a severe outbreak
with large thick plagues covering multiple parts of the body.
There are several ways to measure psoriasis severity. One simple approach is to measure the amount of the body
covered by psoriasis. This is described as the percentage of body surface area.
See larger image
See larger image
Severity is also influenced by the type of psoriasis, the impact the illness
has on a person’s quality of life, and a person’s susceptibility to side effects from treatment. Psoriasis is
generally considered severe if it covers the palms and soles because of its impact on a person’s ability to walk and
perform day-to-day tasks.
About 10-30% of people with psoriasis
will also develop psoriatic arthritis. Symptoms of psoriatic arthritis include stiffness, pain, and swelling of the tendons
and joints, as well as morning stiffness and generalized fatigue.
What causes psoriasis?
cells (keratinocytes) start growing in the deepest layers of the skin (epidermis) and rise to the surface as they mature.
The mature cells at the surface eventually fall off from everyday wear and tear and are replaced by newer cells below. This
process usually takes about a month.
In skin affected
by psoriasis, this process is accelerated and takes just a week or more. The skin cells multiply quickly and accumulate on
the surface in silvery scales. This rapid growth is the result of a problem with the immune system.
Under normal circumstances, the immune system’s T cells patrol the body looking
for bacteria or other foreign substances. The T cells’ attack on such invaders is called the immune response. People
with psoriasis have overactive T cells that trigger an increased production of skin cells.
Many of the treatments for psoriasis are aimed at controlling the immune response.
What are the treatment options for psoriasis?
Although there is currently no cure for psoriasis, there are multiple psoriasis
treatments available that can usually lead to a clearing of symptoms. The goal of treatment is to stop the skin cell
overgrowth that leads to plaque formation and inflammation.
Treatment options include the following category of medications:
- Topical medications applied to the skin, including corticosteroids, topical retinoids (Tazorac)
and vitamin D derivatives (Dovonex, Vectical)
- Oral medications, such as acitretin
(Soriatane), cyclosporine and methotrexate.
- Phototherapy and
UV lasers, and
- A new class of medications called “biologics”
Your doctor will recommend one or more of these treatments depending on
the following factors:
- Type of
- Location (scalp, trunk, hands feet, etc.)
- Severity of psoriasis
- Results of previous treatments
- Ease or convenience of a treatment
- Possible side effects
Since some treatments work better for some patients than others, be prepared
to try more than one treatment.
Although the cause of a particular
outbreak may not be known, some common psoriasis triggers have been identified, including:
- Infection, such
as strep throat or staphylococcus
- Medications, including lithium, beta blockers,
and anti-malarial drugs
- Skin injury, including bruises, chafing from tight clothing,
shaving, tattoos, vaccinations, or sunburn
- Other skin conditions, such as scabies,
blisters, boils, and dermatitis
- Weather that dries the skin, such as cold winter
days and indoor heating or cooling
- Hormones, such as the surges that occur after
puberty and during pregnancy
- Smoking and excessive drinking
What about psoriasis self-care and prevention?
These steps can ease the discomfort of psoriasis and help minimize flare-ups:
Identify and avoid triggers. If you’re not sure exactly what your
triggers are, consider keeping a diary for a couple months.
Limit alcohol consumption. Because heavy drinking can trigger psoriasis and interfere with certain medications (methotrexate
and others), use alcohol in moderation, or avoid it altogether.
Take care of your skin.
- Moisturizers help
lock in your skin’s own moisture. Use them regularly, particularly after bathing.
- Avoid scratching itchy skin. Cold compresses, topical steroids, menthol-based ointments, and oatmeal baths can curb the
- Bathe in warm (not hot) water, keep showers or baths short, and use fragrance-free
cleansers. Gently pat-dry skin instead of rubbing it.
- Do not pick at lesions.
- Protect your skin from the sun during PUVA therapy or if you’re taking retinoids (Soriatane
- Choose cotton clothing over synthetic materials, which can irritate
or overheat the skin.
- Protect your skin in the winter. Step up moisturizing efforts
and use a humidifier.
Take care of your whole self.
To keep your immune system calm and less likely to trigger skin cell overgrowth, follow the basics of good health. Get enough
sleep, eat a balanced diet, and drink plenty of water. And avoid cigarette smoking, which can be a psoriasis trigger and overall
Reduce stress. Stress is a trigger for many people
with psoriasis. While there’s no way to eliminate stress altogether, there are many ways to manage it, such as meditation,
counseling, or exercise. For managing the stress of psoriasis itself, consider joining a support group.
Where can I learn more about psoriasis?
- National Psoriasis Foundation
- PsoriasisNet (American Academy of Dermatology)
© 2010 Vivacare. Last updated July 26, 2010
Images courtesy of Gerald Goldberg, M.D.
information is for general educational uses only. It may not apply to you and your specific medical needs. This information
should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.
Communicate promptly with your physician or other health care professional with any health-related questions or concerns.
Be sure to follow specific instructions given to you by your physician or health care professional.
Our goal at NYC Dermatology is to be the Tiffanys of Skin
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Sun Protection Ultraviolet radiation is the major cause of skin cancer, including melanoma. It is important
for everyone to be aware of its damaging effects and take measures to avoid overexposure.
Although many people enjoy
the appearance of tanned skin and think it looks "healthy," tanned skin is damaged skin. The ultraviolet radiation
in sunlight penetrates the deepest layers of the skin where it harms the cells. The body responds by making more pigment (melanin)
to try to protect itself, but the damage has already happened and may be permanent. The more exposure you have to the sun,
the more likely you are to develop skin problems later in life.
The damaging part of sunlight
is called ultraviolet radiation, or UV rays. It is categorized into three types:
- UVC rays
(wavelengths = 200 nm to 290 nm) are the shortest and most powerful of the UV rays. UVC is
the most likely to cause cancer if it reaches skin. Fortunately, most of it is absorbed by the ozone layer in our atmosphere.
However, there is concern that a thinning of the ozone layer may be causing more UVC to reach the earth's surface.
rays (wavelengths = 290 nm to 320 nm) are less damaging than UVC, but more of it penetrates to the earth's surface.
It is the most common cause of sunburn and skin cancer. UVB is particularly strong at the equator, at high elevations, and
during the summer.
- UVA rays (wavelengths = 320 nm to 400 nm)
are the least powerful of the UV rays, but they are present all year and can penetrate
windows and clouds.
The first and more effective way to avoid sun damage is
to stay out of tthe sun as much as possible.
If you cannot avoid being exposed to sunlight,
there are five basic defenses that you should keep in mind when you go outdoors:
peak hours of sunlight
Avoid Peak Hours of Sunlight (UV Index)
In general, UV rays are the greatest between 10 a.m. and 4 p.m.
It is best to avoid the outdoors during these hours without protection, particularly during summer, in tropical regions, or
at altitude. During this time, you should pay close attention to the appropriate use of sunscreen, clothing, sunglasses, and
You can obtain an accurate measure of the amount of UV rays in your area by looking
up the Ultraviolet (UV) Index. The UV Index is like a weather forecast. It provides a
report on the amount of damaging UV rays that are expected to affect a region on a particular day. The UV Index changes day
to day according to time of year, cloud cover, atmospheric ozone, and other factors.
The following table is a breakdown
of the UV Index. A high UV Index number means that you are at greater risk of being exposed to ultraviolet radiation. You
should take special care to avoid outdoor exposure to sunlight when the UV Index is moderate or greater.
- 0 to 2
- 3 to 4 = Low
- 5 to 6 = Moderate
- 7 to 9 = High
or more = Very high
The UV Index can be found on our Website or in local
papers, usually in the weather section.
There are several factors to consider when selecting the right
sunscreen. (See the Sunscreens handout for more information.)
actor (SPF) - Sunscreens are rated by the amount of protection they provide from UVB, measured as the "sun
protection factor" or SPF. Sunscreens with higher SPF provide greater protection from the sun. It is best to use sunscreens
that offer a minimum SPF of 15.
Broad-spectrum sunscreens - It is best to use a sunscreen that can
protect you from both UVA and UVB rays. These are called "broad-spectrum" sunscreens.
Most of the original sunscreens blocked only UVB, but increased awareness of the damage caused by UVA has lead to the
development of ingredients that protect against UVA too. Broad-spectrum sunscreens combine ingredients to provide a product
with greater protection.
Common sunscreen ingredients that provide protection
from UVB rays:
- PABA (para-aminobenzoic
- Padimate O and Padimate A (Octyl Dimethyl PABA)
sunscreen ingredients that provide protection from UVA rays:
- Avobenzone (Parsol 1789)
(oxybenzone, dioxybenzone, sulisobenzone)
Sunblocks - "Physical"
sunscreen ingredients lie on top of the skin and work by reflecting or scattering UV radiation. They are particularly useful
for people who are sensitive to the ingredients found in other sunscreens. Sunblocks often contain one or more of these ingredients:
- Titanium dioxide
- Iron oxide
Although past formulations
were unsightly (often leaving a white film on the skin), newer "microfine" formulations are invisible after being
applied. Microfine titanium dioxide is effective at protecting from both UVA and UVB rays.
- Sunscreens are classified as "water-resistant" if they maintain their protection after two 20-minute
immersions in water. They are classified as "waterproof" if they maintain their protection after four 20-minute
immersions. You should seek a water-resistant or waterproof sunscreen if you will be participating in water sports, such as
swimming or water skiing, or will be actively sweating.
However, independent testing has shown many products do not
perform well in the real world. So it remains a good idea to apply sunscreen every time you leave the water, or frequently
if you are actively sweating.
Using a Sunscreen
Sunscreen should be applied
evenly and liberally on all sun-exposed skin within 30 minutes before going outside to give sunscreen time to take effect.
(Sunblocks are effective immediately after being applied.) Sunscreens should be reapplied every two hours or following swimming
or sweating. Apply sunscreen generously and reapply frequently at least every two hours.
The chemicals may lose
effectiveness over time, so it is important to throw away sunscreen that is past its expiration date
or is over two years old.
No sunscreen is 100% effective; take additional measures to avoid the
damaging effects of the sun's rays.
Clothing can provide excellent
protection from the sun. However, not all clothing is protective. A thin, wet, white t-shirt will provide almost no protection
from UV rays. When selecting clothes for sun protection, consider the following:
- Cover your head, shoulders, arms,
legs, and feet.
- Use a hat that is broad-brimmed (brim should be at least four
- Wear fabrics that are thicker or with a tight weave; these allow less
sunlight to penetrate the skin.
- Wear darker-colored clothes that absorb more UV rays.
- Wear clothing
made from nylon or Dacron because it is more protective than cotton.
- Avoid remaining
in wet clothes because wet fabric may allow more UV rays to penetrate the skin.
clothing with chemical absorbers to increase their protectiveness.
- Some clothing
comes with a UPF rating that stands for "Ultraviolet Protection Factor." This measures the ability of the fabric
to block UV radiation from penetrating to the skin. A fabric with a UPF 15 allows only 1/15th (6.66%) of the UV radiation
to penetrate your skin as compared to uncovered skin.
Garments fall into 3 categories:
protection: UPF = 15 to 24
- Very good protection: UPF = 25 to 39
protection: UPF = 40 to 50+
Choose clothing with a UPF rating of at least 15. Keep in mind that the UPF of a
garment will decrease over time as the fabric wears.
Overexposure to sunlight can cause cataracts
and macular degeneration, a major cause of blindness. Sunglasses can provide protection. However, not all sunglasses are of
value. A darker lens itself does not guarantee protection. Look at the label to ensure that the glasses provide UV protection.
Sunglasses should be large enough to shield your eyes from many angles. Look for sunglasses that are described as blocking
99% or 100% of UVA and UVB. The glasses may also be described as providing UV absorption up to 400 nm.
possible, remain in the shade when outdoors. Keep in mind that shade does not provide full protection from the sun because
UV rays can bounce off reflective surfaces, such as sand, snow, water, concrete, or even porch decks. In addition, some fabrics
used as shade devices, such as parasols or umbrellas, may not provide sufficient protection. If you seek shade under a cloth,
look for a fabric that is thick, tightly woven, and dark-colored.
Clear window glass provides protection from UVC and
UVB, but not UVA rays. If you are frequently exposed to sunlight while driving, the plastic interleaf of your windshield (which
prevents it from shattering) can help block the light, but side windows have no such protection. Non-drivers can make use
of additional window shade devices. Drivers in some states may be able to use darkly-tinted glass in the side windows, but
this is illegal in some states.
- Avoid the sun when its
UV rays are strongest, between 10 a.m. and 4 p.m.
- Use a broad-spectrum sunscreen with SPF 15 or greater.
Apply it 30 minutes prior to being exposed to the sun and reapply every two hours. Consider using a water-resistant sunscreen
if you will be active (sweating) or in the water.
- Use a sunblock on your lips.
- Wear a broad-brimmed hat
- Wear sunglasses.
- Wear tightly woven, dark clothing to
cover your arms, legs, and feet.
- Stay in the shade when possible.
reflective surfaces, such as water or snow.
- Avoid sunbathing.
be fooled by cloudy days since damaging rays can penetrate clouds.
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Dr. Gary Rothfeld
- Board Certified Dermatologist - New York, NY
30 E. 60th St. Ste. 805
Manhattan, New York 10022