I was sick Monday, the shawl and I arent getting along too well, I got nothing else, Hawkeye has psoriasis (he was diagnosed when he was eight) and we lived together for 7 years, so here we go:
Psoriasis is an autoimmune disease that causes your skin cells to divide faster than normal. Skin is the largest organ (dont get any naughty ideas) which is why psoriasis can be found all over your body. Usually your skin cells take about month or so to divide and come to the surface. With psoriasis, it takes 3-5 days. Because the skin cells divide and come to the surface so quickly it causes plaques to form on the body. Plaques can form around joints or all over the body. Psoriasis can cause pitting of finger and toenails.
The quick division of skin cells is what causes scaley plaques to form on the skin.
Plaques can form on the scalp. This is particularly annoying if you have dark hair because it looks like you have really bad dandruff and it makes wearing dark clothes nearly impossible. Plaques on the palms or feet can inhibit everyday functions and can be very painful.
A little Q&A
Q.Is psoriasis contagious? A. Nope. Psoriasis is thought to be passed along genetically. If there is a family history of psoriasis there is a chance you could develop psoriasis. Most cases develop in childhood through the early teen years.
Q. Is psoriasis related to leprosy? Um . . . not just no, but hell no. Even though this was once common thinking a hundred or more years ago, this is no longer the case. Psoriasis is not going to make your nose or feet fall off.
Q. Do you develop psoriasis from being unclean? Again, no. It’s an autoimmune disorder. An autoimmune disorder is where your own body’s immune system goes a bit haywire and starts attacking you. In the case of psoriasis, the immune system starts attacking the skin.
Q. Is there a cure? A. Frustratingly, no. There are several treatments, everything from lotions and creams for the most mild cases all the way to injections for the most severe. There is a new laser treatment coming to market that can treat large plaques. No idea exactly how effective it is yet. (treatments will be followed up on later)
Severity of psoriasis varies dramatically although, according to Wikipedia at least, over half of people diagnosed with psoriasis have a mild to moderate case. If more than 10% of your body is covered in psoriasis plaques, then it’s considered severe.
Psoriasis can be life threatening in one instance: if you have severe psoriasis, are not treating it, and it gets out of control you can develop a condition called Erythrodermic psoriasis. When this happens, the immune reaction goes completely ape shit and makes it nearly impossible for your body to regulate it’s temperature. The skin, instead of coming off in small flakes, comes off in sheets, and it opens the body for secondary infection. Hawkeye developed this condition (he wasnt taking care of himself) and spent 2 weeks in the hospital once he got back to Iowa.
Generally though, psoriasis is not life threatening but is a complete pain in the ass. It affects not just the body, but the psyche as well. Think about it for a minute. You have silvery, scaley patches on your arms, knees, hands, and maybe face, of course you’re going to feel extremely self-conscious. It’s not a well known condition, and we all know how some people can be when they’re confronted with something they dont understand. You can face a lot of judgement. It effects your self esteem, the kinds of clothes you wear, the colours you wear, and your dating/sex life. Psoriasis may go into remission, but it will never go away. There is no cure. Cuts and scrapes can take longer to heal and can cause your psoriasis to flare up. It effects what kinds of activities you participate in (you may not go swimming because you feel self conscious about your skin) it effects how attractive you feel. The psychological effects of the disease is worse than the disease itself, at least imho.
Treatment: There are several treatments of varying effectiveness for psoriasis and treatment depends on how severe your case is. If you case is mild, you might only have to use over the counter lotions and creams on your plaques. Lubrederm, A&D Ointment, Vitamin E oil, Nutrogena Coal Tar Shampoo, (this is good for scalp psoriasis although it’s not clearly understood why coal tar has a positive effect on psoriasis), Dead Sea Salts, etc. Exposure to sunlight is good too because the UV rays shrink psoriasis spots.
If your case is more severe there are other more dramatic treatments you can pursue:
Photo therapy: This usually involves some type of light box. I’ve only ever seen Hawkeye’s and can tell you it’s about 5 feet tall with lights that look like big fluorescent bulbs. There are two types of light that can be used: UVA and UVB. Sometimes creams and coal tar are used in combination to achieve greater effectiveness. Hawkeye even had little goggles (the kind you get in a tanning salon) to wear. This is how it works: you turn the light on (make sure to wear your little goggles. Safety first!) and stand in front of it for a couple of minutes. Over time you stand in front of the light for longer periods. Because it’s UVA or UVB you can get burned which is why you have to build up a tolerance.
There are systemic treatments too involving drugs and/or injections. Methotrexate is commonly prescribed because it slows cellular growth. It’s also prescribed if you have an ectopic pregnancy. Methotrexate can effect liver functions so it’s important to have monthly blood tests. Liver biopsies are recommended, but having your liver bored into is not the most pleasant experience.
Cyclosporine (which I thought was an antibiotic but isnt) is an immunosuppressant that is usually given to transplant patients but is also used to treat psoriasis.
There are a few other drugs that can be used to treat psoriasis, but we’re going to talk about the big guns now. IV and injections.
Remicade is given through IV injection in a Dr. office. Imagine how much fun it is to sit in your Dr’s office with an IV drip for 4 hours. What a way to spend an afternoon.
Humira and Enbrel are administered through self injection. I dont know much about Humira, but Enbrel is an immunosuppressant. It helps stop the body from attacking itself, but can leave the body open to other infection. It’s also used to treat psoriatic arthritis. It’s very expensive, but also very effective.
Psoriatic Arthritis is a specific form of arthritis associated with guess what? Psoriasis. It’s similar to rhumetoid (yes, it’s a product of an over active immune system), can be very severe, and left to it’s own devices will destroy the joints. It seems to effect the joints in the fingers the most but like any arthritis, can effect joints all over the body.
There are other treatments other than drugs. Stress plays a big role in outbreaks and techniques to reduce stress are helpful in treatment (yoga, meditation, biofeedback, massage, etc) Food allergies can play a role in flare ups. Two common food allergies that play a role are wheat and dairy. Weather can also play a role in flare ups of psoriasis and psoriatic arthritis.
The most important thing to remember is that someone with this condition is the same as you are. Their brains are just as big, their minds are just as clever, and they have the same feelings as you do. Hawkeye doesnt mind questions, even if they seem dumb. I lived with him for 7 years, talk to him a few times a week, and still have questions about his disease process. Practice tact. Dont be a dumb ass and say things like “Eww yuck! How do you live like that” You can ask things like: How long have you had this disease? How do you treat it? How do you take care of yourself? Do you have a hard time with people staring? Yes, btw, people do stare, it’s not nice, but it happens. Just like anyone with diabetes or arthritis, practice respect and kindness.