I was surprised to hear so little in response to my last piece on MRSA (methicillin resistant staphylococcus aureus); I had fully anticipated a lively discussion of this health threat to follow my article. Instead, the silence was deafening. I didn't get any suggestions for a topic for this article either, so I made an executive decision to pick up a topic of interest, at least to me: psoriasis.

What Is It?

The word psoriasis comes from the Greek root psora, which means "the itch." It's mainly a skin condition, although in some circumstances other systems can be involved as well. Psoriasis is quite common in this country, affecting 6 to 7 million Americans. It's most common in Caucasians. About 150,000 new cases are diagnosed every year.

How Does It Work?

Under normal circumstances, superficial skin cells are replaced roughly every 28 to 32 days. (Hmmm, a 28- to 32- day cycle. What does that make you think of?) What we see with psoriasis is that, in certain areas, skin cells replicate at a vastly accelerated rate: instead of a month-long turnover cycle, they are replaced every 4 to 6 days. The consequence is a patchy pile-up of keratinized epithelial cells, often with a silvery scale: these are the plaques of the most common form of psoriasis.

What we don't understand is why this happens. A genetic link might seem to be part of the picture, because the incidence of psoriasis is higher within families. Immune system anomalies are clear as well, and some experts classify psoriasis as an autoimmune disease - a situation in which immune system mechanisms are directed against healthy tissue by mistake. Psoriasis frequently appears with some other autoimmune disorders (ankylosing spondylitis, for instance), and it runs in cycles of flare and remission; both of these characteristics are common in autoimmune disorders.

Types of Psoriasis

Plaque psoriasis (Fig. 1) is the most common form of this disorder. It frequently appears over joints: knees and elbows are common. Some people have one small lesion that appears in the same place for a few weeks every year or so; others have huge lesions that might cover their back or trunk, scalp, hands or feet. Even when the condition goes into remission, the skin might sustain enough damage to appear permanently discolored and scarred. Other forms of psoriasis are less common, but good to know about:

• Guttate psoriasis: this version resembles plaque psoriasis, but the lesions tend to be smaller and shallower.
• Pustular psoriasis: this involves small, itchy, noninfectious pustule, often found on the palms and soles.
• Inverse psoriasis: this appears at skin folds under the breasts, in the armpits, and around the genitals. The skin becomes red and shiny, and is vulnerable to secondary infection.
• Erythrodermic psoriasis: this version is triggered by sunburn and steroidal anti-inflammatories (or by a sudden stop in the use of steroidal anti-inflammatories). It covers large areas of skin in a bright red, hot, painful rash. It can involve massive fluid loss, and can be a medical emergency.

Complications

Psoriasis doesn't usually involve dangerous complications, unless the lesions bleed and get infected, or unless a person with erythrodermic psoriasis has a fluid-loss crisis. However, about 10 percent of the people with psoriasis are at risk for a painful and possibly extreme form of arthritis, called psoriatic arthritis. If a client has psoriatic arthritis, treat it in the same way you would treat rheumatoid arthritis: avoid it when it's hot and inflamed and work for joint mobility and pain reduction when the joint is not actively inflamed.

Treatment Options

We understand a lot about the process of how psoriasis develops, but this still is a basically idiopathic (of unknown origin) disease. Consequently, the treatment options for psoriasis are largely hit-and-miss efforts to control symptoms. Many people with psoriasis develop tolerance for medical interventions, and so, must constantly be looking for the next option.

Allopathic interventions include topical skin creams to reduce itching and help clear up plaques. Oral medication can work with controlled exposure to UV radiation to help this process. In very extreme cases, patients might be prescribed chemotherapeutic drugs to limit skin cell replication. All of these can help to control the frequency and severity of psoriasis outbreaks, but none of them are a permanent cure for the disease.

The newest strategy involves a group of drugs called TNF Blockers. TNF (tumor necrosis factor) is an immune system mediator associated with inflammation. Blocking its activity keeps the inflammatory process (and accompanying proliferation of extra skin cells) under control.

Alternative psoriasis treatments also vary widely. A search for "psoriasis cure" brings up dozens of products claiming to heal this disease. They range from herbal clay applications, to aromatherapy, to visiting the Red Sea so that a species of fish can nibble at the lesions (I am not making this up!).

Personally, I am open-minded to seeing dietary adjustments and herbal or homeopathic applications for psoriasis management, but I retain a healthy skepticism of any product that claims to "permanently cure" this condition.

Massage?

In the olden days (as in, the days of Hippocrates), doctors were instructed to rub olive oil into psoriasis lesions. We know now that when psoriasis is acute, these are areas where cells already are hyperactive. Increasing energy or circulation to these sites might not be the best plan. However, it's important to point out that psoriasis is not contagious! Clients with psoriasis can benefit from bodywork that includes the whole body, as long as the stimulus doesn't increase itching or irritation. Herbal or aromatherapeutic agents could be useful in this context as well. If you have found an application you have seen to improve psoriasis symptoms, please share it with me and other Massage Today readers.

For Next Time

Gentle readers, let me remind you that this is your column! I am at your disposal to gather information on the pathology topics you want to read about. Please go through your client history notes and find one that makes you curious - and let us all know: what's on your table?