This is mainly a skin condition marked by patches of thick, red skin covered with silvery scales that occur primarily on your elbows, knees, legs, lower back, scalp and feet. Certainly not life-threatening, the condition can be painful, affect your ability to function, and cause psychological and emotional distress. Approximately one third of patients with this condition have a family history of the disease.
This type of eczema affects two to three percent of the Caucasian population which includes over seven million Americans with an estimated 125 million world-wide suffering from this affliction. This condition is seen less in African-Americans along with Asian and Eskimo populations. It is virtually unheard of in Native Americans. This condition is seen more in northern exposures as opposed to southern altitudes where people have greater sun exposure.
This dermatitis develops when the ordinary life cycle of skin cells accelerates. Skin cells regularly die and flake off in scales — but in people with psoriasis this process happens within days rather than weeks. Rounded, circumscribed, red, dry, scaly patches of varying sizes characterize the skin. Itching and burning may also be present. On removal of the scaling skin bleeding points occur known as Auspitz’ sign. Koebners’s phenomenon is also frequently found. This is the appearance of typical psoriatic lesions at the site of an injury.
The disease is chronic, but you may have periods when the condition becomes worse alternating with times when it improves or goes into remission. And although no cure exists, treatments may offer significant relief.
Aside from a positive family history being a risk factor for psoriatic conditions, other factors include stress which can have a negative impact on your immune system. Medications particularly beta blockers can predispose someone to this condition. Even lithium may make you more prone to pustular eruptions. Excessive exposure to sun can exacerbate the eczema, while small amounts of exposure to the sun may actually help the condition. People with HIV and children with frequent recurring infections may also be more prone to this type of eczema.
Below is a picture of a typical psoriatic eruption on the bottom of the feet.
About 50 percent of patients with psoriatic eczema eventually develop the condition in the nails of the hands and feet. The classic changes seen within the nails is pitting of the nail plate. This is the result of damage directly to the nail matrix (growth plate of the nail). Other nail changes commonly seen in psoriatic nails include yellow discoloration of the nail plate along with detachment and crumbling of the nail and the accumulation of thick tissue under the nail. These nails may appear very similar to mycotic (fungus) nails.
Below is a picture of a psoriatic nail.
This is another aspect of this disease state that commonly manifests itself in the feet. Approximately 5-7 percent of those suffering from psoriasis will eventually develop arthritis. Men and women are affected equally. The peak incidence is in the fourth to sixth decade.
There are no specific laboratory findings in psoriatic arthritis so the condition has to be differentiated from other arthritides such as osteoarthritis, rheumatoid arthritis, and goutl . When a patient presents with the cutaneous manifestation of psoriasis the diagnosis is easy; it is more perplexing when there are no cutaneous or nail lesions (and no history of the actual disease).
Clinically in the foot psoriatic arthritis has certain characteristics. One is diffuse swelling of one or more toes commonly known as “sausage digits”. This is thought to be due to a combination of swelling from both arthritis and tenosynovitis.
Note the "sausage" appearance of some of the toes.
Although there are a number of skeletal manifestations of the disease the picture below notes the classic findings of psoriatic arthritis in the foot. The blue arrow points to a normal even joint space between the second metatarsal bone and the second toe. Notice the red arrow; that is a classic “cup and saucer” effect of the fourth metatarsal bone being jammed into the base of the fourth toe. The yellow circle shows the destruction in the toes that is characteristic of the disease. This destruction has occurred on the other toes as well.
Treatment for psoriasis is geared to reduce inflammation both in skin and bone manifestations. Since statistically most people who suffer from psoriasis suffer primarily skin eruptions topical medication is usually the treatment of choice.
Additional drugs in this class include Sulfasalazine, Cyclosporin A, Etanercept, Remicade and Humira.
It is important to emphasize that these are serious medications and should not be abused.
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