By Dr. W. Gifford Jones
July 27, 2004
Sir William Osler, was not only one of Canada's most famous physicians, but also realistic enough to know when even he could not help patients. On one occasion a colleague questioned him on how to treat patients suffering from emphysema. He quickly replied, "Send them to Egypt." His startled colleague questioned, "For the arid climate and low altitude?" "No" Osler smiled, "Egypt is just the farthest place I can think of to send them".
Today, psoriasis is a similar disease in that it also frustrates doctors and patients alike. Much confusion also surrounds this infuriating disease. Some people believe that psoriasis merely affects a few areas on the scalp or skin, and look on psoriasis as a minor problem like dandruff. But it's a serious medical disease. Some patients can have extensive lesions covering large areas of the body resulting in both emotional and physical distress.
In this country two percent of Caucasians suffer from psoriasis and it's more common in Blacks, Asians and North American Indians. No age group is immune to psoriasis, but it is more likely to strike young people and those in their 40s. For unknown reasons it's rare in tropical countries.
We don't know what causes psoriasis. There is evidence that stress, infection, drugs and trauma may trigger an attack. And about one-third of patients with psoriasis have a family history of this disease.
But we do know what happens when psoriasis strikes. Under normal conditions, it takes 30 days for the deepest layer of skin to reach the surface where cells are eventually cast off. But patients with psoriasis have cells that reach the surface in just seven days. The big question is what triggers this accelerated cellular growth.
This quickened development results in the typical raised, thickened, circular, red plaques covered by fine-silvery scales. They vary in size and number and can cover large areas of the body. It's as if someone had applied fertilizer over these patches to stimulate growth.
Psoriasis is rarely life-threatening, but one form called "Erythrodema" can be fatal. In these cases psoriasis affects almost the entire surface of the body.
Patients with Erythrodema experience a variety of problems. Excessive shedding of the skin makes it less effective as a protective barrier and some patients develop infections. In addition, they lose large amounts of protein resulting in swelling, muscle wasting, dehydration and the loss of control over body temperature.
Considering the unpredictable nature of psoriasis it creates a mixed bag of physical and emotional reactions. Patients are elated when lesions decrease in size or disappear. Then become distraught and angry when they reappear for no apparent reason.
For the great majority of patients psoriasis is therefore a miserable, depressing, and lifelong disease. They are embarrassed by their appearance and sometimes handicapped by physical problems. There may be difficulty walking when there's extensive involvement of the feet. And if the hands are badly affected carrying on their work may present problems.
But the severity of the disease does not always correspond to how patients react. Some patients with minimal lesions become extremely distraught while others with major skin involvement cope reasonably well.
One patient of mine remarked, "How can I have a normal life. I have psoriasis on my face and what man will be interested in me? Besides, if I ever get married will I be able to have a baby? Or will I infect my child? And is there any hope that a cure will be found?"
How patients are treated today depends on the severity of the disease. For instance, some patients with psoriasis don't even know they have it. They may have one small plaque on the scalp, elbows or elsewhere which they pick at or scratch. In this case a home humidifier and moisturizing the skin with a body lotion is all that's needed.
Topical cortisone cream, medication to slow down the skin's growth and ultraviolet light are helpful. But prolonged use of these treatments can cause complications.
What patients and doctors want is a safe treatment they don't have to take for the rest of their lives. Let's hope that it won't be long before this is available.
For more information see the web site www.PsoriasisSupport.com
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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