FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

PSORIASIS SUFFERER SHOULD ASK DOCTOR FOR A "STRONGER HAMMER"

Question: I have recently developed a problem with my scalp. It started with a small area that itched and had dry flaky scales on it. Occasionally, one of these "sores" makes a sticky substance. Now the condition seems to be spreading over my entire scalp. I saw a dermatologist, who said I have psoriasis. He gave me a prescription for a special shampoo, but this doesn't seem to help very much. Can you recommend something that I can do to cure this problem?

Answer: I think most people are familiar with the name "psoriasis" but may not understand the nature of the condition. Medical scientists believe that psoriasis is due to an abnormality in the body's immune system, specifically in the helper T-cells. In this disorder, the immune system attacks apparently healthy tissue -- most commonly skin, joints or nails -- and causes inflammation of it. This results in a reddish-colored skin lesion with thickened, often silver-colored areas on top that are called scales. These psoriasis lesions can develop on any part of the body, but they are most common on the outside surfaces of the elbows and knees, on the scalp, the palms and the feet.

Psoriasis is certainly a common problem -- it afflicts about 6.4 million Americans. It may first appear at any age, even in childhood, but most people don't show signs of it until they are adults. Psoriasis also has a strong genetic component. That's why those with a family history of it have a much greater risk of developing the disorder. Specifically, the general population risk is about 4 percent, but if one parent has psoriasis, the risk rises to 28 percent, and if both parents suffer from the disease, the risk rises dramatically to 68 percent. Men and women are troubled with this in equal frequency, so the disorder is not linked to the "X" chromosome. Actually, most experts think that there is more than one gene involved in the inheritance of this disorder.

Although a cure for psoriasis hasn't been found, we are fortunate to have a number of treatments that do give a "temporary clearing" of this life-long condition for most sufferers. The shampoo your dermatologist prescribed is one of these. Don't be disheartened that it didn't work. To borrow an explanation from my carpentry experience: You don't use a sledgehammer to drive a carpet tack. Your doctor started you on the mildest medicine that was likely to give you relief -- a tack hammer, if you will. Go talk to him again. He has many other treatment options available before getting to the "sledgehammer" one.

You shouldn't limit your treatment for psoriasis to only the drugs you get from your doctor. A psoriasis attack can be brought on by emotional stress, so try to view life from a more relaxed perspective. Skin irritation from chemicals or tight clothing can do it too, so obviously you should avoid these. One of the most effective treatments you or your doctor can prescribe is sunlight exposure, but don't overdo your first few days out in our gorgeous spring weather because sunburn can make psoriasis worse. I'd suggest that you talk to your dermatologist again because of the medical concerns and the significant social consequences of your condition. You may also want to contact the National Psoriasis Foundation at 6600 S.W. 92nd, Suite 300, Portland, OR 97223, or call (503-244-7404) or 800-723-9166 for more information about your condition. You can also go to the Internet URL: http://www.psoriasis.org.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.