Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.
Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Psoriasis is a chronic disorder of the skin
characterized by reddish, scaly patches of inflammation, most
commonly affecting the elbows, knees, scalp, and/or groin. Psoriasis
can be mild or severe. When it is severe, it can adversely affect
functions of daily living including work and social activities.
Psoriasis has been reported to affect approximately
2% of the world's population.
The treatment of psoriasis depends on its severity
and location. Treatments range from local (cortisone cream
application, emollients, coal tar, anthralin preparations, and sun exposure)
to systemic (internal medications, including methotrexate and
cyclosporine).
PUVA (psoralen and ultraviolet A radiation) treatment
has been used for over two decades to treat severe psoriasis. In
this "combination" therapy, the psoralen, taken internally,
acts as a skin sensitizer. The "sensitized" skin affected
by psoriasis can then be treated by ultraviolet A radiation.
The tendency toward developing psoriasis is
inherited in genes.
Psoriasis is not contagious.
Psoriasis gets better and
worse spontaneously and can have periodic remissions (clear skin).
Psoriasis is controllable with medication.
Psoriasis is currently not curable.
There are many promising therapies, including newer biologic drugs.
Future research for psoriasis is promising.
What is psoriasis?
Psoriasis is a noncontagious skin condition that produces red, dry plaques of thickened skin. The dry flakes and skin scales are thought to result from the rapid proliferation of skin cells that is triggered by abnormal lymphocytes from the blood . Psoriasis commonly affects the skin of the elbows, knees, and scalp.
Some people have such mild psoriasis (small, faint dry skin patches) that they may not even suspect that they have a medical skin condition. Others have very severe psoriasis where virtually their entire body is fully covered with thick, red, scaly skin.
Psoriasis is considered a non-curable, long-term (chronic) skin condition. It has a variable course, periodically improving and worsening. It is not unusual for psoriasis to spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms in the colder winter months.
Psoriasis is seen worldwide, in all races, and both sexes. Although psoriasis
can be seen in people of any age, from babies to seniors, most commonly
patients are first diagnosed in their early adult years.
Patients with more severe psoriasis may have social embarrassment, job
stress, emotional distress, and other personal issues because of the appearance
of their skin.
What causes psoriasis?
The exact cause remains unknown. There may be a combination of factors, including genetic predisposition and environmental factors. It is common for psoriasis to be found in members of the same family. The immune system is thought to play a major role. Despite research over the past 30 years looking at many triggers, the "master switch" that turns on psoriasis is still a mystery.
What does psoriasis look like? What are the symptoms and signs?
Psoriasis typically looks like red or pink areas of thickened, raised, and dry
skin. It classically affects areas over the elbows, knees, and scalp.
Essentially any body area may be involved. It tends to be more common in areas
of trauma, repeat rubbing, use, or abrasions.
Psoriasis has many different appearances. It may be small flattened bumps,
large thick plaques of raised skin, red patches, and pink mildly dry skin to big
flakes of dry skin that flake off.
There are several different types of psoriasis, including psoriasis vulgaris
(common type), guttate psoriasis (small, drop like spots), inverse psoriasis (in
the folds like of the underarms, navel, and buttocks), and pustular psoriasis
(pus-filled, yellowish, small blisters). When the palms and the soles are involved, this is known as palmoplantar psoriasis.
Sometimes pulling of one of these small dry white flakes of skin causes a
tiny blood spot on the skin. This is medically referred to as a special
diagnostic sign in psoriasis called the Auspitz sign.
Genital lesions, especially on the head of the penis, are common. Psoriasis in
moist areas like the navel or area between the buttocks (intergluteal folds) may
look like flat red patches. These atypical appearances may be confused with
other skin conditions like fungal infections, yeast infections, skin irritation,
or bacterial Staph infections.
On the nails, it can look like very small pits (pinpoint depressions or white
spots on the nail) or as larger yellowish-brown separations of the nail bed
called "oil spots." Nail psoriasis may be confused with and incorrectly
diagnosed as a fungal nail infection.
On the scalp, it may look like severe dandruff with dry flakes and red areas
of skin. It may be difficult to tell the difference between scalp psoriasis and
seborrhea (dandruff). However, the treatment is often very similar for both
conditions.
Cellulitis is an acute spreading bacterial infection below the surface of the skin characterized by redness, warmth, inflammation, and pain. The most common cause of cellulitis is the bacteria Staph (Staphylococcus aureus).
Anal itching is the irritation of the skin at the exit of the rectum, known as the anus, accompanied by the desire to scratch. Causes include everything from irritating foods we eat, to certain disease and infections. Treatment options include local anesthetics, vasoconstrictors, protectants, astringents, antiseptics, keratolytics, analgesics, and corticosteroids. If condition persists, a doctor examination may be needed to identify an underlying cause.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Sacroiliac joint (SI) dysfunction is a general term to reflect pain in the SI joints. Causes of SI joint pain include osteoarthritis, abnormal walking pattern, and disorders that can cause SI joint inflammation including gout, rheumatoid arthritis, psoriasis, and ankylosing spondylitis. Treatment includes oral medications, cortisone injections, and surgery.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Fungal nails (onychomycosis) may be caused by many species of fungi but the most common is Trichophyton rubrum. Distal subungal onychomycosis starts as a discolored area at the nail's corner and slowly spread toward the cuticle. In proximal subungal onychomycosis, the infection starts at the cuticle and spreads toward the nail tip. Yeast onychomycosis is caused by Candida and may be the most common cause of fungal fingernail.
Actinic keratoses are rough, scaly patches of skin that are considered precancerous and are due to sun exposure. Prevention is to cut sun exposure and wear sunscreen.
Dry skin (xeroderma) may be caused by external factors, like cold temperatures, low humidity, harsh soaps, and certain medications, or internal factors, such as thyroid disease, diabetes, psoriasis, or Sjogren's syndrome. Symptoms and signs of dry skin include itching and red, cracked or flaky skin. The main treatment for dry skin is frequent, daily lubrication of the skin.
Arthritis is a joint disorder featuring inflammation. A joint is an area of the body where
two different bones meet. A joint functions to move the body parts connected by its bones.
Arthritis literally means inflammation of one or more joints.
Arthritis is frequently accompanied by joint pain. Joint pain is
referred to as arthralgia.
There are many types of arthritis (over 100 identified, and the number is growing). The types range from those related to wear and tear of cartilage (such as osteoarthritis) to those associated with inflammation resulting from an overactive immune system (such as rheumatoid arthritis). Together, the many types of arthritis make up the most common chronic illness in the United States.
The causes of arthritis depend on the form of arthritis. Causes include injury (leading to osteoarthritis), metabolic abnormalities (such as gout and pseudogout), hereditary facto...
Psoriasis is a chronic disorder of the skin
characterized by reddish, scaly patches of inflammation, most
commonly affecting the elbows, knees, scalp, and/or groin. Psoriasis
can be mild or severe. When it is severe, it can adversely affect
functions of daily living including work and social activities.
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