Psoriasis: More Than Cosmetic

It's not easy living in Leah Bird's skin. "The worst thing is when people just stare," says Bird. "I almost like it better if someone comes up to me and asks me what it is."

Then she'll tell them, "I have psoriasis. It's not contagious."

Bird, 51, of suburban Boston, has had flare-ups of this chronic skin disease since she was a teen-ager. The dry, red, scaly patches of skin that characterize psoriasis have covered as much as 85 percent of her body, she says. "It alarms people. It looks very scary to people who don't know what it is."

But psoriasis is more than cosmetic. "This disease is common, chronic, and costly, both in monetary terms and in quality of life," says Jonathan Wilkin, M.D., director of the Food and Drug Administration's Division of Dermatologic and Dental Drug Products.

More than 5 million Americans have psoriasis, and they spend between $1.6 billion and $3.2 billion each year to treat the disease, according to the National Psoriasis Foundation (NPF). Between 150,000 and 260,000 new cases are diagnosed each year, including 20,000 in children younger than 10.

"Psoriasis can be painful and can be profoundly disruptive to a person's life," says Jill Lindstrom, M.D., an FDA dermatologist. "People who don't have it don't understand how burdensome the disease can be. There is constant shedding of scales. There can be functional impairment, itching, and pain." And health complications, such as arthritis, accompany some cases.

There is no cure for psoriasis, but a broad range of treatments is available to reduce the symptoms, clear up the skin, and send the disease into remission. FDA-approved treatments range from creams rubbed into the skin, to lasers that aim ultraviolet rays at the skin, to the newest treatments--injectable drugs made from living cells.

Emotional Impact

For many people, dealing with the emotional impact of psoriasis can be as challenging as treating the disease.

Bird says that mothers have pulled their children away from her on the subway, and some people, horrified by her skin lesions, have asked her if she has AIDS. As her disease has evolved over 30 years, so has Bird's way of dealing with these reactions. In her teens, she'd tell people she had leprosy just for the shock value, she says. Today, Bird is open about the disease but still relies on her defiant attitude to "steel myself for the experience" of going to the beach. "I love to swim," she says. But Bird knows that without covering herself up in a public place, she "runs the risk of people just rubbernecking."

"When I'm feeling forgiving, I try to ignore them," she says, "but when I'm angry, I think 'didn't your mother teach you not to stare?'"

Bird advises others with psoriasis to find out what works best for them to cope with the emotional effects of the disease. Going to therapy has helped her, she says. So has leading a support group for psoriasis sufferers. "It's important for people to work on their emotional well-being," says Bird, "however they choose--whether it's meditation, yoga, or putting on long pants and going out dancing."

What is Psoriasis?

Psoriasis is an inflammatory skin disease in which skin cells replicate at an extremely rapid rate. New skin cells are produced about eight times faster than normal--over several days instead of a month--but the rate at which old cells slough off is unchanged. This causes cells to build up on the skin's surface, forming thick patches, or plaques, of red sores (lesions) covered with flaky, silvery-white dead skin cells (scales).


In psoriasis, an activated immune system triggers the skin to reproduce every three to four days, building up on the outer layers (epidermis and keratin). The epidermis thickens, blood flow increases and reddens the skin, and silver-gray scales cover it.

Rarely life-threatening, at its mildest, psoriasis can be itchy and sore. At its worst, it's painful, disfiguring, and debilitating. About two-thirds of the people with psoriasis have a mild form of the disease, says the NPF. About one-third have moderate or severe psoriasis. Psoriasis can affect people at any age, but it most often strikes those between the ages of 15 and 35.

There are five forms of psoriasis. Plaque psoriasis is the most common--affecting 4 out of 5 people who have psoriasis, says the NPF. Plaque psoriasis may start with small red bumps and progress to larger lesions.

The plaques of psoriasis occur most frequently on the elbows, knees, other parts of the legs, scalp, back, face, palms, and soles of the feet. Psoriasis can also affect the fingernails and toenails, causing pitting, discoloration, or tissue buildup around the nails. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, about 15 percent of people with psoriasis also get psoriatic arthritis, which can be progressively disabling if untreated.

For more, please read the Psoriasis article.

Source: Food and Drug Administration, author Linda Bren

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Last Editorial Review: 9/22/2004