DEAR MAYO CLINIC: What causes psoriasis, and what are the most effective treatments? I've tried a few without much success.
ANSWER: The exact cause of psoriasis is tough to pinpoint. In general, the disease has a tendency to run in families, and exacerbations are often linked to the body's immune system responding to certain external factors. Treatment depends on how severe psoriasis is and how responsive it has been to previous treatment. Typically, treatment starts with mild approaches and proceeds to stronger remedies only as needed.
skin disease that affects the life cycle of skin cells. Normal skin grows and sheds every 28 days, or about once a month. Psoriasis skin regenerates every 72 hours. Because the body cannot shed skin that quickly, psoriasis causes cells to build up rapidly on the surface of the skin. When the immune system tries to attack those overgrown cells, a callous forms on the skin. The result is thick, silvery or white scales and dry, red skin patches that can sometimes be itchy and painful.
Psoriasis seems to have a genetic component, but it can occur in people who do not have any family members with the disease. Many people who are predisposed to psoriasis may be free of symptoms for years until the disease is triggered by some environmental factor.
One of the most common psoriasis triggers is stress. It could be physical stress that can come from illness, fatigue or sleep deprivation, or emotional stress that's the result of a difficult life event, such as the death of a family member, divorce, or loss of a job. In some cases, a high level of stress may spark a dramatic psoriasis outbreak, with skin appearing normal one day and then developing multiple patches all over the body several days later.
Along with stress, other influences that can raise a person's risk of psoriasis outbreaks include being overweight, smoking and exposure to second-hand smoke. Not only can these factors trigger psoriasis, but they may also make the disease harder to treat.
Although there's currently no cure for psoriasis, a variety of treatment choices are available that may help manage symptoms and decrease flare-ups. In mild to moderate cases, treatment usually starts with creams and ointments used alone. In more severe cases, light therapy combined with topical treatment can be useful.
If psoriasis does not respond to other treatments, or if it's severe, oral or injected medications may be helpful. But because they can lead to serious side effects, these medications typically are used only for limited periods of time.
Successfully treating psoriasis can be challenging. What works for one person might not work for someone else. Treatments may be effective for some time, and then the body builds up resistance to them and they no longer work. In addition, the disease can be unpredictable, going through cycles of improvement and worsening, seemingly at random.
Despite these challenges, it is important for you to continue with treatment and find one that works for you. If left untreated, psoriasis may lead to or intensify other medical problems, such as arthritis and heart disease.
Talk to your doctor about your options, especially if psoriasis persists despite treatment or if you are having uncomfortable side effects from therapy. He or she can help you develop a treatment plan or change your current treatment approach to best control your psoriasis symptoms. -- Dawn Davis, M.D., Dermatology, Mayo Clinic, Rochester, Minn.
(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. To submit a question, write to: firstname.lastname@example.org. For health information, visit http://www.mayoclinic.com.)
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Mayo Clinic Medical Edge: New approach may be needed if current psoriasis treatment no longer effective
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