Definitions of Skin Problems

Dermatitis is used as a term to describe a number of conditions that are inflammatory processes and are generally characterised by erythema. The term literally means an inflammation of the skin. Dermatitis can be characterised by various skin appearances, such as a macula, wheal, subcorneal blister, intradermal blister, subepidermal blister, pustule, papule, rhagades, ulcer, squama,keratosis, scab (crusta), scar (cicatrix). Treatment of dermatitis can include the use anti-inflammatory agents, antibiotics, antifungals, corticosteroids, anaesthetics and others.

Dermatosis is a nonspecific term used for any cutaneous abnormality or eruption. It includes many disorders and literally means, a disorder of the skin. Treatment depends upon the specific problem and the portion of the skin involved.

Eczema is a generic term for inflammatory conditions of the skin, particularly with vesiculation in the acute stage, typically erythematous, edematous, papular and crusting; followed by lichenification and scaling and occasionally by duskiness of the erythema and, infrequently, hyperpigmentation; often accompanied by sensations of itching and burning; the vesicles form by intraepidermal spongiosis. Eczema is treated by anti-inflammatories, antibiotics, antifungals, corticosteroids, anesthetics and other agents.

Psoriasis is a chronic scaling disease of the skin, affects between 1 and 2% of the population. It primarily affects adults but does occur in all age groups; most common between the ages of 15 and 35.

Psoriasis affects men and women about equally but may be slightly more prevalent in women. Patients with pso­riasis may suffer discomfort (pain, itching, restricted motion in some of their joints or emotional distress. Psoriasis is generally a mild condition and there are many medications (prescription and nonprescription) that can be used to help alleviate the discomfort.

Definition of Psoriasis

Psoriasis is actually a non-contagious, chronic skin disease presenting in many different forms and any different levels of severity. When joints are involved, it is called psoriatic arthritis and is similar to rheumatoid arthritis.

Individuals with psoriasis often experience a variety of emotions, including sadness, despair, guilt, anger and even low self-esteem. Sometimes they are embarrassed due to the unsightly patches skin that manifest the disease and sometimes are frustrated at not knowing why they developed the disease or why it cannot be cured.

Psoriasis is defined as "a common multifactorial inherited condition characterised by the eruption of circumscribed, discrete and confluent, reddish, silvery-scaled maculopapules; the lesions occur predominantly on the elbows, knees, scalp, and trunk, and microscopically show characteristic parakeratosis and elongation of rete ridges with shortening of epidermal keratinocyte transit time due to decreased cyclic guanosine monophosphate.

Cause of Psoriasis

The actual cause of psoriasis is unknown but may be related to disorders in the body's immune system; it is an immune-mediated disorder. Signals are generated which increase the growth rate and cycle in skin cells resulting in cells that accumulate on the surface of the body and they are not shed fast enough. Where normal skin cells mature in 28 to 30 days, a psoriatic cell may mature in only 3 to 4 days and stack up on top of each other on the skin surface, forming elevated red lesions.

Psoriasis apparently has a genetic component but may also involve certain "triggers" for it to appear. These triggers may be environmental or involve emotional stress, injury to the skin, certain infections and reactions to certain drugs.

Plaque psoriasis (psoriasis vulgaris) is the most common, affecting about 80% of individuals suffering from the disorder. It appears on almost any skin surface, especially the elbows, scalp, knees, trunk and nails. The lesions are described as well-defined patches of red, raised skin. The buildup on the patches, composed of dead skin cells, is called scale and appears flaky and silvery-white. The scale constantly sheds as it becomes loose. The psoriatic area is usually dry and exhibits symptoms of pain, itching and cracking.

Guttate (Latin for "drop") psoriasis is indicated by the presence of small, red, individual "drops" on the skin, generally the trunk and limbs and sometimes the scalp. Guttate psoriasis lesions are generally not covered with scales and are generally not as thick as the plaque psoriasis.

Inverse (flexural) psoriasis is commonly found in the armpits, breasts and in skin folds around the genitals and buttocks. The appearance is smooth and dry but also red and inflamed; it does not have the scales present. It is easily irritated from rubbing and sweating and is more common in overweight patients.

Eythrodermic psoriasis is the least common form of the disease, is particularly inflammatory and is characterized by periodic, widespread skin redness. This reddening and accompanying exfoliation, covering most of the body, is often accompanied by severe itching and pain.

Generalized pustular psoriasis (also called Von zumbusch pustular psoriasis), like it's name, occurs widespread over the body but is a relatively rare fonn of the disease. The skin may become intensely painful and tender and pustules may appear, then dry up and reappear.

Localized pustular psoriasis is a more confined form of the disease. The pustules appear, turn brown and peel. One form is palmo-plantar pustulosis that is characterized by large pustules in fleshy areas of the hands and feet. Psoriatic arthritis may develop in about 10 to 30% of patients with psoriasis. Symptoms can include stiffness, pain, swelling/tenderness of joints and soft tissue, reduced range of motion, morning stiffness and tiredness.

Additional symptoms include conjunctivitis and changes in the nails. Joints usually affected include the wrists, knees, ankles, lower back and neck. It affects men and women equally and generally occurs between the ages of 30 and 50.

Severity of Psoriasis

There are three categories of psoriasis that makes it easier to select treatment. The categories include (1) Mild Psori­asis, (2) Moderate Psoriasis and (3) Severe Psoriasis. Also, the way the psoriasis affects an individual's quality of life is considered in the classification'

Mild psoriasis is experienced by about 75-80% of the patients. It involves less than about 2% of their body and generally involves isolated patches on the knees, elbows, scalp, hands and feet. Treatment often includes topical products, including moisturisers and over the counter and prescription only creams, ointments and shampoos, which are generally sufficient to control the symptoms.

Moderate psoriasis affects about 2-10% of the body's surface and involves the arms, legs, torso, scalp and other areas. Treatment includes topical medications, phototherapy and oral medications.

Severe psoriasis involves more than 10% of the body, which may be covered with psoriasis plaques or pustules or widespread erythrodermic psoriasis; it can cause severe peeling of the skin. Patients with this category of psoriasis tend to develop psoriatic arthritis. Therapy includes phototherapy, oral medications or a combination of both.

The severity of psoriasis can be made worse by injury and irritation, sun exposure, stress and anxiety, some medications, infections and possibly diet.