Carl Chiaras, the director of brand projects and special projects for Levi’s® brand recently told The Wall Street Journal that after six months of wearing his shrink to fit Levis, he’ll fill a bathtub to about six-inches with room-temperature water and add two tablespoons of Dr. Bronner’s Magic Liquid Soap. He’ll let them soak for 20 minutes before hanging them by a belt loop to dry.

By Mary Jo Rapini

Nov 1, 2010 - 6:05:00 AM

According to a new Canadian study published in Health Psychology, people who feel insecure in their relationships may be at an increased risk for cardiovascular disease and other health problems. In fact, according to the United States National Co-morbidity Survey of Replication, those who feel insecure in relationships or avoid getting close to others appear to have an increased risk of developing several chronic illnesses.

Research was done on 5,646 adults between the ages of 18 and 60 years. They found an association between “avoidant attachments” and chronic pain, such as severe headaches. If you feel unable to get close to people or have people depend on you, then you may become stressed because you do not share problems or feelings that you may have. Carrying this burden alone not only stresses people psychologically, but also physically. People who felt insecure about their current relationships were further stressed with “anxious attachment.” These people reported feeling overly needy and found that others were reluctant to get close to them. These feelings were associated with several health problems, including heart-related problems, hypertension, strokes, ulcers and chronic pain.

Most of us have experienced the upset stomach and headaches that go along with being in an insecure relationship. You may have an insecure relationship if you cannot count on the person, if you feel they are lying to you, or if you feel “clingy.” If you feel this way and you have children, many times they will experience headaches and tummy aches or complain they are not feeling well. Your insecurity is transferred to them, and they become insecure about you and their other parent. With a divorce rate above fifty percent, we see stress not only among spouses, but also among children, who are experiencing stress-related illnesses.

If you are feeling insecure in your relationship, here are a few suggestions that may make you feel stronger:

1. Being clingy is never attractive. It feels terrible to the person experiencing it, and the spouse who has to deal with it may move further away. A better tactic is to create boundaries for yourself. Instead of calling your spouse ten times a day, have a set time and ask them to call you. Explain to them that you are working on becoming less dependent.
2. Stop comparing your spouse to past relationships that did not work out. Instead, focus on allowing your partner to be free to prove themselves to you.
3. Make dates with your friends or go out with your family instead of demanding all of your partner’s time. Friends are important to all of us. If your spouse wants you to join him or her while they are out with their friends, they will ask you. If you begin inviting yourself to your spouse’s outings, you will become a nuisance. Couples need friends they share, and they also need friends that are exclusive to them.
4. If your partner has children from another marriage, don’t insist that you go out with them every time they are together. They were a family before you came along. They will love you more if you understand and encourage their time together.
5. When your partner has hurt you, talk about it. Tell them while you were hurt. When hurt feelings are ignored, they usually remain in our heads as tapes. When we are feeling insecure, they play very loud. The replaying of old tapes makes us cling more.
6. Make your relationship one of transparency. Many couples get jealous and insecure when things are left open with ambiguity. When you are asked a question, don’t skirt around the issue. Be direct and say it like it is.
7. Listen to your partner, and try to see things from their point of view. It doesn’t have to be your way and needing it to be so makes people move further from you rather than closer.
8. Make a rule not to communicate with old lovers from the past. Women and men have a vivid imagination, and when they feel threatened from your past, they become more dependent and controlling.
9. Don’t cheat. The most insecure relationships I see are the ones where two cheaters married each other. If you know your partner cheated in the past, it is difficult to believe they won’t cheat on you. If you cheated in the past, you know lies can disguise the truth all too well.
10. Work on yourself. Usually, when we feel insecure in a relationship, it is because we doubt our own assets. Explore and be curious about yourself. Get to know all the wonderful things about you.

We all know the importance of being healthy. We try to eat right, exercise, and live a healthy lifestyle. Sometimes we forget the health of our relationships. Working on your relationships not only improves your marriage and family; it could save your life. –Mary Jo Rapini

Compliments of HealthNewsDigest.com

By American Academy of Dermatology

Aug 5, 2010 - 9:20:22 AM

For many people, the phrase “tough as nails” doesn’t apply to their own nails. Instead of strong nails, their nails may be brittle and break or split easily. Or, nail fungus might cause nails to look unattractive and unhealthy. Fortunately, dermatologists can help people improve the health and overall appearance of their nails with proper diagnosis and treatment.

At the American Academy of Dermatology’s Summer Academy Meeting 2010 in Chicago, dermatologist Phoebe Rich, MD, FAAD, adjunct professor of dermatology at the Oregon Health & Science University in Portland, discussed the most common nail ailments and how to prevent and treat them.

Brittle Nails Require Handling with Care

Brittle nails affect millions of people and are characterized by peeling, splitting, fracturing and chipping, often causing aesthetic and functional problems. While no segment of the population is spared, brittle nails are more commonly seen in women, and the incidence increases with advancing age in both women and men. People who work in certain occupations with exposure to irritating substances and water also are more at risk for brittle nails.

Dr. Rich explained that brittle nails are caused by both internal and external factors. Internal factors that contribute to brittle nails include genetics, aging, or other nail problems such as nail psoriasis and nail fungus. On rare occasion, certain internal disorders such as thyroid abnormalities, anemia, or the effects of chemotherapy may be responsible for brittle nails. However, external factors - including exposure to harsh irritants, such as chemicals and solvents and even excessive water exposure - are far more likely to cause brittle nails.

“Brittle nails can sometimes be painful to the point of making it difficult to do simple activities like buttoning a shirt,” said Dr. Rich. “The nail plate itself is not living, which is why we can cut and file our nails without discomfort. But if a nail split or chip goes into the live nail bed tissue to which the nail plate attaches, it can be painful until the nail plate grows out and covers the exposed nail bed.”

While treatment of brittle nails can be challenging in some cases, Dr. Rich explained that a three-pronged approach is always recommended. The first step is to rule out any underlying medical conditions or correct those that are contributing to the problem. The second step is to protect the nails from environmental exposure in daily activities in order to prevent conditions that can cause brittle nails. For example, a good line of defense is wearing gloves to do chores that expose the nails to harsh chemicals, limiting exposure to water and avoiding excessive hand washing.

“Using mild soaps to wash hands, washing primarily the palm side of the hands, drying hands well after washing and avoiding waterless hand sanitizers that contain a high alcohol content will help control brittle nails in most cases,” said Dr. Rich.

The third step is to treat the nails by several methods known to strengthen the nails. The correct water content in the nail must be maintained to keep nail cells properly hydrated and flexible. Dr. Rich recommends “greasy” products, such as plain petroleum jelly to provide a protective barrier over the nail. High water content moisturizers that shake or pour should be avoided, as the water actually evaporates and leaves little protection behind. In general, thick hand creams found in a tube or jar are more effective than watery ones.

“Hand lotions that contain humectants, such are urea, which attract and hold water in the nail can be helpful in keeping the nail flexible and less likely to fracture,” said Dr. Rich. “A dermatologist can help patients find the best therapeutic moisturizers to keep brittle nails adequately hydrated.”

While foods rich in calcium help strengthen bones, they do not help strengthen nails, but adequate protein in a well-balanced diet is helpful in improving nail health. However, Dr. Rich cautioned that the old data on protein-rich gelatin as the magic bullet for weak nails is not scientifically significant.

Similarly, the known health benefits of vitamins do not always translate into improving nail health. For example, Dr. Rich added that too much vitamin A may actually make nails brittle and fragile and should best be avoided. But there also is some suggestion that the B vitamin biotin at doses of 2.5 mg per day may improve brittle nails in some cases, but it may take four to six months to notice an improvement.

Nail Fungus Could be Here to Stay without Proper Medication

The prevalence of fungal infections, known as onychomycosis, is high and reported to be as high as 30 percent in the senior population. Since the infection occurs under the nail plate in the nail bed, it can be difficult to treat. Dr. Rich explained that the same fungus that causes athlete’s foot and ringworm is responsible for nail fungus as well, which is why people with nail fungus are susceptible to athlete’s foot and should try not to walk barefoot in public places. They also should wear water sandals or flip flops if they must use public showers.

While topical antifungal medications are readily available to treat nail fungus, Dr. Rich said that most of these over-the-counter formulas don’t work very well because these products are only applied on the surface of the nail and do not penetrate deep within the nail bed under the nail plate - where the fungus lives. Dr. Rich added that systemic medications can work well in clearing nail fungus and target the affected nail bed by way of the bloodstream.

“How fast the nail grows will determine how quickly the nail fungus will clear, but in most cases this can take up to a year,” said Dr. Rich. “The nail has to grow healthy from the base up in order for the fungus to clear completely.”

In addition, several new systemic medications and topical preparations currently being studied in clinical trials hold promise as future treatments. “There is a lot of exciting research being conducted in treating nail fungus, including creative vehicles to deliver antifungal medication to the nail such as patches, lacquers, and gels,” said Dr. Rich.

It is important to remember that nail fungus most likely will not subside on its own without some type of prescription treatment. While there is no harm in trying over-the-counter treatments or home remedies, patients should see a dermatologist if the condition does not improve or worsens.

Compliments of American Academy of Dermatology

By Tuberous Sclerosis Alliance
Oct 30, 2010 - 10:42:45 AM

SILVER SPRING, Md., Oct. 30 — The Tuberous Sclerosis Alliance (TS Alliance) today announced the first drug approved for a tuberous sclerosis complex (TSC) indication by the Federal Drug Administration (FDA). This drug, manufactured by Novartis Oncology, is called Afinitor and will be used to treat subependymal giant cell astrocytomas (SEGAs) in individuals with TSC. This type of tumor develops in approximately 15-20 percent of individuals with TSC, and typically becomes symptomatic in children and adolescents, and rarely in adults.

“SEGAs can be challenging for individuals with tuberous sclerosis complex and for the whole family, which is why we are encouraged to see ongoing research and new treatment options for these individuals,” said Vicky Whittemore, Ph.D., TS Alliance Vice President and Chief Scientific Officer. “Prior to Afinitor the only treatment option for individuals with growing SEGAs, many of them children, was brain surgery.”

“At the TS Alliance, it’s crucial for us to raise awareness about the tuberous sclerosis complex, as many individuals go undiagnosed or even misdiagnosed,” explained Kari Luther Rosbeck, President and Chief Executive Officer for the TS Alliance. “Therefore, it’s important that anyone with TSC get the care needed by having multiple treatment options available.”

“TSC research has moved from the identification of the genes for TSC in the 1990s to clinical trials in recent years, and the development of new treatment options for all of the symptoms of TSC is our priority,” Whittemore continued. “This is the first treatment that has been approved by the FDA specifically for TSC, and Afinitor offers a new treatment option for individuals with the disease.”

“Because identifying new treatments is so important, the TS Alliance instituted a new TSC Drug Screening Program in 2010, which will help drive and accelerate basic and translational research,” Rosbeck said. According to Rosbeck, the program provides funding to test drugs that are already FDA-approved or new compounds in animal models of TSC in order to fast-track the translation of basic research to new treatments for patients.

“By bringing together biotech and pharmaceutical companies with researchers interested in TSC, our hope is that we can accelerate the testing of new treatments for TSC,” added Dr. Whittemore.

The TS Alliance is the only national voluntary health organization dedicated to finding a cure for tuberous sclerosis complex (TSC) and improving the lives of those affected. TSC is a multi-system genetic disorder affecting many parts of the body, primarily due to the growth of tumors in the vital organs, such as the brain, heart, kidneys, lungs, eyes and skin. People with TSC commonly have epilepsy, behavioral disorders (such as attention deficit disorder-ADD), skin disorders (such as lesions) and other symptoms. TSC is estimated to affect nearly 50,000 people in the U.S., and more than 1 million worldwide.

Courtesy of HealthNewsDigest.com

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CHICAGO (Aug 5, 2010) — For many people, the phrase “tough as nails” doesn’t apply to their own nails. Instead of strong nails, their nails may be brittle and break or split easily. Or, nail fungus might cause nails to look unattractive and unhealthy. Fortunately, dermatologists can help people improve the health and overall appearance of their nails with proper diagnosis and treatment.

At the American Academy of Dermatology’s Summer Academy Meeting 2010 in Chicago, dermatologist Phoebe Rich, MD, FAAD, adjunct professor of dermatology at the Oregon Health & Science University in Portland, discussed the most common nail ailments and how to prevent and treat them.

Brittle Nails Require Handling with Care
Brittle nails affect millions of people and are characterized by peeling, splitting, fracturing and chipping, often causing aesthetic and functional problems. While no segment of the population is spared, brittle nails are more commonly seen in women, and the incidence increases with advancing age in both women and men. People who work in certain occupations with exposure to irritating substances and water also are more at risk for brittle nails.

Dr. Rich explained that brittle nails are caused by both internal and external factors. Internal factors that contribute to brittle nails include genetics, aging, or other nail problems such as nail psoriasis and nail fungus. On rare occasion, certain internal disorders such as thyroid abnormalities, anemia, or the effects of chemotherapy may be responsible for brittle nails. However, external factors – including exposure to harsh irritants, such as chemicals and solvents and even excessive water exposure – are far more likely to cause brittle nails.

“Brittle nails can sometimes be painful to the point of making it difficult to do simple activities like buttoning a shirt,” said Dr. Rich. “The nail plate itself is not living, which is why we can cut and file our nails without discomfort. But if a nail split or chip goes into the live nail bed tissue to which the nail plate attaches, it can be painful until the nail plate grows out and covers the exposed nail bed.”

While treatment of brittle nails can be challenging in some cases, Dr. Rich explained that a three-pronged approach is always recommended. The first step is to rule out any underlying medical conditions or correct those that are contributing to the problem. The second step is to protect the nails from environmental exposure in daily activities in order to prevent conditions that can cause brittle nails. For example, a good line of defense is wearing gloves to do chores that expose the nails to harsh chemicals, limiting exposure to water and avoiding excessive hand washing.

“Using mild soaps to wash hands, washing primarily the palm side of the hands, drying hands well after washing and avoiding waterless hand sanitizers that contain a high alcohol content will help control brittle nails in most cases,” said Dr. Rich.

The third step is to treat the nails by several methods known to strengthen the nails. The correct water content in the nail must be maintained to keep nail cells properly hydrated and flexible. Dr. Rich recommends “greasy” products, such as plain petroleum jelly to provide a protective barrier over the nail. High water content moisturizers that shake or pour should be avoided, as the water actually evaporates and leaves little protection behind. In general, thick hand creams found in a tube or jar are more effective than watery ones.

“Hand lotions that contain humectants, such as urea, which attract and hold water in the nail can be helpful in keeping the nail flexible and less likely to fracture,” said Dr. Rich. “A dermatologist can help patients find the best therapeutic moisturizers to keep brittle nails adequately hydrated.”

While foods rich in calcium help strengthen bones, they do not help strengthen nails, but adequate protein in a well-balanced diet is helpful in improving nail health. However, Dr. Rich cautioned that the old data on protein-rich gelatin as the magic bullet for weak nails is not scientifically significant.

Similarly, the known health benefits of vitamins do not always translate into improving nail health. For example, Dr. Rich added that too much vitamin A may actually make nails brittle and fragile and should best be avoided. But there also is some suggestion that the B vitamin biotin at doses of 2.5 mg per day may improve brittle nails in some cases, but it may take four to six months to notice an improvement.

Nail Fungus Could be Here to Stay without Proper Medication
The prevalence of fungal infections, known as onychomycosis, is high and reported to be as high as 30 percent in the senior population. Since the infection occurs under the nail plate in the nail bed, it can be difficult to treat. Dr. Rich explained that the same fungus that causes athlete’s foot and ringworm is responsible for nail fungus as well, which is why people with nail fungus are susceptible to athlete’s foot and should try not to walk barefoot in public places. They also should wear water sandals or flip flops if they must use public showers.

While topical antifungal medications are readily available to treat nail fungus, Dr. Rich said that most of these over-the-counter formulas don’t work very well because these products are only applied on the surface of the nail and do not penetrate deep within the nail bed under the nail plate – where the fungus lives. Dr. Rich added that systemic medications can work well in clearing nail fungus and target the affected nail bed by way of the bloodstream.

“How fast the nail grows will determine how quickly the nail fungus will clear, but in most cases this can take up to a year,” said Dr. Rich. “The nail has to grow healthy from the base up in order for the fungus to clear completely.”

In addition, several new systemic medications and topical preparations currently being studied in clinical trials hold promise as future treatments. “There is a lot of exciting research being conducted in treating nail fungus, including creative vehicles to deliver antifungal medication to the nail such as patches, lacquers, and gels,” said Dr. Rich.

It is important to remember that nail fungus most likely will not subside on its own without some type of prescription treatment. While there is no harm in trying over-the-counter treatments or home remedies, patients should see a dermatologist if the condition does not improve or worsens.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM www.aad.org.

Compliments of the American Academy of Dermatology

These no-nonsense tips from dermatologists can help people living with psoriasis ease their discomfort and maximize the effectiveness of treatment.

Follow the basics of good health. Eating a balanced diet, drinking plenty of water, and getting enough sleep are all steps patients can take to avoid feeling tired and overstressed. This also can help the body fight off infections that can aggravate the skin.

Learn the triggers. Research shows there are known triggers for psoriasis — certain infections, some medications, skin injury, stress, and winter weather. Smoking also may trigger psoriasis. While it is not always possible to avoid every trigger, knowing what triggers psoriasis can help you make informed decisions. To learn more, see Psoriasis Triggers.

Keep track of flares. This can be an especially helpful technique for managing psoriasis. When a flare-up strikes, write down when it occurred and include information about what was happening at the time that may have triggered the psoriasis. Was there a stressful event in your life? Did spending a summer evening outdoors result in numerous mosquito bites? Keep in mind that psoriasis may not flare for 10 to 14 days after the skin is injured. This information can reveal facts about how psoriasis affects you and offer insight to help you and your dermatologist better manage the condition.

Quit smoking. If you have psoriasis or a family history of psoriasis, don’t start smoking. If you do smoke, here’s another good reason to quit. Research continues to suggest that smoking may trigger psoriasis. It appears that localized pustular psoriasis, which occurs on the palms and soles, can be aggravated by smoking and that in some cases, quitting smoking clears the skin. Research also suggests that severe psoriasis may be linked to smoking.

If you are trying to quit, do not use a nicotine patch before consulting a dermatologist. Nicotine patches can aggravate psoriasis.

Limit alcohol consumption. Research indicates that heavy drinking may trigger psoriasis and even prevent treatment from being effective. Studies also are finding that there may be a link between severe psoriasis and heavy drinking. Dermatologists recommend that their patients who drink should do so in moderation. However, people taking methotrexate, a medication used to treat moderate to severe psoriasis, should not drink alcohol. Mixing methotrexate and alcohol can have serious side effects.

Reduce stress. Many people with psoriasis say they experience flare-ups during stressful times. While stress cannot be prevented, there are a number of healthy ways to reduce stress. Some people find that joining a psoriasis support group helps. Others find comfort in psychological counseling. Exercise and a number of relaxation techniques also can effectively reduce stress.

According to the National Psoriasis Foundation, stress reduction works best when combined with medical treatment.

Take good care of your skin:

Apply emollients and moisturizers. Emollients soften the skin. Moisturizers lock in the skin’s own moisture to prevent dryness and cracking. One of the best ways to lock in moisture is to apply moisturizer after bathing. Regular use of moisturizers can help prevent the itch and pain of dry skin and reduce scaling and inflammation. People often get good results by applying a lotion during the day and a cream or ointment, which are thicker than lotion, at night.

Avoid scratching. There is no doubt about it, psoriasis itches. In fact, the word “psoriasis” derives from the Greek word for itch, “psora” The thought of not scratching can seem maddening. However, scratching can puncture the skin, allowing bacteria to enter and cause an infection. Scratching also causes the skin to bleed and worsens psoriasis. After scratching, lesions can appear on previously clear skin. To alleviate the itch, dermatologists recommend:

Treat the psoriasis. Dermatologists say that one of the most effective ways to stop the itch is to treat the psoriasis. When the psoriasis clears, the itch usually disappears. In the interim, these can curb the itch:

Apply a cold compress. Applying a cold compress can reduce inflammation and lessen the desire to scratch.

Apply a menthol-based ointment or topical steroid. These can help manage the itch until the psoriasis clears.

Moisturize. Moisturizing, especially after bathing, can help relieve the dry skin that causes itching.

Soak in a warm oatmeal bath. This relieves itching for some people. A dermatologist can recommend an appropriate oatmeal-bath preparation.

Once lesions clear, it is important to continue using emollients and moisturizers. Regular use can help soften skin and prevent the dryness that causes the skin to itch.

Bathe in warm, not hot water. Dermatologists recommend that patients with psoriasis take short, warm showers and use fragrance-free cleansers.

Never pick at lesions. Like scratching, picking at lesions can cause bleeding, infection, and a worsening of the psoriasis. Dermatologists recommend treatment to clear the psoriasis and regular use of emollients and moisturizers to help soften skin and prevent dryness.

Pat your skin dry; rubbing can irritate it. Rubbing, or irritating the skin in any way, can cause psoriasis lesions to form. Developing a habit of gently patting your skin dry can alleviate this problem.

Use sunscreen. While sunlight can help treat psoriasis, many treatments make the skin sun-sensitive. Anyone using a topical or systemic retinoid or PUVA therapy must protect their skin from the sun. Patients using retinoids should apply sunscreen 15 to 20 minutes before going outdoors and wear protective clothing. Additionally, sun exposure can cause sunburn, which can trigger psoriasis.

Wear cotton clothing next to your skin. Cotton is less likely than other fabrics to irritate the skin or cause overheating.

Compliments of the American Academy of Dermatology; www.aad.org

Psoriasis is a persistent, inflammatory skin condition. Some cases of psoriasis are so mild that people don’t know they have it. Alternatively, severe psoriasis may cover large areas of the body. Dermatologists can help even the most severe cases.

Psoriasis is not contagious, so it cannot be passed from one person to another. Psoriasis does, however, have a tendency to run in families, meaning it can be an inherited condition.

CAUSES OF PSORIASIS

While the cause is unknown, research indicates that the immune system plays a key role.  It is believed that the person’s immune system mistakenly activates T cells, a type of white blood cell. Once activated, the T cells trigger inflammation, which causes the skin to grow too rapidly. Normally, the skin replaces itself about every 30 days. When the process speeds up and the skin replaces itself in three to four days, psoriasis develops.

A “trigger” is usually needed to make psoriasis appear, whether for the first time or the twentieth. Psoriasis can be triggered by stress; an infection, such as strep throat; and by taking certain medicines, such as interferon and lithium. Cold, dry winter weather and lack of sunlight also can trigger psoriasis. Others see psoriasis flare 10 to 14 days after their skin is injured, such as by a cut, scratch, or severe sunburn. This is known as Koebner’s phenomenon.

TYPES OF PSORIASIS

There are five major types of psoriasis, each with unique signs and symptoms:

Plaque psoriasis

The most common type, plaque psoriasis appears as patches of raised, reddish skin covered by silvery-white scale. Patches frequently form on the elbows, knees, lower back, and scalp, but can occur anywhere on the skin.

• Guttate psoriasis

Appearing as small, red spots, guttate psoriasis usually affects children and young adults. It often starts after a sore throat, and frequently clears up by itself in weeks or a few months.

• Pustular psoriasis

Characterized by white pustules surrounded by red skin, pustular psoriasis tends to confine itself to certain areas of the body, usually the palms and soles. Dermatologists call this “localized pustular psoriasis.” When widespread, the condition is known as “generalized pustular psoriasis,” which is a rare and severe form of psoriasis that can be life threatening.

• Inverse psoriasis

This type occurs when smooth, red lesions form in the skin folds. Lesions can appear in the armpit, under the breasts, and around the groin, buttocks, and genitals.

• Erythrodermic psoriasis

Causing widespread redness with severe itching and pain, erythrodermic psoriasis can be life threatening.

Psoriasis frequently develops on the scalp and the nails. When psoriasis occurs on the scalp, psoriasis often causes silvery-white scale, which may be misdiagnosed as dandruff. Psoriatic nails frequently have tiny pits. The nails may loosen, thicken, or crumble. These signs may be misdiagnosed as a nail infection. Both scalp psoriasis and nail psoriasis can be difficult to treat.

PSORIATIC ARTHRITIS

Between 10% and 30% of people who develop psoriasis get a related form of arthritis called “psoriatic arthritis,” which causes inflammation of the joints. Psoriatic arthritis is a lifelong condition that causes deterioration, pain, and stiffness in the joints. Medication can help prevent joint deformities and disability if used early. Without treatment, permanent joint degeneration and destruction can occur.

DIAGNOSING PSORIASIS

Dermatologists diagnose psoriasis by examining the skin, nails and scalp.  A skin biopsy may be taken to confirm the diagnosis.

TREATMENT OF PSORIASIS

While psoriasis cannot be cured, a number of treatment options can help control psoriasis.

A patient’s health, age, lifestyle, and the severity of the psoriasis determine which treatment options are appropriate. Gaining control over psoriasis may require different types of treatment and several visits to your dermatologist.

To help patients control psoriasis, a dermatologist may prescribe medications to apply to the skin.  These medications may contain cortisone compounds, retinoids, tar, or anthralin.  These may be used in combination with natural sunlight or another ultraviolet (UV) light treatment. The more severe forms of psoriasis may require oral or injectable medications with or without UV light treatment.

TYPES OF TREATMENT

TOPICALS

• Corticosteroids (cortisone)

Cortisone is a medication that reduces inflammation.  Cortisone creams, ointments, and lotions may clear the skin temporarily and control the condition in many patients.  Weaker preparations should be used on more sensitive areas of the body such as the genitals, armpits and face.  Stronger preparations will usually be needed to control lesions on the scalp, elbows, knees, palms, soles, and parts of the torso. Dressing may be applied to enhance the effectiveness of the medication.  Corticosteroids must be used cautiously and with your dermatologist’s  instructions.  Side effects of stronger cortisone preparations include thinning of the skin, dilated blood vessels, bruising, stretch marks, and skin color changes. Stopping these medications suddenly may result in a flare-up.

When used for many months, psoriasis can become resistant to the corticosteroid. Difficult-to-treat spots may be treated with an injection of a corticosteroid.

• Anthralin

Often effective on tough-to-treat thick patches of psoriasis, anthralin decreases the skin’s rapid growth rate and reduces inflammation. Newer preparations and treatment methods minimize the traditional side effects of skin irritation and staining.

• Calcipotriene

Useful for individuals with localized psoriasis, calcipotriene may be combined with other treatments. Be sure to apply calpotriene as instructed by your dermatologist to avoid side effects, such as skin irritation.

• Retinoids

This medication may be used alone or in combination with topical corticosteroids for treatment of localized psoriasis. Women who are, or may become, pregnant should not use topical retinoids.

• Coal Tar

For more than 100 years, coal tar has been used safely and effectively to treat psoriasis. Today’s products are greatly improved and less messy. Stronger prescriptions can be made specifically to treat difficult areas.

• Light Therapy

Ultraviolet (UV) light, which is found in sunlight, slows the rapid growth of skin cells. Patients with psoriasis may receive light therapy treatments at a dermatologist’s office, psoriasis center, or hospital. Psoriasis patients who live in warm climates may be directed to carefully sunbathe. Under a dermatologist’s care, light therapy offers many patients a safe and effective treatment option. Seek the advice of your dermatologist before self-treating with natural or artificial UV light.

Patients who receive light therapy at the medical facility may receive UVB light therapy, PUVA, or Goeckerman treatment.

• Ultraviolet B (UVB) Light

This treatment exposes the skin to a wavelength of UV light called UVB.  The therapy may be used alone or in combination with topical or systemic treatments.  To receive UVB therapy, a patient either enters a light box that surrounds the patient or stands in front of a light panel.  About 24 treatments over a two-month period are needed for clearing. Although UVB is very safe and effective, it does have possible side effects that include burns, freckling, and premature aging.  Risks of skin cancer appear to be no greater than the risk caused by sun exposure.

• PUVA

An acronym, PUVA stands for “psoralen + UVA,” which are the two components of this treatment. Used to treat widespread psoriasis and psoriasis that has not responded to other therapies, PUVA is effective in approximately 85% of cases. To receive PUVA, a patient is given a drug called psoralen, which may be taken orally or applied to the psoriasis. The patient is then exposed to a carefully measured amount of a special form of ultraviolet A (UVA) light. Because psoralen remains in the lens of the eye, patients must wear UVA-blocking eyeglasses when exposed to sunlight from the time the psoralen is taken until sunset that day. Clearing usually occurs after approximately 25 PUVA treatments, which are given over a two- or three-month period. Keeping psoriasis under control requires about 30 to 40 treatments a year. PUVA treatments over a long period increase the risk of premature aging, freckling, and skin cancer. Dermatologists and their staff monitor PUVA treatment very carefully.

• Goeckerman Treatment

Named after the Mayo Clinic dermatologist who first reported it, this treatment combines coal tar dressings with UV light. Used to treat patients with severe psoriasis, Goeckerman treatment is performed daily for a prescribed amount of time.  UV exposure times vary with the type of psoriasis and the sensitivity of the patient’s skin.  Access to this therapy is limited because only a few specialized centers in the United States offer it.

SYSTEMIC THERAPIES

• Methotrexate

This anti-cancer medication can dramatically clear psoriasis. Because methotrexate can cause serious side effects, particularly liver disease, it is reserved for treating moderate to severe psoriasis that has not responded to other therapies.  Patients taking methotrexate receive regular blood tests. Chest x-rays and occasional liver biopsies may be required.  Other side effects include upset stomach, nausea, and dizziness.  Methotrexate should not be used by pregnant women, nor by men or women who are trying to conceive a child. Conception should be avoided for at least 12 weeks after stopping methotrexate.
Patients who take methotrexate should not drink alcoholic beverages.

• Retinoids

An oral retinoid may be prescribed alone or in combination with ultraviolet light  for severe cases of psoriasis.  Side effects include dryness of the skin, lips and eye; elevation of fat levels in the blood (cholesterol and triglycerides); and formation of tiny bone spurs.  Oral retinoids can cause birth defects and should not be used by pregnant women, or women who intend to become pregnant during or within three years of discontinuing therapy.  Patients taking oral retnoid require close monitoring, which includes regular blood tests.

• Cyclosporine

This medication suppresses the immune system and is used to prevent rejection of a transplanted organ, such as a liver or kidney. While cyclosporine proves extremely effective in treating psoriasis, it is generally reserved for patients with severe psoriasis who have not responded to other therapies. Due to potential side effects, kidney function and blood pressure must be checked before the drug can be prescribed. Patients taking cyclosporine require close medical monitoring, which includes regular blood tests.

BIOLOGIC AGENTS

Biologics are systemic medications that are given by injection or infusion.  What makes biologics unique is that these drugs pinpoint  precise immune responses involved with psoriasis.  For this reason, careful consultation with your dermatologist is important as there are a variety of treatments and combinations of treatments to consider and many medical tests to undergo before finding the most appropriate biologic treatment. The biologics used to treat psoriasis are:

• Alefacept

By blocking the over-activated T cells, alefacept can treat moderate to severe chronic plaque psoriasis. A medical professional must give each treatment of alefacept by an intramuscular injection (IM), which is used to deliver medication deep into large muscles of the body. The patient typically receives one injection per week for 12 weeks.

• Etanercept

For the treatment of psoriasis and psoriatic arthritis, this biologic agent blocks tumor necrosis factor-alpha (TNF), a messenger in the immune system that directs cells to cause the inflammation that leads to psoriasis. Given by subcutaneous (under the skin) injection, which patients can learn to give themselves, etanercept is typically used as long-term therapy.

• Infliximab

For the treatment of psoriasis and psoriatic arthritis, this biologic blocks tumor necrosis factor-alpha.  It is given as an infusion, so the treatment must be given in a medical office.

• Adalimumab

This biologic blocks tumor necrosis factor-alpha and is effective in treating psoriatic arthritis.  Patients can learn how to give themselves adalimumab which is given by subcutaneous injections.

A dermatologist is a physician who specializes in treating the medical, surgical, and cosmetic conditions of the skin, hair, and nails. To learn more about psoriasis, log onto www.aad.org, www.skincarephysicians.com/psoriasisnet, or call toll-free (888) 462-DERM

Compliments of the American Academy of Dermatology; www.aad.org

Plaque (pronounced plak) psoriasis is the most common type of psoriasis. This type of psoriasis can develop anywhere on the skin. When it develops on the scalp, people call it “scalp psoriasis.”

Who Gets Scalp Psoriasis?
Psoriasis is common on the scalp. Researchers estimate that at least half (50%) of the people who have plaque psoriasis will have at least one flare-up on the scalp.

Signs and Symptoms of Scalp Psoriasis
Scalp psoriasis can appear anywhere on the scalp. Sometimes one small patch develops, which can be easy to hide with hair. Scalp psoriasis also can cover the entire scalp. It can even creep beyond the scalp, appearing on the forehead, back of the neck, or behind the ears.

When scalp psoriasis develops, people have one or more of these signs and symptoms:

· Reddish plaque on the scalp. Plaques range from barely noticeable to thick and inflamed.

· Silvery-white scale. This often develops on the scalp and can be mistaken for dandruff.

· Dandruff-like flaking. This is common due to the continual shedding of the new skin cells. Unlike dandruff, scalp psoriasis causes a silvery sheen and dry scale on the scalp.

· Dry scalp. The scalp may be so dry that the skin cracks and bleeds.

· Itching. This is one of the most common symptoms. For some the itch is mild; others have intense itching that can interfere with everyday life and cause them to lose sleep.

· Bleeding. Because scalp psoriasis can be very itchy, almost everyone scratches. This can cause the scalp to bleed. Scratching also injures the skin, which tends to worsen the psoriasis. This is why dermatologists tell their patients “Try not to scratch your scalp.”

· Burning sensation or soreness. The scalp can burn. It can feel extremely sore.

· Temporary hair loss. Scratching the scalp a lot or forcefully removing scale can cause hair loss. Once the scalp psoriasis clears, hair usually re-grows.

These signs and symptoms can come and go. Some people have only one mild flare. Others experience flare-ups that range in intensity, with some flare-ups being milder than other flare-ups. Many things can trigger a flare-up, including stress, cold, and a dry environment.

Scalp Psoriasis can be Controlled
Scalp psoriasis causes many people to feel uncomfortable and embarrassed. There are many safe and effective treatments. A dermatologist can tell you what can help control your scalp psoriasis.

Reference:
Van de Kerkhof PCM and Schalkwijk J. “Psoriasis.” In Bolognia JL, Jorizzo JL, Rapini et al. [editors]. Dermatology. Spain. Mosby Elsevier; 2008. p. 122.

Compliments of the American Academy of Dermatology; http://www.skincarephysicians.com/psoriasisnet/scalp_psoriasis_overview.html

Yes, scalp psoriasis can be controlled. There are many treatments for scalp psoriasis. Some people get relief from a medicated shampoo or solution that can be purchased without a prescription. But scalp psoriasis can be stubborn. Many people see a dermatologist for treatment.

Diagnosis: The First Step in Successfully Treating Scalp Psoriasis
Before prescribing treatment for scalp psoriasis, a dermatologist will examine your scalp. Usually a dermatologist will simply look at the scalp and make the diagnosis.
Sometimes scalp psoriasis can look like another skin condition, and a dermatologist will remove a bit of skin and send the skin to a lab. The lab report will tell the dermatologist whether the condition is scalp psoriasis. Your dermatologist may refer to this process as a biopsy. A dermatologist can safely and quickly perform a biopsy in the office.

Scalp Psoriasis Treatments
The treatments that dermatologists prescribe for their patients who have scalp psoriasis can be divided into these categories:

• Medication applied to the scalp. This is the most commonly prescribed treatment for scalp psoriasis. Your dermatologist may call it a “topical.” These medications include:
  • Corticosteroid (may be called a steroid
  • Calcipotriol/calcipotriene
  • Tazarotene

• A corticosteroid that can be applied to the scalp is the mainstay treatment for scalp psoriasis.
  Studies show that a corticosteroid is more effective than any other treatment that you can apply to the scalp. It is prescribed for a short period of time and works quickly to clear the scalp.

  Topical corticosteroids are safe when used as directed. Because side effects can occur with long-term use, other medications may be used to keep the scalp clear. These medications includecalcipotriol/calcipotriene and tazarotene.

• Treatment Tip: When applying the medication, be sure to lift your hair away from the scalp so that you can apply the medication directly to your scalp.

• Medicated shampoos. A shampoo may be part of your treatment plan. For people who have moderate to severe psoriasis on their scalp, a dermatologist may prescribe a psoriasis shampoo that contains clobetasol propionate. While clobetasol propionate is a strong corticosteroid, studies show that when used in a shampoo, it can provide safe and effective treatment for scalp psoriasis.In studies, patients have been able to use a psoriasis shampoo containing clobetasol propionate daily for as long as 4 weeks. If the scalp responds, the shampoo can be used once or twice a week to maintain the results.

• Treatment Tip: When shampooing, be gentle. Rubbing, scrubbing, and scratching your scalp tends to make scalp psoriasis worse.

• Scale softeners. Psoriasis can be thick, which makes it difficult for topical (applied to the scalp) treatment to work. Applying a scale softener to the psoriasis can help. A product that contains salicylic acid can soften the thick, stubborn patches of psoriasis. Studies show that topical corticosteroids can produce better results when a patient also uses salicylic acid.

• Injections. Some patients receive injections of corticosteroids. Your dermatologist may call this treatment an “intralesional corticosteroid” because the corticosteroid is injected into the psoriasis.

• Light treatments. When scalp psoriasis does not clear with treatment that is applied to the scalp, light treatments may be an option. Your dermatologist may call this type of treatment “phototherapy.”Until recently, light treatments were not useful for scalp psoriasis unless the person was bald or had very thin hair. Thanks to recent advances, even people with thick hair can have light treatments on their scalp. Some patients are treated with a UV comb. Others receive laser therapy.

• Biologics and other medicines that work throughout the body. Scalp psoriasis can be stubborn. Sometimes it does not respond to topical (applied to the scalp) medicine or light treatments. When a patient needs aggressive treatment, a dermatologist may prescribe a medication that works on the immune system. Some of these medications come in pill form. Others require self-injections. Sometimes the medicine is given by infusion, which requires the patient to go to a hospital or psoriasis treatment center.

• Medication that may be prescribed for aggressive treatment of scalp psoriasis includes:
  • Oral (taken by mouth) retinoids
  • Methotrexate
  • Cyclosporine
  • Biologic (medicine that works on the immune system and is given as a shot or intravenously)

Most cases of scalp psoriasis can be effectively treated. Sometimes treatment requires using more than one treatment option. Dermatologists have the expertise required to combine these treatments and minimize side effects.

References:
Bovenschen HJ, Van de Kerkhof PC. “Treatment of scalp psoriasis with clobetasol-17 propionate 0.05% shampoo: a study on daily clinical practice.” Journal of the European Academy of Dermatology and Venereology; April 2010; 24: 439-44.

Chan CS, Van Voorhees AS, Lebwohl MG et al. “Treatment of severe scalp psoriasis: from the Medical Board of the National Psoriasis Foundation.” Journal of the American Academy of Dermatology June 2009; 60: 962-71.

Krell J, Nelson C, Spencer L et al. “An open-label study evaluating the efficacy and tolerability of alefacept for the treatment of scalp psoriasis.” Journal of the  American Academy of Dermatology April 2008; 58: 609-16.

Poulin Y, Papp K, Bissonnette R et al. “Clobetasol propionate shampoo 0.05% is efficacious and safe for long-term control of moderate scalp psoriasis.” The Journal of Dermatological Treatment; May 2010; 21: 185-92.

Poulin Y, Papp K, Bissonnette R et al. “Clobetasol propionate shampoo 0.05% is efficacious and safe for long-term control of scalp psoriasis.” Cutis; January 2010; 85: 43-50.

Compliments of the American Academy of Dermatology http://www.skincarephysicians.com/psoriasisnet/scalp_psoriasis_treatment.html

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