[ed note: Michael Jorrin, who I like to call “Doc Gumshoe,” writes non-investment articles for us about medical and health topics a couple times a month. He is a medical writer, not a doctor, and his words and thoughts are his own.]
Just possibly a tiny few of the Gumshoe faithful may remember that advertising campaign, way back in the Golden Years of the Twentieth Century, that touted a preparation as a sure-fire remedy for the so-called “Heartbreak of Psoriasis.” The ads and TV spots definitely made a valid point, that psoriasis was not merely an episode of dry skin, that it was not a temporary allergy, that it was not akin to poison ivy, that it was not contagious, that it was not leprosy, et cetera, et cetera. They observed, correctly, that it was a chronic skin condition that would not go away on its own, and, not so correctly, that this wondrous drug would quell it once and for all.
In case you don’t remember, that miracle stuff was called Tegrin. And Tegrin is nothing more than a topical coal-tar preparation, which, for some people with psoriasis, may provide some relief of the skin symptoms of psoriasis – the skin symptoms, and only the skin symptoms.
Unfortunately, there is frequently a lot more to psoriasis than skin symptoms, and that’s where the term, “the heartbreak of psoriasis,” has more meaning than the makers of Tegrin intended.
To hoist the black flag right at the start, here are some nasty facts about psoriasis (the good news will come later on in this piece):
- First, a substantial fraction (perhaps as high as 40%) of all people with psoriasis have psoriatic arthritis, which means that in addition to surface involvement (skin, nails, scalp), the joints are also affected. Psoriatic arthritis is generally classified as a spondyloarthropathy, meaning that the joint symptoms are somewhat different than those in rheumatoid arthritis (RA). Psoriatic arthritis symptoms are more likely to be in the lower spine and the connections between the spine and the pelvis (the sacroiliac joints), although there is a good deal of overlap between psoriatic arthritis (PsA) symptoms and RA symptoms.
- Second, persons with Pso/PsA are also more likely to have other conditions that affect not only quality of life, but survival. These include cardiovascular disease, diabetes, and inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis. These other diseases and conditions are related to the degree of inflammation resulting from the underlying PsA; controlling PsA reduces the likelihood of these complications.
- Third, psoriasis itself (PsO) has a considerable impact on the general well-being of persons affected with this condition. It’s not only that patients are upset about how they look; patients with PsO are more likely to suffer from depression. In a study of the effects of psoriasis on well-being, 60% of patients with PsO reported being depressed, and 10% reported a wish to be dead.
Let’s start with a few facts about the PsO / PsA spectrum.
The common presenting symptoms of PsO are patches of reddened, rough, scaly skin, which may have papules and pustules (papules are small, raised pimples that do not contain pus; pustules contain pus.) There may be rough, scaly patches in the scalp, and persons with PsO may also have little pits in their finger- or toenails. The joint involvement characteristic of PsA is associated with more severe or long-standing cases of PsO.
Psoriasis is one of the autoimmune diseases, meaning that the disease process is mediated by one of the many agents in the body’s immune system. In psoriasis, the mediating agents are CD4+ and CD8+ T lymphocytes. PsO/PsA is now recognized as the most common T-cell- mediated disease in humans, and is the most prevalent autoimmune disease in the U. S. The psoriasis disease process essentially is inflammatory, and the inflammatory process can take place not only at the skin surface, but, if it is allowed to progress unchecked, at other body sites, especially the joints. One of the effects of the inflammatory process in psoriasis is proliferation of keratinocytes, which underlies the manifestation of the psoriatic skin lesions. In fact, before PsO was understood as an autoimmune disease, keratinocyte proliferation was thought to account for the symptoms.
According to a National Health and Nutrition Examination Survey (NHANES), approximately 7.5 million persons in the US are diagnosed with psoriasis, amounting to about 3.2% of the US adult population. Prevalence is highest in Caucasians (3.6%), followed by African-Americans (1.9%), Hispanics (1.6%), and others (1.4%). We should note that NHANES data is based on voluntary surveys; respondents were counted as having psoriasis only if they had received a diagnosis; an unknown but probably considerable percentage of persons with psoriasis have not been diagnosed, and this percentage may vary with socio-economic status and ethnicity.
(In other words, well-to-do Caucasians are perhaps more likely to seek medical intervention for a smallish patch of rough, scaly skin than are other cohorts of the US population.)
We should add that undiagnosed PsO is apt to be mild, as measured by the percentage of skin area affected. The National Psoriasis Foundation has defined mild PsO as disease affecting less than 3% of the total body skin area. Disease affecting 3% to 10% of total body skin area is considered moderate, and more than 10% involvement is considered severe. As a point of comparison, the amount of skin covered by the palm of your ha